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BMC Health Services Research
Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

Variations and inter-relationship in outcome from emergency admissions in England: a retrospective analysis of Hospital Episode Statistics from 2005–2010

Authors: Peter James Edward Holt, Sidhartha Sinha, Baris Ata Ozdemir, Alan Karthikesalingam, Jan Dominik Poloniecki, Matt Merfyn Thompson

Published in: BMC Health Services Research | Issue 1/2014

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Abstract

Background

The quality of care delivered and clinical outcomes of care are of paramount importance. Wide variations in the outcome of emergency care have been suggested, but the scale of variation, and the way in which outcomes are inter-related are poorly defined and are critical to understand how best to improve services. This study quantifies the scale of variation in three outcomes for a contemporary cohort of patients undergoing emergency medical and surgical admissions. The way in which the outcomes of different diagnoses relate to each other is investigated.

Methods

A retrospective study using the English Hospital Episode Statistics 2005–2010 with one-year follow-up for all patients with one of 20 of the commonest and highest-risk emergency medical or surgical conditions. The primary outcome was in-hospital all-cause risk-standardised mortality rate (in-RSMR). Secondary outcomes were 1-year all-cause risk-standardised mortality rate (1 yr-RSMR) and 28-day all-cause emergency readmission rate (RSRR).

Results

2,406,709 adult patients underwent emergency medical or surgical admissions in the groups of interest. Clinically and statistically significant variations in outcome were observed between providers for all three outcomes (p < 0.001). For some diagnoses including heart failure, acute myocardial infarction, stroke and fractured neck of femur, more than 20% of hospitals lay above the upper 95% control limit and were statistical outliers. The risk-standardised outcomes within a given hospital for an individual diagnostic group were significantly associated with the aggregated outcome of the other clinical groups.

