Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan
Abstract Background Maintenance of activities of daily living (ADL) during acute hospitalization is an important treatment goal, especially for elderly inpatients with diseases that often leave disabilities, such as cerebral infarction. However, studies assessing risk-adjusted ADL changes are limite...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-023-03957-4 |
| _version_ | 1797840893093347328 |
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| author | Ryo Onishi Yosuke Hatakeyama Koki Hirata Kunichika Matsumoto Kanako Seto Yinghui Wu Takefumi Kitazawa Tomonori Hasegawa |
| author_facet | Ryo Onishi Yosuke Hatakeyama Koki Hirata Kunichika Matsumoto Kanako Seto Yinghui Wu Takefumi Kitazawa Tomonori Hasegawa |
| author_sort | Ryo Onishi |
| collection | DOAJ |
| description | Abstract Background Maintenance of activities of daily living (ADL) during acute hospitalization is an important treatment goal, especially for elderly inpatients with diseases that often leave disabilities, such as cerebral infarction. However, studies assessing risk-adjusted ADL changes are limited. In this study, we developed and calculated a hospital standardized ADL ratio (HSAR) using Japanese administrative claims data to measure the quality of hospitalization care for patients with cerebral infarction. Methods This study was designed as a retrospective observational study using the Japanese administrative claim data from 2012 to 2019. The data of all hospital admissions with a primary diagnosis of cerebral infarction (ICD-10, I63) were used. The HSAR was defined as the ratio of the observed number of ADL maintenance patients to the expected number of ADL maintenance patients multiplied by 100, and ratio of ADL maintenance patients was risk-adjusted using multivariable logistic regression analyses. The c-statistic was used to evaluate the predictive accuracy of the logistic models. Changes in HSARs in each consecutive period were assessed using Spearman’s correlation coefficient. Results A total of 36,401 patients from 22 hospitals were included in this study. All variables used in the analyses were associated with ADL maintenance, and evaluations using the HSAR model showed predictive ability with c-statistics (area under the curve, 0.89; 95% confidence interval, 0.88–0.89). Conclusions The findings indicated a need to support hospitals with a low HSAR because hospitals with high/low HSAR were likely to produce the same results in the subsequent periods. HSAR can be used as a new quality indicator of in-hospital care and may contribute to the assessment and improvement of the quality of care. |
| first_indexed | 2024-04-09T16:22:09Z |
| format | Article |
| id | doaj.art-f13986c5442449b88e6d6029ea333faa |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-04-09T16:22:09Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-f13986c5442449b88e6d6029ea333faa2023-04-23T11:27:25ZengBMCBMC Geriatrics1471-23182023-04-012311810.1186/s12877-023-03957-4Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in JapanRyo Onishi0Yosuke Hatakeyama1Koki Hirata2Kunichika Matsumoto3Kanako Seto4Yinghui Wu5Takefumi Kitazawa6Tomonori Hasegawa7Department of Social Medicine, Toho University School of MedicineDepartment of Social Medicine, Toho University School of MedicineDepartment of Social Medicine, Toho University School of MedicineDepartment of Social Medicine, Toho University School of MedicineDepartment of Social Medicine, Toho University School of MedicineSchool of Nursing, Shanghai Jiao Tong UniversityDepartment of Nursing, Faculty of Health Sciences, Tokyo Kasei UniversityDepartment of Social Medicine, Toho University School of MedicineAbstract Background Maintenance of activities of daily living (ADL) during acute hospitalization is an important treatment goal, especially for elderly inpatients with diseases that often leave disabilities, such as cerebral infarction. However, studies assessing risk-adjusted ADL changes are limited. In this study, we developed and calculated a hospital standardized ADL ratio (HSAR) using Japanese administrative claims data to measure the quality of hospitalization care for patients with cerebral infarction. Methods This study was designed as a retrospective observational study using the Japanese administrative claim data from 2012 to 2019. The data of all hospital admissions with a primary diagnosis of cerebral infarction (ICD-10, I63) were used. The HSAR was defined as the ratio of the observed number of ADL maintenance patients to the expected number of ADL maintenance patients multiplied by 100, and ratio of ADL maintenance patients was risk-adjusted using multivariable logistic regression analyses. The c-statistic was used to evaluate the predictive accuracy of the logistic models. Changes in HSARs in each consecutive period were assessed using Spearman’s correlation coefficient. Results A total of 36,401 patients from 22 hospitals were included in this study. All variables used in the analyses were associated with ADL maintenance, and evaluations using the HSAR model showed predictive ability with c-statistics (area under the curve, 0.89; 95% confidence interval, 0.88–0.89). Conclusions The findings indicated a need to support hospitals with a low HSAR because hospitals with high/low HSAR were likely to produce the same results in the subsequent periods. HSAR can be used as a new quality indicator of in-hospital care and may contribute to the assessment and improvement of the quality of care.https://doi.org/10.1186/s12877-023-03957-4Cerebral infarctionActivities of daily livingQuality indicatorAdministrative dataJapan |
| spellingShingle | Ryo Onishi Yosuke Hatakeyama Koki Hirata Kunichika Matsumoto Kanako Seto Yinghui Wu Takefumi Kitazawa Tomonori Hasegawa Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan BMC Geriatrics Cerebral infarction Activities of daily living Quality indicator Administrative data Japan |
| title | Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan |
| title_full | Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan |
| title_fullStr | Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan |
| title_full_unstemmed | Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan |
| title_short | Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan |
| title_sort | development and usability of a hospital standardized adl ratio hsar for elderly patients with cerebral infarction a retrospective observational study using administrative claim data from 2012 to 2019 in japan |
| topic | Cerebral infarction Activities of daily living Quality indicator Administrative data Japan |
| url | https://doi.org/10.1186/s12877-023-03957-4 |
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