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Short Term Survival...
Short Term Survival after Admission for Heart Failure in Sweden : Applying Multilevel Analyses of Discriminatory Accuracy to Evaluate Institutional Performance
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- Ghith, Nermin M (author)
- Lund University,Lunds universitet,Socialepidemiologi,Forskargrupper vid Lunds universitet,Social Epidemiology,Lund University Research Groups,Copenhagen University Hospital,Lund Univ, Fac Med, Unit Social Epidemiol, Malmo, Sweden.;Bispebjerg Hosp, Res Unit Chron Condit, Copenhagen, Denmark.
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- Wagner, Philippe (author)
- Uppsala University,Lund University,Lunds universitet,Uppsala universitet,Centrum för klinisk forskning, Västerås,Lund Univ, Fac Med, Unit Social Epidemiol, Malmo, Sweden.,Socialepidemiologi,Forskargrupper vid Lunds universitet,Social Epidemiology,Lund University Research Groups
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- Frolich, Anne (author)
- Bispebjerg Hosp, Res Unit Chron Condit, Copenhagen, Denmark.,Copenhagen University Hospital
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- Merlo, Juan (author)
- Lund University,Lunds universitet,Socialepidemiologi,Forskargrupper vid Lunds universitet,Social Epidemiology,Lund University Research Groups,Lund Univ, Fac Med, Unit Social Epidemiol, Malmo, Sweden.
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(creator_code:org_t)
- 2016-02-03
- 2016
- English.
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:2
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Abstract
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- Background Hospital performance is frequently evaluated by analyzing differences between hospital averages in some quality indicators. The results are often expressed as quality charts of hospital variance (e.g., league tables, funnel plots). However, those analyses seldom consider patients heterogeneity around averages, which is of fundamental relevance for a correct evaluation. Therefore, we apply an innovative methodology based on measures of components of variance and discriminatory accuracy to analyze 30-day mortality after hospital discharge with a diagnosis of Heart Failure (HF) in Sweden. Methods We analyzed 36,943 patients aged 45-80 treated in 565 wards at 71 hospitals during 2007-2009. We applied single and multilevel logistic regression analyses to calculate the odds ratios and the area under the receiver-operating characteristic (AUC). We evaluated general hospital and ward effects by quantifying the intra-class correlation coefficient (ICC) and the increment in the AUC obtained by adding random effects in a multilevel regression analysis (MLRA). Finally, the Odds Ratios (ORs) for specific ward and hospital characteristics were interpreted jointly with the proportional change in variance (PCV) and the proportion of ORs in the opposite direction (POOR). Findings Overall, the average 30-day mortality was 9%. Using only patient information on age and previous hospitalizations for different diseases we obtained an AUC = 0.727. This value was almost unchanged when adding sex, country of birth as well as hospitals and wards levels. Average mortality was higher in small wards and municipal hospitals but the POOR values were 15% and 16% respectively. Conclusions Swedish wards and hospitals in general performed homogeneously well, resulting in a low 30-day mortality rate after HF. In our study, knowledge on a patient's previous hospitalizations was the best predictor of 30-day mortality, and this information did not improve by knowing the sex and country of birth of the patient or where the patient was treated.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
Publication and Content Type
- ref (subject category)
- art (subject category)
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