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Variations in the Quality of Care at Large Public Hospitals in Beijing, China: A Condition-Based Outcome Approach.

Xu Y, Liu Y, Shu T, Yang W, Liang M - PLoS ONE (2015)

Bottom Line: We found good overall quality with large variations by hospital and condition (mean/range, in %): RSMR-AMI: 6.23 (2.37-14.48), RSMR-stroke: 4.18 (3.58-4.44), RSMR-pneumonia: 7.78 (7.20-8.59), RSMR-CABG: 1.93 (1.55-2.23), RS-CR: 11.38 (9.9-12.88), and RS-FTR: 6.41 (5.17-7.58).Hospital grade was not significantly associated with any risk-adjusted outcome measures.Going to a higher grade public hospital does not always lead to better patient outcome because hospital grade only contains information about hospital structural resources.

View Article: PubMed Central - PubMed

Affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America.

ABSTRACT

Background: Public hospitals deliver over ninety percent of all outpatient and inpatient services in China. Their quality is graded into three levels (A, B, and C) largely based on structural resources, but empirical evidence on the quality of process and outcome of care is extremely scarce. As expectations for quality care rise with higher living standards and cost of care, such evidence is urgently needed and vital to improve care and to inform future health reforms.

Methods: We compiled and analyzed a multicenter database of over 4 million inpatient discharge summary records to provide a comprehensive assessment of the level and variations in clinical outcomes of hospitalization at 39 tertiary hospitals in Beijing. We assessed six outcome measures of clinical quality: in-hospital mortality rates (RSMR) for AMI, stroke, pneumonia and CABG, post-procedural complication rate (RS-CR), and failure-to-rescue rate (RS-FTR). The measures were adjusted for pre-admission patient case-mix using indirect standardization method with hierarchical linear mixed models.

Results: We found good overall quality with large variations by hospital and condition (mean/range, in %): RSMR-AMI: 6.23 (2.37-14.48), RSMR-stroke: 4.18 (3.58-4.44), RSMR-pneumonia: 7.78 (7.20-8.59), RSMR-CABG: 1.93 (1.55-2.23), RS-CR: 11.38 (9.9-12.88), and RS-FTR: 6.41 (5.17-7.58). Hospital grade was not significantly associated with any risk-adjusted outcome measures.

Conclusions: Going to a higher grade public hospital does not always lead to better patient outcome because hospital grade only contains information about hospital structural resources. A hospital report card with some outcome measures of quality would provide valuable information to patients in choosing providers, and for regulators to identify gaps in health care quality. Reducing the variations in clinical practice and patient outcome should be a focus for policy makers in the next round of health sector reforms in China.

No MeSH data available.


Related in: MedlinePlus

Observed mortality-to-expected mortality ratios for AMI patients at study hospitals.Source: Author’s calculations. Note: Y axis: hospital ID, X axis: standardized mortality ratio (SMR). SMR>1 indicates higher mortality than expected, thus worse clinical outcome.
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pone.0138948.g001: Observed mortality-to-expected mortality ratios for AMI patients at study hospitals.Source: Author’s calculations. Note: Y axis: hospital ID, X axis: standardized mortality ratio (SMR). SMR>1 indicates higher mortality than expected, thus worse clinical outcome.

Mentions: Second, the variations in hospital clinical quality were still substantial after risk-standardization (S1 Fig). As an example, Fig 1 shows the standardized mortality rate (SMRs) of AMI patients from 37 hospitals that treated at least 30 AMI patients. If a hospital’s SMR is not significantly different from one, then the hospital is performing as good as expected; if a hospital’s SMR is significantly smaller than one, the hospital’s performance is better than expected, and vice versa. The greater the SMR deviates from one, the more extreme quality of a hospital. Hospitals can then be ranked by how far they are from their expected performance level. The number of hospitals that had higher-than-expected outcomes (thus worse quality) was 7 on RSMR-AMI (18.9%), 4 on RSMR-Stroke (10.2%), 7 on RSMR-pneumonia (17.9%), 3 on RSMR-CABG (17.6%), and 12 on RSCR and FTR (30.8%). We observed the largest gap between the top hospital and the bottom hospital for AMI treatment, in which the high quality hospital had 60% less mortality than would-be-expected and the low quality hospital had 150% more mortality than would-be-expected. This gap ranged 18% to 35% for the other measures.


