Abstract
ObjectivesTo develop a model of in-hospital mortality using medical record front page (MRFP) data and assess its validity in case-mix standardisation by comparison with a model developed using the complete medical record data.DesignA nationally representative retrospective study.SettingRepresentative hospitals in China, covering 161 hospitals in modelling cohort and 156 hospitals in validation cohort.ParticipantsRepresentative patients admitted for acute myocardial infarction. 8370 patients in modelling cohort and 9704 patients in validation cohort.Primary outcome measuresIn-hospital mortality, which was defined explicitly as death that occurred during hospitalisation, and the hospital-level risk standardised mortality rate (RSMR).ResultsA total of 14 variables were included in the model predicting in-hospital mortality based on MRFP data, with the area under receiver operating characteristic curve of 0.78 among modelling cohort and 0.79 among validation cohort. The median of absolute difference between the hospital RSMR predicted by hierarchical generalised linear models established based on MRFP data and complete medical record data, which was built as ‘reference model’, was 0.08% (10th and 90th percentiles: −1.8% and 1.6%). In the regression model comparing the RSMR between two models, the slope and intercept of the regression equation is 0.90 and 0.007 in modelling cohort, while 0.85 and 0.010 in validation cohort, which indicated that the evaluation capability from two models were very similar.ConclusionsThe models based on MRFP data showed good discrimination and calibration capability, as well as similar risk prediction effect in comparison with the model based on complete medical record data, which proved that MRFP data could be suitable for risk adjustment in hospital performance measurement.
Funder
the 111 Project from the Ministry of Education of China
the National Key Technology R&D Program from the Ministry of Science and Technology of China
the Chinese Academy of Medical Sciences Innovation Fund for Medical Science
the National Key Research and Development Program from the Ministry of Science and Technology of China
Reference21 articles.
1. General Office of the State Council of the People’s Republic of China . Opinions of the general office of the state council on strengthening the performance evaluation of public hospitals, 2019.
2. National Health Commission . Measures for medical quality management. secondary measures for medical quality management, 2016. Available: http://www.nhc.gov.cn/fzs/s3576/201610/ae125f28eef24ca7aac57c8ec530c6d2.shtml
3. Li X , Krumholz HM . What does it take to improve nationwide healthcare quality in China? BMJ Qual Saf 2019;379:bmjqs-2019-009839. doi:10.1136/bmjqs-2019-009839
4. Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system
5. Department of Medical Management of the Ministry of Health . Notice on the pilot project of direct reporting of medical service supervision information network, 2011.
Cited by
4 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献