Cristin-resultat-ID: 1251311
Sist endret: 2. februar 2016 14:18
NVI-rapporteringsår: 2015
Resultat
Vitenskapelig artikkel
2015

Survival curves to support quality improvement in hospitals with excess 30-day mortality after acute myocardial infarction, cerebral stroke and hip fracture: A before-after study

Bidragsytere:
  • Doris Tove Kristoffersen
  • Jon Helgeland
  • Halfrid Waage
  • Jacob Thalamus
  • Dirk Clemens
  • Anja Schou Lindman
  • mfl.

Tidsskrift

BMJ Open
ISSN 2044-6055
e-ISSN 2044-6055
NVI-nivå 1

Om resultatet

Vitenskapelig artikkel
Publiseringsår: 2015
Volum: 5
Hefte: 3
Artikkelnummer: e006741
Open Access

Importkilder

Scopus-ID: 2-s2.0-84926432175

Beskrivelse Beskrivelse

Tittel

Survival curves to support quality improvement in hospitals with excess 30-day mortality after acute myocardial infarction, cerebral stroke and hip fracture: A before-after study

Sammendrag

Objectives To evaluate survival curves (Kaplan-Meier) as a means of identifying areas in the clinical pathway amenable to quality improvement. Design Observational before–after study. Setting In Norway, annual public reporting of nationwide 30-day in-and-out-of-hospital mortality (30D) for three medical conditions started in 2011: first time acute myocardial infarction (AMI), stroke and hip fracture; reported for 2009. 12 of 61 hospitals had statistically significant lower/higher mortality compared with the hospital mean. Participants Three hospitals with significantly higher mortality requested detailed analyses for quality improvement purposes: Telemark Hospital Trust Skien (AMI and stroke), Østfold Hospital Trust Fredrikstad (stroke), Innlandet Hospital Trust Gjøvik (hip fracture). Outcome measures Survival curves, crude and risk-adjusted 30D before (2008–2009) and after (2012–2013). Interventions Unadjusted survival curves for the outlier hospitals were compared to curves based on pooled data from the other hospitals for the 30-day period 2008–2009. For patients admitted with AMI (Skien), stroke (Fredrikstad) and hip fracture (Gjøvik), the curves suggested increased mortality from the initial part of the clinical pathway. For stroke (Skien), increased mortality appeared after about 8 days. The curve profiles were thought to reflect suboptimal care in various phases in the clinical pathway. This informed improvement efforts. Results For 2008–2009, hospital-specific curves differed from other hospitals: borderline significant for AMI (p=0.064), highly significant (p≤0.005) for the remainder. After intervention, no difference was found (p>0.188). Before–after comparison of the curves within each hospital revealed a significant change for Fredrikstad (p=0.006). For the three hospitals, crude 30D declined and they were non-outliers for risk-adjusted 30D for 2013. Conclusions Survival curves as a supplement to 30D may be useful for identifying suboptimal care in the clinical pathway, and thus informing design of quality improvement projects.

Bidragsytere

Doris Tove Kristoffersen

  • Tilknyttet:
    Forfatter
    ved Avdeling for forskning og analyse av helsetjenesten ved Folkehelseinstituttet

Jon Helgeland

  • Tilknyttet:
    Forfatter
    ved Avdeling for forskning og analyse av helsetjenesten ved Folkehelseinstituttet

Halfrid Waage

  • Tilknyttet:
    Forfatter
    ved Sykehuset Telemark HF

Jacob Thalamus

  • Tilknyttet:
    Forfatter
    ved Medisinsk klinikk ved Sykehuset Telemark HF

Dirk Clemens

  • Tilknyttet:
    Forfatter
    ved Div Gjøvik ved Sykehuset Innlandet HF
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