Relationship between preventable hospital deaths and other measures of safety: an exploratory study.
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ABSTRACT:
SUBMITTER: Hogan H
PROVIDER: S-EPMC7299426 | biostudies-literature | 2015 Apr
REPOSITORIES: biostudies-literature
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Relationship between preventable hospital deaths and other measures of safety: an exploratory study.
Hogan Helen H Healey Frances F Neale Graham G Thomson Richard R Vincent Charles C Black Nick N
International journal for quality in health care : journal of the International Society for Quality in Health Care 20150218 2
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Project description:BackgroundThe extent to which patient experiences with hospital care are related to other measures of hospital quality and safety is unknown. METHODS; We examined the relationship between Hospital Consumer Assessment of Healthcare Providers and Systems scores and technical measures of quality and safety using service-line specific data in 927 hospitals. We used data from the Hospital Quality Alliance to assess technical performance in medical and surgical processes of care and calculated Patient Safety Indicators to measure medical and surgical complication rates.ResultsThe overall rating of the hospital and willingness to recommend the hospital had strong relationships with technical performance in all medical conditions and surgical care (correlation coefficients ranging from 0.15 to 0.63; p<.05 for all). Better patient experiences for each measure domain were associated with lower decubitus ulcer rates (correlations -0.17 to -0.35; p<.05 for all), and for at least some domains with each of the other assessed complications, such as infections due to medical care.ConclusionsPatient experiences of care were related to measures of technical quality of care, supporting their validity as summary measures of hospital quality. Further study may elucidate implications of these relationships for improving hospital care.
| S-EPMC2910567 | biostudies-literature
Project description:ObjectiveTo examine the relationship between hospital volume and in-hospital adverse events.Data sourcesPatient safety indicator (PSI) was used to identify hospital-acquired adverse events in the Nationwide Inpatient Sample database in abdominal aortic aneurysm, coronary artery bypass graft, and Roux-en-Y gastric bypass from 2005 to 2008.Study designIn this observational study, volume thresholds were defined by mean year-specific terciles. PSI risk-adjusted rates were analyzed by volume tercile for each procedure.Principal findingsOverall, hospital volume was inversely related to preventable adverse events. High-volume hospitals had significantly lower risk-adjusted PSI rates compared to lower volume hospitals (p < .05).ConclusionThese data support the relationship between hospital volume and quality health care delivery in select surgical cases. This study highlights differences between hospital volume and risk-adjusted PSI rates for three common surgical procedures and highlights areas of focus for future studies to identify pathways to reduce hospital-acquired events.
| S-EPMC3419887 | biostudies-literature
Project description:Studies estimate that 6% to 27% of deaths in hospitals might be prevented with higher quality care. These estimates may be inaccurate because they fail to account for the uncertainty associated with classifying preventability. The purpose of this study was to measure the prevalence of preventable deaths, accounting for the uncertainty in preventability ratings.We created standardized structured case abstracts for all deaths at a multisite academic teaching hospital over a 3-month period. Each case abstract was evaluated independently by 4 reviewers who rated death preventability on a 100-point scale ranging from 0 ("Definitely not preventable") to 100 ("Definitely preventable"). Ratings were categorized into a 4-level ordinal scale and latent class analysis was used to measure the prevalence of each preventability class and estimate the probability that deaths in each class were preventable.There were 480 deaths (3.4% of all admissions) during the study period. The latent class model (LCM) found that 91.6% (95% CI: 88.4-94.8%) of deaths were "nonpreventable" and 8.4% (5.2-11.6%) were "possibly preventable." "Possibly preventable" deaths could be identified with 90% certainty, but due to error in reviewer ratings, a "possibly preventable" death had a 50% probability of being receiving a rating of less than 25/100 by any single reviewer. Only 5 of 31 deaths classified as a "possibly preventable" (1.0% of all deaths) were judged to likely be alive in 3 months with perfect care.After accounting for uncertainty associated with rating the preventability of hospital deaths, we found that 8.4% of deaths were deemed possibly preventable. There was only moderate probability that these deaths were truly preventable.
| S-EPMC5569428 | biostudies-literature
Project description:BackgroundMedication errors are common in hospital inpatients. While many interventions have been proposed to address these problems, few have been shown to have significant benefits. A complementary approach is to facilitate greater involvement of patients with their inpatient medication. However, there is relatively little research in this area and it is not known which interventions lead to improved healthcare outcomes. Work is therefore needed to investigate the roles that healthcare professionals and patients believe are appropriate for hospital inpatients to take relating to safety.ObjectiveTo explore the extent to which hospital inpatients reported that they engaged with medication safety-related behaviours, the extent to which they would like to, and the extent to which healthcare professionals reported that they would support such engagement.SettingAn NHS hospital Trust in West London.Methods100 Patients and healthcare professionals were recruited on ten wards within the Trust and invited to complete quantitative questionnaires. Data were analysed descriptively and exploratory comparisons made between different groups of respondents.Main outcome measuresinpatient medication safety involvement scale and control preference scale for patient involvement in decision making.Results100 patients (98 % response rate) and 104 healthcare professionals (59 % response rate) were recruited. The majority of patients and healthcare professionals were supportive of hospital inpatients being involved with their medication. However there was a significant gap between desire for patient involvement and what patients reported having experienced. Female patients and those under 65 wanted a significantly higher level of involvement than males and over 65s. Few associations were found between healthcare professionals' reported support for involvement and their profession or gender. However, pharmacists and nurses were significantly more likely to report supporting patients asking questions about their medicines and self administering their own medicines than doctors.ConclusionHealthcare professionals and patients desire a higher level of patient involvement with their medication while in hospital than patients currently report. Interventions need to be developed to bridge the gap between desired and actual patient involvement.
