Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stay
Objectives To study between-hospital variation in mortality, readmissions and prolonged length of stay across Belgian hospitals.Design A retrospective nationwide observational study.Setting Secondary and tertiary acute-care hospitals in Belgium.Participants We studied 4 560 993 hospital stays in 99...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-01-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e082489.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Objectives To study between-hospital variation in mortality, readmissions and prolonged length of stay across Belgian hospitals.Design A retrospective nationwide observational study.Setting Secondary and tertiary acute-care hospitals in Belgium.Participants We studied 4 560 993 hospital stays in 99 (98%) Belgian acute-care hospitals between 2016 and 2018.Primary outcome measures Using generalised linear mixed models, we calculated hospital-specific and Major Diagnostic Category (MDC)-specific risk-adjusted in-hospital mortality, readmissions within 30 days and length of stay above the MDC-specific 90th percentile and assessed between-hospital variation through estimated variance components.Results There was strong evidence of between-hospital variation in mortality, readmissions and prolonged length of stay across the vast majority of patient service lines. Overall, should hospitals with upper-quartile risk-standardised rates succeed in improving to the median level, a yearly 4076 hospital deaths, 3671 readmissions and 15 787 long patient stays could potentially be avoided in those hospitals. Our analysis revealed a select set of ‘high-impact-opportunity hospitals’ characterised by poor performance across outcomes and across a large number of MDCs.Conclusions Analysis of between-hospital variation highlights important differences in patient outcomes that are not explained by known patient or hospital characteristics. Identifying ‘high-impact-opportunity hospitals’ can help government inspection bodies and hospital managers to establish targeted audits and inspections to generate effective quality improvement initiatives. |
|---|---|
| ISSN: | 2044-6055 |