Ranking hospitals according to acute myocardial infarction mortality: should transfers be included?

摘要: Objective: The objective of this population-based observational cohort study was to estimate the extent which inclusion/ exclusion transferred patients with acute myocardial infarction (AMI) impacts on hospital performance rankings. Subjects: authors studied 91,633 adult admitted 116 care hospitals in Quebec, Canada, a primary diagnosis AMI between 1992 and 1999. Main Outcome Measure: Hospital ranks, based 30-day mortality rates, were estimated hierarchical models compared using 3 different methods for handling (exclude all transfers; include transfers assign outcome referring hospital; receiving hospital). explanatory variable interest patient's attributed. Results: Using methods, 4 ranked "best performers" once, 1 among best 2 analyses performed. Nine "worst at least once (4 "worst" only, twice, consistently analyses). There significant variation rates hospitals, difference highest lowest ranking exceeded clinically relevant benchmark 1%. Conclusions: Performance evaluation studies that compare typically exclude patients. However, used deal patient influenced ranks when comparing rates. Excluding may lead an inaccurate depiction quality healthcare services regionalized systems call timely interhospital transfer AMI.