Conclusions

Hospital-level risk-standardised outcomes for emergency admissions across a range of specialties vary considerably and cross traditional speciality boundaries. This suggests that global institutional infra-structure and processes of care influence outcomes. The implications are far reaching, both in terms of investigating performance at individual hospitals and in understanding how hospitals can learn from the best performers to improve outcomes.
Appendix
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Literature
1.
Kennedy I: Learning from Bristol: The Report of the Public Inquiry into Children’s Heart Surgery at the Bristol Royal Infirmary 1984–1995. 2001, London: Bristol Royal Infirmary Inquiry
2.
Francis R: Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust January 2005 – March 2009. 2010, London: Mid Staffordshire NHS Foundation Trust Inquiry
3.
The Nuffield Trust: Rating Providers for Quality: A Policy Worth Pursuing?. 2013, London: The Nuffield Trust
4.
5.
Jha AK, Li Z, Orav EJ, Epstein AM: Care in U.S. hospitals — The Hospital Quality Alliance Program. N Eng J Med. 2005, 353 (3): 265-274.CrossRef
6.
Bottle A, Jarman B, Aylin P: Strengths and weaknesses of hospital standardised mortality ratios. BMJ. 2010, 341: c7116.CrossRef
7.
Chassin MR, Park RE, Lohr KN, Keesey J, Brook RH: Differences among hospitals in Medicare patient mortality. Health Serv Res. 1989, 24 (1): 1-31.PubMedPubMedCentral
8.
Dimick JB, Staiger DO, Birkmeyer JD: Are mortality rates for different operations related?: implications for measuring the quality of noncardiac surgery. Med Care. 2006, 44 (8): 774-778.CrossRefPubMedPubMedCentral
9.
Urbach DR, Baxter NN: Does it matter what a hospital is “high volume” for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data. Qual Saf Health Care. 2004, 13 (5): 379-383.CrossRefPubMedPubMedCentral
10.
Holt P, Poloniecki J, Thompson M: Multicentre study of the quality of a large administrative data set and implications for comparing death rates. Br J Surg. 2012, 99: 58-65.CrossRefPubMed
11.
Blunt I, Bardsley M, Dixon J: Trends in Emergency Admissions in England 2004–2009. 2010, London: The Nuffield Trust
12.
Sinha S, Peach G, Poloniecki JD, Thompson M, Holt PJ: Studies using English administrative data (Hospital Episode Statistics) to assess healthcare outcomes – systematic review and recommendations for reporting. Eur J Public Health. 2013, 23 (1): 86-92.CrossRefPubMed
13.
Krumholz HM, Lin Z, Keenan PS, Chen J, Ross JS, Drye EE, Bernheim SM, Wang Y, Bradley EH, Han LF, Normand S-LT: Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia. JAMA. 2013, 309 (6): 587-593.CrossRefPubMedPubMedCentral
14.
Sinha S, Karthikesalingam A, Poloniecki JD, Thompson MM, Holt PJ: Inter-relationship of procedural mortality rates in vascular surgery in England - retrospective analysis of Hospital Episode Statistics from 2005–2010. Circ Cardiovasc Qual Outcomes. 2014, 7 (1): 131-141.CrossRefPubMed
15.
Holt PJE, Poloniecki JD, Loftus IM, Michaels JA, Thompson MM: Epidemiological study of the relationship between volume and outcome after abdominal aortic aneurysm surgery in the UK from 2000 to 2005. Br J Surg. 2007, 94 (4): 441-448.CrossRefPubMed
16.
Moxey PW, Hofman D, Hinchliffe RJ, Jones K, Thompson MM, Holt PJ: Epidemiological study of lower limb amputation in England between 2003 and 2008. Br J Surg. 2010, 97 (9): 1348-1353.CrossRefPubMed
17.
Sinha S, Hofman D, Stoker DL, Friend PJ, Poloniecki JD, Thompson MM, Holt PJ: Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics. Surg Endosc. 2013, 27 (1): 162-175.CrossRefPubMed
18.
Aylin P, Bottle A, Majeed A: Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models. BMJ. 2007, 334: 1044-1047.CrossRefPubMedPubMedCentral
19.
Armitage JN, van der Meulen JH: Identifying co-morbidity in surgical patients using administrative data with the Royal College of Surgeons Charlson score. Br J Surg. 2010, 97 (5): 772-781.CrossRefPubMed
20.
Elixhauser A, Steiner C, Harris DR, Coffey RM: Comorbidity measures for use with administrative data. Med Care. 1998, 36 (1): 8-27.CrossRefPubMed
21.
Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987, 40 (5): 373-383.CrossRefPubMed
22.
The Department for Communities and Local Government: The English Indices of Deprivation 2010. 2011, London: Department for Communities and Local Government
23.
24.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007, 4 (10): e296.CrossRefPubMedPubMedCentral
25.
26.
Hearld LR, Alexander JA, Fraser I, Jiang HJ: How do hospital organizational structure and processes affect quality of care?. Med Care Res Rev. 2008, 65 (3): 259-299.CrossRefPubMed
27.
Darzi A: High Quality Care for All: NHS Next Stage Review Final Report. 2008, London: Department of Health
28.
29.
Almoudaris AM, Burns EM, Mamidanna R, Bottle A, Aylin P, Vincent C, Faiz O: Value of failure to rescue as a marker of the standard of care following reoperation for complications after colorectal resection. Br J Surg. 2011, 98 (12): 1775-1783.CrossRefPubMed
30.
Ghaferi AA, Osborne NH, Birkmeyer JD, Dimick JB: Hospital characteristics associated with failure to rescue from complications after pancreatectomy. J Am Coll Surg. 2010, 211 (3): 325-330.CrossRefPubMed
31.
