Comparison of In-Hospital Versus 30-Day Mortality Assessments for Selected Medical Conditions

BACKGROUND: In-hospital mortality measures such as the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators (IQIs) are easily derived using hospital discharge abstracts and publicly available software. However, hospital assessments based on a 30-day postadmission interval might be more accurate given potential differences in facility discharge practices. OBJECTIVES: To compare in-hospital and 30-day mortality rates for 6 medical conditions using the AHRQ IQI software. METHODS: We used IQI software (v3.1) and 2004-2007 Veterans Health Administration (VA) discharge and Vital Status files to derive 4-year facility-level in-hospital and 30-day observed mortality rates and observed/expected ratios (O/Es) for admissions with a principal diagnosis of acute myocardial infarction, congestive heart failure, stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia. We standardized software-calculated O/Es to the VA population and compared O/Es and outlier status across sites using correlation, observed agreement, and kappas. RESULTS: Of 119 facilities, in-hospital versus 30-day mortality O/E correlations were generally high (median: r = 0.78; range: 0.31-0.86). Examining outlier status, observed agreement was high (median: 84.7%, 80.7%-89.1%). Kappas showed at least moderate agreement (k > 0.40) for all indicators except stroke and hip fracture (k ≤ 0.22). Across indicators, few sites changed from a high to nonoutlier or low outlier, or vice versa (median: 10, range: 7-13). CONCLUSIONS: The AHRQ IQI software can be easily adapted to generate 30-day mortality rates. Although 30-day mortality has better face validity as a hospital performance measure than in-hospital mortality, site assessments were similar despite the definition used. Thus, the measure selected for internal benchmarking should primarily depend on the healthcare system's data linkage capabilities

Confidence interval · Health care · Hip fracture · Hospital medicine · Mortality rate · Myocardial infarction · Osteoporosis · Stroke (engine) · Emergency Medicine · Heart Failure Treatment and Management · Internal Medicine · Medicine · Primary Care and Health Outcomes · Sepsis Diagnosis and Treatment

• Differences in Use of High-quality and Low-quality Hospitals Among Working-age Individuals by Insurance Type

  Irina Popescu, Ioana Popescu et al.•Medical Care•2017

  Incluir item

• Hospital Comparisons Based on Mortality

  Agathe Lamarche-Vadel, Agathe Lamarche‐Vadel et al.•Medical Care•2015

  Incluir item

• Measuring Mortality Performance

  H Joanna Jiang, Hui Jiang et al.•Medical Care•2016

  Incluir item

• Heterogeneous effects of patient choice and hospital competition on mortality

  Open Access•Giuseppe Moscelli, H Gravelle et al.•Social Science & Medicine•2018

  Incluir item

• Are Patients at Veterans Affairs Medical Centers Sicker?

  Zia Agha, Richard P Lofgren et al.•A.M.A. Archives of Internal…•2000

  Incluir item

• Mortality Trends During a Program That Publicly Reported Hospital Performance

  David W Baker, Doug Einstadter et al.•Medical Care•2002

  Incluir item