Determinants of between-hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit (AUDIPOC) in Spain.

摘要: Summary Background Previous studies have demonstrated significant variability in the processes of care and outcomes chronic obstructive pulmonary disease (COPD) exacerbations. The AUDIPOC is a Spanish nationwide clinical audit that identified large between-hospital variations outcomes. Here, we test hypothesis these can be attributed to either patient characteristics, hospital characteristics and/or so-called hospital-clustering effect, which indicates patients with similar may experience different depending on they are admitted. Methods A 5178 COPD consecutively admitted 129 public hospitals was performed, 90-day follow-up. Multilevel regression analysis conducted model probability experiencing adverse For each outcome, an empty (with no independent variables) fitted assess clustering followed by adjusted for patient- hospital-level covariables. effect estimated using intracluster correlation coefficient (ICC); cluster heterogeneity median odds ratio (MOR), coefficients predictors were (OR). Results In models, ICC (MOR) inpatient mortality follow-up readmission 0.10 (1.80), 0.08 (1.65) 0.01 (1.24), respectively. In variables most represented patients’ conditions interventions as outcome further reduced variations. By contrast, resource factors primarily unrelated outcomes. Conclusions This study demonstrates noteworthy reduction observed crude variation after accounting hospital-cluster representing patient's conditions. This emphasises predictor importance interventions, understates impacts resources organisational factors.