Clinical investigations: Outcomes, health policy, and managed careImpact of the choice of benchmark on the conclusions of hospital report cards☆
Section snippets
Data sources
Data consisted of patients discharged from hospital with a most responsible diagnosis of AMI (International Classification of Disease 9th Revision, [ICD-9] code 410) between April 1, 2000, and March 31, 2001, in Ontario, Canada. The creation of the Ontario Myocardial Infarction Database (OMID), a linked population-based administrative database is described elsewhere.9
Adjustments for differences in case mix were done using the Ontario AMI mortality prediction rule for 30-day mortality.10 The
Results
The data consisted of 19,585 patients with an AMI admitted to 163 hospitals. The number of teaching, large, medium, and small hospitals was 14 (8.6%), 21 (12.9%), 51 (31.3%), and 77 (47.2%), respectively. Eight hospitals (4.9%) had cardiac revascularization facilities. The mean and median percentage of patients cared for by cardiologists was 13.7% and 0%, respectively (interquartile range: 0% to 0%). The mean and median percentage of patients cared for by general internists was 24.7% and 2.2%,
Discussion
Report cards are being published with increasing frequency in order to enhance accountability and improve quality. These reports adjust for patient characteristics so that providers treating sicker patients are not unfairly penalized. After adjusting only for patient characteristics, 7 hospitals had significantly different mortality compared to an average-mortality hospital. However, after adjusting for peer group, only 1 hospital was identified as having significantly decreased mortality
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2022, BMC Health Services Research
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Financial support for this study was provided in part by a grant from the Canadian Institutes for Health Research (CIHR). The funding agreement ensured the authors' independence in designing the study, interpreting the data, writing and publishing the report. The Institute for Clinical Evaluative Sciences is supported in part by a grant from the Ontario Ministry of Health and Long Term Care. The opinions, results and conclusions are those of the authors and no endorsement by the Ministry of Health and Long-Term Care or by the Institute for Clinical Evaluative Sciences is intended or should be inferred. Dr. Austin is supported by a New Investigator Award from the CIHR. Dr. Tu is supported by a Canada Research Chair in Health Services Research. Dr. Alter is supported by a New Investigator Award from the CIHR and Heart and Stroke Foundation of Canada.