Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stay
Objectives To study between-hospital variation in mortality, readmissions and prolonged length of stay across Belgian hospitals.Design A retrospective nationwide observational study.Setting Secondary and tertiary acute-care hospitals in Belgium.Participants We studied 4 560 993 hospital stays in 99...
| Главные авторы: | , , , , , |
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| Формат: | Статья |
| Язык: | English |
| Опубликовано: |
BMJ Publishing Group
2025-01-01
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| Серии: | BMJ Open |
| Online-ссылка: | https://bmjopen.bmj.com/content/15/1/e082489.full |
| _version_ | 1826884167138279424 |
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| author | Kris Vanhaecht Luk Bruyneel Dirk De Ridder Fien Claessens Bianca Cox Astrid Van Wilder |
| author_facet | Kris Vanhaecht Luk Bruyneel Dirk De Ridder Fien Claessens Bianca Cox Astrid Van Wilder |
| author_sort | Kris Vanhaecht |
| collection | DOAJ |
| description | Objectives To study between-hospital variation in mortality, readmissions and prolonged length of stay across Belgian hospitals.Design A retrospective nationwide observational study.Setting Secondary and tertiary acute-care hospitals in Belgium.Participants We studied 4 560 993 hospital stays in 99 (98%) Belgian acute-care hospitals between 2016 and 2018.Primary outcome measures Using generalised linear mixed models, we calculated hospital-specific and Major Diagnostic Category (MDC)-specific risk-adjusted in-hospital mortality, readmissions within 30 days and length of stay above the MDC-specific 90th percentile and assessed between-hospital variation through estimated variance components.Results There was strong evidence of between-hospital variation in mortality, readmissions and prolonged length of stay across the vast majority of patient service lines. Overall, should hospitals with upper-quartile risk-standardised rates succeed in improving to the median level, a yearly 4076 hospital deaths, 3671 readmissions and 15 787 long patient stays could potentially be avoided in those hospitals. Our analysis revealed a select set of ‘high-impact-opportunity hospitals’ characterised by poor performance across outcomes and across a large number of MDCs.Conclusions Analysis of between-hospital variation highlights important differences in patient outcomes that are not explained by known patient or hospital characteristics. Identifying ‘high-impact-opportunity hospitals’ can help government inspection bodies and hospital managers to establish targeted audits and inspections to generate effective quality improvement initiatives. |
| first_indexed | 2025-02-17T04:01:11Z |
| format | Article |
| id | doaj.art-ee18d8db539d4f39b51c2652aa99a299 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2025-02-17T04:01:11Z |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-ee18d8db539d4f39b51c2652aa99a2992025-01-10T05:25:10ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2023-082489Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stayKris Vanhaecht0Luk Bruyneel1Dirk De Ridder2Fien Claessens3Bianca Cox4Astrid Van Wilder51 Department of Public Health and Primary Care - Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Flanders, Belgium1 Department of Public Health and Primary Care - Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Flanders, Belgium1 Department of Public Health and Primary Care - Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Flanders, Belgium1 Department of Public Health and Primary Care - Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Flanders, Belgium1 Department of Public Health and Primary Care - Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Flanders, Belgium1 Department of Public Health and Primary Care - Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Flanders, BelgiumObjectives To study between-hospital variation in mortality, readmissions and prolonged length of stay across Belgian hospitals.Design A retrospective nationwide observational study.Setting Secondary and tertiary acute-care hospitals in Belgium.Participants We studied 4 560 993 hospital stays in 99 (98%) Belgian acute-care hospitals between 2016 and 2018.Primary outcome measures Using generalised linear mixed models, we calculated hospital-specific and Major Diagnostic Category (MDC)-specific risk-adjusted in-hospital mortality, readmissions within 30 days and length of stay above the MDC-specific 90th percentile and assessed between-hospital variation through estimated variance components.Results There was strong evidence of between-hospital variation in mortality, readmissions and prolonged length of stay across the vast majority of patient service lines. Overall, should hospitals with upper-quartile risk-standardised rates succeed in improving to the median level, a yearly 4076 hospital deaths, 3671 readmissions and 15 787 long patient stays could potentially be avoided in those hospitals. Our analysis revealed a select set of ‘high-impact-opportunity hospitals’ characterised by poor performance across outcomes and across a large number of MDCs.Conclusions Analysis of between-hospital variation highlights important differences in patient outcomes that are not explained by known patient or hospital characteristics. Identifying ‘high-impact-opportunity hospitals’ can help government inspection bodies and hospital managers to establish targeted audits and inspections to generate effective quality improvement initiatives.https://bmjopen.bmj.com/content/15/1/e082489.full |
| spellingShingle | Kris Vanhaecht Luk Bruyneel Dirk De Ridder Fien Claessens Bianca Cox Astrid Van Wilder Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stay BMJ Open |
| title | Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stay |
| title_full | Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stay |
| title_fullStr | Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stay |
| title_full_unstemmed | Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stay |
| title_short | Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stay |
| title_sort | identifying high impact opportunity hospitals for improving healthcare quality based on a national population analysis of inter hospital variation in mortality readmissions and prolonged length of stay |
| url | https://bmjopen.bmj.com/content/15/1/e082489.full |
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