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Variations and inter-relationship in outcome from emergency admissions in England: a retrospective analysis of Hospital Episode Statistics from 2005-2010.

Holt, PJ; Sinha, S; Ozdemir, BA; Karthikesalingam, A; Poloniecki, JD; Thompson, MM (2014) Variations and inter-relationship in outcome from emergency admissions in England: a retrospective analysis of Hospital Episode Statistics from 2005-2010. BMC Health Services Research, 14 (270). ISSN 1472-6963 https://doi.org/10.1186/1472-6963-14-270
SGUL Authors: Holt, Peter James Edward Poloniecki, Jan Dominik Thompson, Matthew Merfyn Sinha, Sidhartha

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Abstract

BACKGROUND: The quality of care delivered and clinical outcomes of care are of paramount importance. Wide variations in the outcome of emergency care have been suggested, but the scale of variation, and the way in which outcomes are inter-related are poorly defined and are critical to understand how best to improve services. This study quantifies the scale of variation in three outcomes for a contemporary cohort of patients undergoing emergency medical and surgical admissions. The way in which the outcomes of different diagnoses relate to each other is investigated. METHODS: A retrospective study using the English Hospital Episode Statistics 2005-2010 with one-year follow-up for all patients with one of 20 of the commonest and highest-risk emergency medical or surgical conditions. The primary outcome was in-hospital all-cause risk-standardised mortality rate (in-RSMR). Secondary outcomes were 1-year all-cause risk-standardised mortality rate (1 yr-RSMR) and 28-day all-cause emergency readmission rate (RSRR). RESULTS: 2,406,709 adult patients underwent emergency medical or surgical admissions in the groups of interest. Clinically and statistically significant variations in outcome were observed between providers for all three outcomes (p < 0.001). For some diagnoses including heart failure, acute myocardial infarction, stroke and fractured neck of femur, more than 20% of hospitals lay above the upper 95% control limit and were statistical outliers. The risk-standardised outcomes within a given hospital for an individual diagnostic group were significantly associated with the aggregated outcome of the other clinical groups. CONCLUSIONS: Hospital-level risk-standardised outcomes for emergency admissions across a range of specialties vary considerably and cross traditional speciality boundaries. This suggests that global institutional infra-structure and processes of care influence outcomes. The implications are far reaching, both in terms of investigating performance at individual hospitals and in understanding how hospitals can learn from the best performers to improve outcomes.

Item Type: Article
Additional Information: © 2014 Holt et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Quality of Health Care [MeSH], Benchmarking [MeSH], Outcomes assessment (Health Care) [MeSH], Health services research [MeSH], Mortality [MeSH], General surgery [MeSH], Orthopaedics [MeSH], Myocardial infarction [MeSH], Stroke [MeSH], Sepsis [MeSH], Femoral neck fractures [MeSH], Science & Technology, Life Sciences & Biomedicine, Health Care Sciences & Services, QUALITY-OF-CARE, DISCHARGE CODING ACCURACY, ADMINISTRATIVE DATA, MORTALITY-RATES, HEALTH-CARE, SURGICAL OUTCOMES, GREAT-BRITAIN, CO-MORBIDITY, SURGERY, RISK, 1117 Public Health And Health Services, Health Policy & Services, 0807 Library And Information Studies
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Vascular & Cardiac Surgery (INCCVC)
Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: BMC Health Services Research
ISSN: 1472-6963
Language: eng
Dates:
DateEvent
19 June 2014Published
PubMed ID: 24947670
Web of Science ID: WOS:000339023500001
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/107234
Publisher's version: https://doi.org/10.1186/1472-6963-14-270

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