| S-EPMC4019827 | biostudies-literature
Project description:ObjectiveEvidence-based performance measures have been increasingly used to evaluate hospital quality of stroke care, but their impact on stroke outcomes has not been verified. We aimed to evaluate the correlations between hospital performance measures and outcomes among patients with acute ischaemic stroke in a Chinese population.MethodsData were derived from a prospective cohort, which included 120 hospitals participating in the China National Stroke Registry between September 2007 and August 2008. Adherence to nine evidence-based performance measures was examined, and the composite score of hospital performance measures was calculated. The primary stroke outcomes were hospital-level, 30-day and 1-year risk-standardised mortality (RSM). Associations of individual performance measures and composite score with stroke outcomes were assessed using Spearman correlation coefficients.ResultsOne hundred and twenty hospitals that recruited 12 027 patients with ischaemic stroke were included in our analysis. Among 12 027 patients, 61.59% were men, and the median age was 67 years. The overall composite score of performance measures was 63.3%. The correlation coefficients between individual performance measures ranged widely from 0.01 to 0.66. No association was observed between the composite score and 30-day RSM. The composite score was modestly associated with 1-year RSM (Spearman correlation coefficient, 0.34; p<0.05). The composite score explained only 2.53% and 10.18% of hospital-level variation in 30-day and 1-year RSM for patients with acute stroke.ConclusionsAdherence to evidence-based performance measures for acute ischaemic stroke was suboptimal in China. There were various correlations among hospital individual performance measures. The hospital performance measures had no correlations with 30-day RSM rate and modest correlations with 1-year RSM rate.
| S-EPMC6074631 | biostudies-literature
Project description:BackgroundHospital-level measures of patient satisfaction and quality are now reported publically by the Centers for Medicare and Medicaid Services. There are limited metrics specific to cancer patients. We examined whether publically reported hospital satisfaction and quality data were associated with surgical oncologic outcomes.MethodsThe Nationwide Inpatient Sample was utilized to identify patients with solid tumors who underwent surgical resection in 2009 and 2010. The hospitals were linked to Hospital Compare, which collects data on patient satisfaction, perioperative quality, and 30-day mortality for medical conditions (pneumonia, myocardial infarction [MI], and congestive heart failure [CHF]). The risk-adjusted hospital-level rates of morbidity and mortality were calculated for each hospital and the means compared between the highest and lowest performing hospital quartiles and reported as absolute reduction in risk (ARR), the difference in risk of the outcome between the two groups. All statistical tests were two-sided.ResultsA total of 63197 patients treated at 448 hospitals were identified. For patients at high vs low performing hospitals based on Hospital Consumer Assessment of Healthcare Providers and Systems scores, the ARR in perioperative morbidity was 3.1% (95% confidence interval [CI] = 0.4% to 5.7%, P = .02). Similarly, the ARR for mortality based on the same measure was -0.4% (95% CI = -1.5% to 0.6%, P = .40). High performance on perioperative quality measures resulted in an ARR of 0% to 2.2% for perioperative morbidity (P > .05 for all). Similarly, there was no statistically significant association between hospital-level mortality rates for MI (ARR = 0.7%, 95% CI = -1.0% to 2.5%), heart failure (ARR = 1.0%, 95% CI = -0.6% to 2.7%), or pneumonia (ARR = 1.6%, 95% CI = -0.3% to 3.5%) and complications for oncologic surgery patients.ConclusionCurrently available measures of patient satisfaction and quality are poor predictors of outcomes for cancer patients undergoing surgery. Specific metrics for long-term oncologic outcomes and quality are needed.
| S-EPMC4565527 | biostudies-literature
Project description:ObjectiveThe 340B program allows safety-net hospitals to acquire discounted outpatient drugs and charge payers full price. We examined whether 340B participation increases safety-net engagement.Data sources340B participation data, Medicare hospital cost reports, American Hospital Association Survey, and Schedule 990 nonprofit hospital tax returns.Study designQuasi-experimental difference-in-differences design comparing 340B hospitals (the "treatment" group) before and after participating to changes over time to three alternative "control" groups: all other nonprofit and public hospitals, hospitals that are not participating during our study, and hospitals that were not-yet-participating but started after 2015. Outcome measures include a range of safety-net care measures that are alternatives to the standard uncompensated care: charity care, community benefit spending, charity care policies, and low-profit service-line provision.Data extractionWe extracted data on all nonprofit and public hospitals from 2011 to 2015. We linked 340B participation data to Medicare hospital cost reports and American Hospital Association data using Medicare hospital identifiers. 990 Data was linked on name and address.Principal findingsNew 340B participation was not associated with a change in uncompensated care, but was associated with a 28.9 percent increase in charity care spending (SE = 8.8), or about $880,000 per hospital. However, total community benefit spending (including charity care) did not change. 340B was associated with an increase in the probability of offering discounted care (4.3 percentage points, SE = 1.6) from 84 to 88 percent and an increase in the income eligibility limit for discounted care (18.9 percentage points, SE = 5.6) from 294 to 313 percent. Participation was not associated with the probability of offering low-profit medical care services.ConclusionsAlternative measures show that newly participating hospitals may increase charity care, potentially through offering more patients discounted care. However, increases appear to be fully offset by reductions in other community benefit programs.
