Abstract
BackgroundHospital discharge records (HDRs) are routinely used to assess outcomes of care and to compare hospital performance for heart failure. The advantages of using clinical data from medical charts to improve risk-adjustment models remain controversial. The aim of the present study was to evaluate the additional contribution of clinical variables to HDR-based 30-day mortality and readmission models in patients with heart failure.MethodsThis retrospective observational study included all patients residing in the Local Healthcare Authority of Bologna (about 1 million inhabitants) who were discharged in 2012 from one of three hospitals in the area with a diagnosis of heart failure. For each study outcome, we compared the discrimination of the two risk-adjustment models (i.e., HDR-only model and HDR-clinical model) through the area under the ROC curve (AUC).ResultsA total of 1145 and 1025 patients were included in the mortality and readmission analyses, respectively. Adding clinical data significantly improved the discrimination of the mortality model (AUC = 0.84 vs. 0.73, p < 0.001), but not the discrimination of the readmission model (AUC = 0.65 vs. 0.63, p = 0.08).ConclusionsWe identified clinical variables that significantly improved the discrimination of the HDR-only model for 30-day mortality following heart failure. By contrast, clinical variables made little contribution to the discrimination of the HDR-only model for 30-day readmission.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1731-9) contains supplementary material, which is available to authorized users.
Highlights
Hospital discharge records (HDRs) are routinely used to assess outcomes of care and to compare hospital performance for heart failure
In Italy, the National Outcome Evaluation Program (Programma Nazionale Esiti – PNE), an initiative endorsed by the National Agency for Regional Health Services (Agenzia Nazionale per i Servizi Sanitari Regionali–AGENAS) that monitors healthcare outcomes across hospitals and municipalities, routinely uses HDRs to derive hospital-specific indicators and important patient characteristics used in risk-adjustment of different patient populations [9]
None of the data on filled prescriptions were retained in the final risk-adjustment models of 30-day mortality and readmission. In this large, comprehensive, regional study of patients with Heart failure (HF) across three hospitals, our results indicate that adding specific clinical variables retrieved from medical charts significantly contributed to the discrimination of HDR-only models for 30-day mortality, but not for 30-day readmissions
Summary
Hospital discharge records (HDRs) are routinely used to assess outcomes of care and to compare hospital performance for heart failure. Especially outcomes of care, and comparing hospital performance have become important issues needed to ensure a healthcare system that is cost-effective for HF [3, 4]. To this end, statistical models to compare hospital performance across important outcomes must adjust for differences in demographic and clinical characteristics, as the case mix of patients may vary among regions and hospitals [5, 6]. In Italy, the National Outcome Evaluation Program (Programma Nazionale Esiti – PNE), an initiative endorsed by the National Agency for Regional Health Services (Agenzia Nazionale per i Servizi Sanitari Regionali–AGENAS) that monitors healthcare outcomes across hospitals and municipalities, routinely uses HDRs to derive hospital-specific indicators and important patient characteristics used in risk-adjustment of different patient populations [9]
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