000095899 001__ 95899
000095899 005__ 20210902121713.0
000095899 0247_ $$2doi$$a10.1371/journal.pone.0228425
000095899 0248_ $$2sideral$$a116831
000095899 037__ $$aART-2020-116831
000095899 041__ $$aeng
000095899 100__ $$aComendeiro-Maaløe, M.
000095899 245__ $$aAcknowledging the role of patient heterogeneity in hospital outcome reporting: Mortality after acute myocardial infarction in five European countries
000095899 260__ $$c2020
000095899 5060_ $$aAccess copy available to the general public$$fUnrestricted
000095899 5203_ $$aBackground
Hospital performance, presented as the comparison of average measurements, dismisses that hospital outcomes may vary across types of patients. We aim at drawing out the relevance of accounting for patient heterogeneity when reporting on hospital performance.
Methods
An observational study on administrative data from virtually all 2009 hospital admissions for Acute Myocardial Infarction (AMI) discharged in Denmark, Portugal, Slovenia, Spain, and Sweden. Hospital performance was proxied using in-hospital risk-adjusted mortality. Multilevel Regression Modelling (MLRM) was used to assess differences in hospital performance, comparing the estimates of random intercept modelling (capturing hospital general contextual effects (GCE)), and random slope modelling (capturing hospital contextual effects for patients with and without congestive heart failure -CHF). The weighted Kappa Index (KI) was used to assess the agreement between performance estimates.
Results
We analysed 46,875 admissions of AMI, 6,314 with coexistent CHF, discharged from 107 hospitals. The overall in-hospital mortality rate was 5.2%, ranging from 4% in Sweden to 6.9% in Portugal. The MLRM with random slope outperformed the model with only random intercept, highlighting a much higher GCE in CHF patients [VPC = 8.34 (CI95% 4.94 to 13.03) and MOR = 1.69 (CI95% 1.62 to 2.21) vs. VPC = 3.9 (CI95% 2.4 to 5.9), MOR of 1.42 (CI95% 1.31 to 1.54) without CHF]. No agreement was observed between estimates [KI = -0,02 (CI95% -0,08 to 0.04].
Conclusions
The different GCE in AMI patients with and without CHF, along with the lack of agreement in estimates, suggests that accounting for patient heterogeneity is required to adequately characterize and report on hospital performance.
000095899 536__ $$9info:eu-repo/grantAgreement/EUR/ERDF-ESF/Investing in your future$$9info:eu-repo/grantAgreement/EC/FP7/242189/EU/Improving access to health care data/ECHO$$9info:eu-repo/grantAgreement/EC/H2020/664691/EU/BRidging Information and Data Generation for Evidence-based Health policy and research/BRIDGEHealth$$9This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No H2020 664691-BRIDGEHealth$$9info:eu-repo/grantAgreement/ES/ISCIII-REDISSEC/RD16-0001-0007
000095899 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000095899 590__ $$a3.24$$b2020
000095899 591__ $$aMULTIDISCIPLINARY SCIENCES$$b26 / 73 = 0.356$$c2020$$dQ2$$eT2
000095899 592__ $$a0.99$$b2020
000095899 593__ $$aMultidisciplinary$$c2020$$dQ1
000095899 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000095899 700__ $$aEstupiñán-Romero, F.
000095899 700__ $$aThygesen, L. C.
000095899 700__ $$aMateus, C.
000095899 700__ $$aMerlo, J.
000095899 700__ $$0(orcid)0000-0002-0961-3298$$aBernal-Delgado, E.
000095899 700__ $$abehalf of the, ECHO consortium
000095899 773__ $$g15, 2 (2020), e0228425 [14 pp]$$pPLoS One$$tPloS one$$x1932-6203
000095899 8564_ $$s750680$$uhttps://zaguan.unizar.es/record/95899/files/texto_completo.pdf$$yVersión publicada
000095899 8564_ $$s440303$$uhttps://zaguan.unizar.es/record/95899/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000095899 909CO $$ooai:zaguan.unizar.es:95899$$particulos$$pdriver
000095899 951__ $$a2021-09-02-09:22:02
000095899 980__ $$aARTICLE