Pronovost PJ, Jenckes MW, Dorman T, Garrett E, Breslow MJ, Rosenfeld BA, Lipsett PA, Bass E: Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA. 1999, 281 (14): 1310-1317.CrossRefPubMed
32.
Elixhauser A, Steiner C, Fraser I: Volume thresholds and hospital characteristics in the United States. Health Aff Millwood). 2003, 22 (2): 167-177.CrossRef
33.
Ebaugh JL, Feinglass J, Pearce WH: The effect of hospital vascular operation capability on outcomes of lower extremity arterial bypass graft procedures. Surgery. 2001, 130 (4): 561-567.CrossRefPubMed
34.
Hannan EL, Popp AJ, Feustel P, Halm E, Bernardini G, Waldman J, Shah D, Chassin MR: Association of surgical specialty and processes of care with patient outcomes for carotid endarterectomy. Stroke. 2001, 32 (12): 2890-2897.CrossRefPubMed
35.
Rubin HR, Pronovost P, Diette GB: The advantages and disadvantages of process‒based measures of health care quality. International J Qual Health Care. 2001, 13 (6): 469-474.CrossRef
36.
Palmer RH: Process-based measures of quality: the need for detailed clinical data in large health care databases. Ann Intern Med. 1997, 127 (2): 733-738.CrossRefPubMed
37.
38.
39.
Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ: Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network. Br J Anaesth. 2012, 109 (3): 368-375.CrossRefPubMed
40.
Faiz O, Warusavitarne J, Bottle A, Tekkis PP, Clark SK, Darzi AW, Aylin P: Nonelective excisional colorectal surgery in English National Health Service trusts: a study of outcomes from Hospital Episode Statistics data between 1996 and 2007. J Am Coll Surg. 2010, 210 (4): 390-401.CrossRefPubMed
41.
Ingraham AM, Cohen ME, Raval MV, Ko CY, Nathens AB: Comparison of hospital performance in emergency versus elective general surgery operations at 198 hospitals. J Am Coll Surg. 2011, 212 (1): 20-28 e21.CrossRefPubMed
42.
Lilford R, Pronovost P: Using hospital mortality rates to judge hospital performance: a bad idea that just won’t go away. BMJ. 2010, 340: c2016.CrossRefPubMed
43.
Mohammed MA, Deeks JJ, Girling A, Rudge G, Carmalt M, Stevens AJ, Lilford RJ: Evidence of methodological bias in hospital standardised mortality ratios: retrospective database study of English hospitals. BMJ. 2009, 338: b780.CrossRefPubMedPubMedCentral
44.
Almoudaris AM, Burns EM, Bottle A, Aylin P, Darzi A, Vincent C, Faiz O: Single measures of performance do not reflect overall institutional quality in colorectal cancer surgery. Gut. 2012, 62 (3): 423-429.CrossRefPubMed
45.
Campbell SE, Campbell MK, Grimshaw JM, Walker AE: A systematic review of discharge coding accuracy. J Public Health Med. 2001, 23 (3): 205-211.CrossRefPubMed
46.
Burns EM, Rigby E, Mamidanna R, Bottle A, Aylin P, Ziprin P, Faiz OD: Systematic review of discharge coding accuracy. Journal of Public Health (Oxf). 2012, 34 (1): 138-148.CrossRef
47.
Shahian DM, Wolf RE, Iezzoni LI, Kirle L, Normand S-LT: Variability in the Measurement of Hospital-wide Mortality Rates. N Eng J Med. 2010, 363 (26): 2530-2539.CrossRef
48.
Bottle A, Jarman B, Aylin P: Hospital standardized mortality ratios: Sensitivity analyses on the impact of coding. Health Serv Res. 2011, 46 (6 PART 1): 1741-1761.CrossRefPubMedPubMedCentral
49.
Wilson R, Goodacre SW, Klingbajl M, Kelly A-M, Rainer T, Coats T, Holloway V, Townend W, Crane S: Evaluation of the DAVROS (Development And Validation of Risk-adjusted Outcomes for Systems of emergency care) risk-adjustment model as a quality indicator for healthcare. Emerg Med J. 2014, 31 (6): 471-475.CrossRefPubMed
50.
Almoudaris AM, Burns EM, Bottle A, Aylin P, Darzi A, Faiz O: A colorectal perspective on voluntary submission of outcome data to clinical registries. Br J Surg. 2010, 98 (1): 132-139.CrossRefPubMed
51.
Drye EE, Normand SLT, Wang Y, Ross JS, Schreiner GC, Han L, Rapp M, Krumholz HM: Comparison of hospital risk-standardized mortality rates calculated by using in-hospital and 30-day models: An observational study with implications for hospital profiling. Ann Intern Med. 2012, 156 (1): 19-26.CrossRefPubMedPubMedCentral
52.
53.
Borzecki AM, Christiansen CL, Chew P, Loveland S, Rosen AK: Comparison of in-hospital versus 30-day mortality assessments for selected medical conditions. Med Care. 2010, 48 (12): 1117-1121.CrossRefPubMed
54.
Garout M, Tilney H, Tekkis P, Aylin P: Comparison of administrative data with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) colorectal cancer database. Int J Colorectal Dis. 2008, 23 (2): 155-163.CrossRefPubMed
55.
Aylin P, Lees T, Baker S, Prytherch D, Ashley S: Descriptive study comparing routine hospital administrative data with the Vascular Society of Great Britain and Ireland's National Vascular Database. Eur J Vasc Endovasc Surg. 2007, 33 (4): 461-465.CrossRefPubMed
56.
57.
Bottle A, Aylin P: Comorbidity scores for administrative data benefited from adaptation to local coding and diagnostic practices. J Clin Epidemiol. 2011, 64 (12): 1426-1433.CrossRefPubMed
Metadata
Title
Variations and inter-relationship in outcome from emergency admissions in England: a retrospective analysis of Hospital Episode Statistics from 2005–2010
Authors
Peter James Edward Holt
Sidhartha Sinha
Baris Ata Ozdemir
Alan Karthikesalingam
Jan Dominik Poloniecki
Matt Merfyn Thompson
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-14-270

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