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Understanding the large heterogeneity in hospital readmissions and mortality for acute myocardial infarction.
Metadata
Journalhealth policy2.212Date
2020 May 19
5 months ago
Type
Journal Article
Volume
2020-Jul / 124 : 684-694
Author
Lobo MF 1, Azzone V 2, Lopes F 3, Freitas A 3, Costa-Pereira A 3, Normand SL 4, Teixeira-Pinto A 5
Affiliation
  • 2. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
  • 3. Center for Health Technology and Services Research (CINTESIS) and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.
  • 4. Department of Health Care Policy, Harvard Medical School, and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • 5. Armando Teixeira-Pinto, School of Public Health, The University of Sydney, Sydney, NSW, Australia.
Doi
PMIDMESH
Abstract
This study aims to investigate the variation in two acute myocardial infarction (AMI) outcomes across public hospitals in Portugal. In-hospital mortality and 30-day unplanned readmissions were studied using two distinct AMI cohorts of adults discharged from all acute care public hospital centers in Portugal from 2012-2015. Hierarchical generalized linear models were used to assess the association between patient and hospital characteristics and hospital variability in the two outcomes. Our findings indicate that hospitals are not performing homogeneously-the risk of adverse events tends to be consistently larger in some hospitals and consistently lower in other hospitals. While patient characteristics accounted for a larger share of the explained between-hospital variance, hospital characteristics explain an additional 8% and 10% of hospital heterogeneity in the mortality and the readmission cohorts respectively. Admissions to hospitals with low AMI caseloads or located in Alentejo/Algarve and Lisbon had a higher risk of mortality. Discharges from larger-sized hospitals were associated with increased risk of readmissions. Future health policies should incorporate these findings in order to incentivize more consistent health care outcomes across hospitals. Further investigation addressing geographical disparities, hospital caseload and practices is needed to direct actions of improvement to specific hospitals.
Keywords: 30-Day unplanned readmissions Acute myocardial infarction Administrative data Hierarchical regression models Hospital healthcare quality In-hospital mortality
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Health Policyhealth policy
Metadata
LocationIreland
FromELSEVIER IRELAND LTD

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