| Title |
Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database
|
|---|---|
| Published in |
BMC Health Services Research, February 2018
|
| DOI | 10.1186/s12913-018-2916-1 |
| Pubmed ID | |
| Authors |
Hester F. Lingsma, Alex Bottle, Steve Middleton, Job Kievit, Ewout W. Steyerberg, Perla J. Marang-van de Mheen |
| Abstract |
Hospital mortality, readmission and length of stay (LOS) are commonly used measures for quality of care. We aimed to disentangle the correlations between these interrelated measures and propose a new way of combining them to evaluate the quality of hospital care. We analyzed administrative data from the Global Comparators Project from 26 hospitals on patients discharged between 2007 and 2012. We correlated standardized and risk-adjusted hospital outcomes on mortality, readmission and long LOS. We constructed a composite measure with 5 levels, based on literature review and expert advice, from survival without readmission and normal LOS (best) to mortality (worst outcome). This composite measure was analyzed using ordinal regression, to obtain a standardized outcome measure to compare hospitals. Overall, we observed a 3.1% mortality rate, 7.8% readmission rate (in survivors) and 20.8% long LOS rate among 4,327,105 admissions. Mortality and LOS were correlated at the patient and the hospital level. A patient in the upper quartile LOS had higher odds of mortality (odds ratio = 1.45, 95% confidence interval 1.43-1.47) than those in the lowest quartile. Hospitals with a high standardized mortality had higher proportions of long LOS (r = 0.79, p < 0.01). Readmission rates did not correlate with either mortality or long LOS rates. The interquartile range of the standardized ordinal composite outcome was 74-117. The composite outcome had similar or better reliability in ranking hospitals than individual outcomes. Correlations between different outcome measures are complex and differ between hospital- and patient-level. The proposed composite measure combines three outcomes in an ordinal fashion for a more comprehensive and reliable view of hospital performance than its component indicators. |
X Demographics
The data shown below were collected from the profiles of 11 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 2 | 18% |
| United States | 1 | 9% |
| Netherlands | 1 | 9% |
| France | 1 | 9% |
| Sweden | 1 | 9% |
| Unknown | 5 | 45% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 5 | 45% |
| Practitioners (doctors, other healthcare professionals) | 4 | 36% |
| Science communicators (journalists, bloggers, editors) | 1 | 9% |
| Scientists | 1 | 9% |
Mendeley readers
The data shown below were compiled from readership statistics for 172 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 172 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 27 | 16% |
| Researcher | 25 | 15% |
| Student > Bachelor | 15 | 9% |
| Student > Postgraduate | 13 | 8% |
| Other | 11 | 6% |
| Other | 25 | 15% |
| Unknown | 56 | 33% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 39 | 23% |
| Nursing and Health Professions | 16 | 9% |
| Business, Management and Accounting | 8 | 5% |
| Computer Science | 7 | 4% |
| Social Sciences | 5 | 3% |
| Other | 25 | 15% |
| Unknown | 72 | 42% |
Attention Score in Context
This research output has an Altmetric Attention Score of 8. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 09 January 2023.
All research outputs
#4,893,112
of 25,651,057 outputs
Outputs from BMC Health Services Research
#2,322
of 8,731 outputs
Outputs of similar age
#102,967
of 457,120 outputs
Outputs of similar age from BMC Health Services Research
#80
of 187 outputs
Altmetric has tracked 25,651,057 research outputs across all sources so far. Compared to these this one has done well and is in the 80th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 8,731 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 8.2. This one has gotten more attention than average, scoring higher than 73% of its peers.
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We're also able to compare this research output to 187 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 57% of its contemporaries.