| S-EPMC7080377 | biostudies-literature
Project description:BackgroundOur goal was to compare hospital scores from the most widely used commercial website in the USA to hospital scores from more systematic measures of patient experience and outcomes, and to assess what drives variation in the commercial website scores.MethodsFor a national sample of US hospitals, we compared scores on Yelp.com, which aggregates website visitor ratings (1-5 stars), with traditional measures of hospital quality. We calculated correlations between hospital Yelp scores and the following: hospital percent high ratings (9 or 10, scale 0-10) on the 'Overall' item on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey; hospital individual HCAHPS domain scores (eg, nurse communication, pain control); hospital 30-day mortality; and hospital 30-day readmission rates.ResultsOf hospitals reporting HCAHPS (n=3796), 962 (25%) had scores on Yelp. Among hospitals with >5 Yelp ratings, the correlation of percent high ratings between Yelp and HCAHPS was 0.49 (p<0.001). The percent high ratings within each HCAHPS domain increased monotonically with increasing Yelp scores (p≤0.001 for all domains). Percent high ratings in Yelp and HCAHPS were statistically significantly correlated with lower mortality for myocardial infarction (MI; -0.19 for Yelp and -0.13 for HCAHPS) and pneumonia (-0.14 and -0.18), and fewer readmissions for MI (-0.17 and -0.39), heart failure (-0.31 and -0.39), and pneumonia (-0.18 and -0.27).ConclusionsThese data suggest that rater experiences for Yelp and HCAHPS may be similar, and that consumers posting ratings on Yelp may observe aspects of care related to important patient outcomes.
| S-EPMC4074426 | biostudies-literature
Project description:ObjectiveTo examine if low life satisfaction is associated with an increased risk of being hospitalised for an ambulatory care sensitive condition (ACSC), in comparison to high life satisfaction DESIGN AND SETTING: Population-based cohort study of adults from Ontario, Canada. Baseline data were captured through the Canadian Community Health Survey (CCHS) and linked to health administrative data for follow-up information.Participants129 467 men and women between the ages 18 and 74.Main outcome measuresTime to avoidable hospitalisations defined by ACSCs.ResultsLife satisfaction was measured at baseline through the CCHS and follow-up information on ACSC hospitalisations were captured by linking participant respondents to hospitalisation records covered under a single payer health system. Within the study time frame (maximum of 14 years), 3037 individuals were hospitalised. Older men in the lowest household income quintile were more likely to be hospitalised with an ACSC. After controlling for age, sex, socioeconomic status (SES) and other behavioural factors, low life satisfaction at baseline had a strong relationship with future hospitalisations for ACSCs (HR 2.71; 95% CI 1.87 to 3.93). The hazards were highest for those who jointly had the lowest levels of life satisfaction and low household income (HR 3.80; 95% CI 2.13 to 6.73). Results did not meaningful change after running a competing risk survival analysis.ConclusionsThis study demonstrates that poor life satisfaction is associated with hospitalisations for ACSCs after adjustment for several confounders. Furthermore, the magnitude of this relationship was greater for those who were more socioeconomically disadvantaged. This study adds to the existing literature on the impact of life satisfaction on health system outcomes by documenting its impact on avoidable hospitalisations in a universal health system.
| S-EPMC7045202 | biostudies-literature
Project description:Trauma is a significant public health issue worldwide, particularly affecting economically active age groups. Quality management of trauma care at the national level is crucial to improve outcomes of major trauma. In Korea, a biennial nationwide survey on preventable trauma death rate is conducted. Based on the survey results, we analyzed opportunities for improving the trauma treatment process. Expert panels reviewed records of 8282 and 8482 trauma-related deaths in 2017 and 2019, respectively, identifying 258 and 160 cases in each year as preventable deaths. Opportunities for improvement were categorized into prehospital, interhospital, and hospital stages. Hemorrhage was the primary cause of death, followed by sepsis/multiorgan failure and central nervous system injury. Delayed hemostatic procedures and transfusions were common areas for improvement in hospital stage. Interhospital transfers experienced significant delays in arrival time. This study emphasizes the need to enhance trauma care by refining treatment techniques, centralizing patients in specialized facilities, and implementing comprehensive reviews and performance improvements throughout the patient transfer system. The findings offer valuable insights for addressing trauma care improvement from both clinical and systemic perspectives.
| S-EPMC10454732 | biostudies-literature