Variations in the Quality of Care at Large Public Hospitals in Beijing, China: A Condition-Based Outcome Approach.

Xu Y, Liu Y, Shu T, Yang W, Liang M - PLoS ONE (2015)

Observed mortality-to-expected mortality ratios for AMI patients at study hospitals.Source: Author’s calculations. Note: Y axis: hospital ID, X axis: standardized mortality ratio (SMR). SMR>1 indicates higher mortality than expected, thus worse clinical outcome.
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Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4592271&req=5

pone.0138948.g001: Observed mortality-to-expected mortality ratios for AMI patients at study hospitals.Source: Author’s calculations. Note: Y axis: hospital ID, X axis: standardized mortality ratio (SMR). SMR>1 indicates higher mortality than expected, thus worse clinical outcome.
Mentions: Second, the variations in hospital clinical quality were still substantial after risk-standardization (S1 Fig). As an example, Fig 1 shows the standardized mortality rate (SMRs) of AMI patients from 37 hospitals that treated at least 30 AMI patients. If a hospital’s SMR is not significantly different from one, then the hospital is performing as good as expected; if a hospital’s SMR is significantly smaller than one, the hospital’s performance is better than expected, and vice versa. The greater the SMR deviates from one, the more extreme quality of a hospital. Hospitals can then be ranked by how far they are from their expected performance level. The number of hospitals that had higher-than-expected outcomes (thus worse quality) was 7 on RSMR-AMI (18.9%), 4 on RSMR-Stroke (10.2%), 7 on RSMR-pneumonia (17.9%), 3 on RSMR-CABG (17.6%), and 12 on RSCR and FTR (30.8%). We observed the largest gap between the top hospital and the bottom hospital for AMI treatment, in which the high quality hospital had 60% less mortality than would-be-expected and the low quality hospital had 150% more mortality than would-be-expected. This gap ranged 18% to 35% for the other measures.

Bottom Line: We found good overall quality with large variations by hospital and condition (mean/range, in %): RSMR-AMI: 6.23 (2.37-14.48), RSMR-stroke: 4.18 (3.58-4.44), RSMR-pneumonia: 7.78 (7.20-8.59), RSMR-CABG: 1.93 (1.55-2.23), RS-CR: 11.38 (9.9-12.88), and RS-FTR: 6.41 (5.17-7.58).Hospital grade was not significantly associated with any risk-adjusted outcome measures.Going to a higher grade public hospital does not always lead to better patient outcome because hospital grade only contains information about hospital structural resources.

View Article: PubMed Central - PubMed

Affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America.

ABSTRACT

Background: Public hospitals deliver over ninety percent of all outpatient and inpatient services in China. Their quality is graded into three levels (A, B, and C) largely based on structural resources, but empirical evidence on the quality of process and outcome of care is extremely scarce. As expectations for quality care rise with higher living standards and cost of care, such evidence is urgently needed and vital to improve care and to inform future health reforms.

Methods: We compiled and analyzed a multicenter database of over 4 million inpatient discharge summary records to provide a comprehensive assessment of the level and variations in clinical outcomes of hospitalization at 39 tertiary hospitals in Beijing. We assessed six outcome measures of clinical quality: in-hospital mortality rates (RSMR) for AMI, stroke, pneumonia and CABG, post-procedural complication rate (RS-CR), and failure-to-rescue rate (RS-FTR). The measures were adjusted for pre-admission patient case-mix using indirect standardization method with hierarchical linear mixed models.

Results: We found good overall quality with large variations by hospital and condition (mean/range, in %): RSMR-AMI: 6.23 (2.37-14.48), RSMR-stroke: 4.18 (3.58-4.44), RSMR-pneumonia: 7.78 (7.20-8.59), RSMR-CABG: 1.93 (1.55-2.23), RS-CR: 11.38 (9.9-12.88), and RS-FTR: 6.41 (5.17-7.58). Hospital grade was not significantly associated with any risk-adjusted outcome measures.

Conclusions: Going to a higher grade public hospital does not always lead to better patient outcome because hospital grade only contains information about hospital structural resources. A hospital report card with some outcome measures of quality would provide valuable information to patients in choosing providers, and for regulators to identify gaps in health care quality. Reducing the variations in clinical practice and patient outcome should be a focus for policy makers in the next round of health sector reforms in China.

No MeSH data available.


Related in: MedlinePlus