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Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database

Overview of attention for article published in BMC Health Services Research, February 2018
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7 X users

Citations

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138 Dimensions

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182 Mendeley
Title
Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database
Published in
BMC Health Services Research, February 2018
DOI 10.1186/s12913-018-2916-1
Pubmed ID
Authors

Hester F. Lingsma, Alex Bottle, Steve Middleton, Job Kievit, Ewout W. Steyerberg, Perla J. Marang-van de Mheen

Abstract

Hospital mortality, readmission and length of stay (LOS) are commonly used measures for quality of care. We aimed to disentangle the correlations between these interrelated measures and propose a new way of combining them to evaluate the quality of hospital care. We analyzed administrative data from the Global Comparators Project from 26 hospitals on patients discharged between 2007 and 2012. We correlated standardized and risk-adjusted hospital outcomes on mortality, readmission and long LOS. We constructed a composite measure with 5 levels, based on literature review and expert advice, from survival without readmission and normal LOS (best) to mortality (worst outcome). This composite measure was analyzed using ordinal regression, to obtain a standardized outcome measure to compare hospitals. Overall, we observed a 3.1% mortality rate, 7.8% readmission rate (in survivors) and 20.8% long LOS rate among 4,327,105 admissions. Mortality and LOS were correlated at the patient and the hospital level. A patient in the upper quartile LOS had higher odds of mortality (odds ratio = 1.45, 95% confidence interval 1.43-1.47) than those in the lowest quartile. Hospitals with a high standardized mortality had higher proportions of long LOS (r = 0.79, p < 0.01). Readmission rates did not correlate with either mortality or long LOS rates. The interquartile range of the standardized ordinal composite outcome was 74-117. The composite outcome had similar or better reliability in ranking hospitals than individual outcomes. Correlations between different outcome measures are complex and differ between hospital- and patient-level. The proposed composite measure combines three outcomes in an ordinal fashion for a more comprehensive and reliable view of hospital performance than its component indicators.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 182 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 182 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 28 15%
Researcher 25 14%
Student > Bachelor 15 8%
Student > Postgraduate 13 7%
Other 11 6%
Other 26 14%
Unknown 64 35%
Readers by discipline Count As %
Medicine and Dentistry 40 22%
Nursing and Health Professions 17 9%
Business, Management and Accounting 8 4%
Computer Science 7 4%
Social Sciences 5 3%
Other 26 14%
Unknown 79 43%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 December 2022.
All research outputs
#7,363,401
of 26,526,336 outputs
Outputs from BMC Health Services Research
#3,441
of 8,959 outputs
Outputs of similar age
#138,380
of 462,371 outputs
Outputs of similar age from BMC Health Services Research
#101
of 188 outputs
Altmetric has tracked 26,526,336 research outputs across all sources so far. This one has received more attention than most of these and is in the 72nd percentile.
So far Altmetric has tracked 8,959 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 8.4. This one has gotten more attention than average, scoring higher than 61% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 462,371 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 69% of its contemporaries.
We're also able to compare this research output to 188 others from the same source and published within six weeks on either side of this one. This one is in the 46th percentile – i.e., 46% of its contemporaries scored the same or lower than it.