Evidence map›Paper›PMID 37670336›Full record

ArticleBMC health services research2023

Standardized mortality ratios for regionalized acute cardiovascular care.

Sanne J den Hartog, Bob Roozenbeek, Sjoukje van der Bij, Marzyeh Amini, Nikki van Leeuwen, Eric Boersma, Clemens M F Dirven, Diederik W J Dippel, Hester F Lingsma

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.4field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 4 citations in OpenAlex.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

Sanne J den HartogDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. s.denhartog@erasmusmc.nl.
Bob RoozenbeekDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Sjoukje van der BijDutch Hospital Data, Utrecht, The Netherlands.
Marzyeh AminiDepartment of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Nikki van LeeuwenDepartment of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Eric BoersmaDepartment of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Clemens M F DirvenDepartment of Neurosurgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Diederik W J DippelDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Hester F LingsmaDepartment of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Erasmus MC · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundStandardized Mortality Ratios (SMRs) are case-mix adjusted mortality rates per hospital and are used to evaluate quality of care. However, acute care is increasingly organized on a regional level, with more severe patients admitted to specialized hospitals. We hypothesize that the current case-mix adjustment insufficiently captures differences in case-mix between non-specialized and specialized hospitals. We aim to improve the SMR by adding proxies of disease severity to the model and by calculating a regional SMR (RSMR) for acute cerebrovascular disease (CVD) and myocardial infarction (MI).

methodsWe used data from the Dutch National Basic Registration of Hospital Care. We selected all admissions from 2016 to 2018. SMRs and RSMRs were calculated by dividing the observed in-hospital mortality by the expected in-hospital mortality. The expected in-hospital mortality was calculated using logistic regression with adjustment for age, sex, socioeconomic status, severity of main diagnosis, urgency of admission, Charlson comorbidity index, place of residence before admission, month/year of admission, and in-hospital mortality as outcome.

resultsThe IQR of hospital SMRs of CVD was 0.85-1.10, median 0.94, with higher SMRs for specialized hospitals (median 1.12, IQR 1.00-1.28, 71%-SMR > 1) than for non-specialized hospitals (median 0.92, IQR 0.82-1.07, 32%-SMR > 1). The IQR of RSMRs was 0.92-1.09, median 1.00. The IQR of hospital SMRs of MI was 0.76-1.14, median 0.98, with higher SMRs for specialized hospitals (median 1.00, IQR 0.89-1.25, 50%-SMR > 1 versus median 0.94, IQR 0.74-1.11, 44%-SMR > 1). The IQR of RSMRs was 0.90-1.08, median 1.00. Adjustment for proxies of disease severity mostly led to lower SMRs of specialized hospitals.

conclusionSMRs of acute regionally organized diseases do not only measure differences in quality of care between hospitals, but merely measure differences in case-mix between hospitals. Although the addition of proxies of disease severity improves the model to calculate SMRs, real disease severity scores would be preferred. However, such scores are not available in administrative data. As a consequence, the usefulness of the current SMR as quality indicator is very limited. RSMRs are potentially more useful, since they fit regional organization and might be a more valid representation of quality of care.

Indexed as

Myocardial InfarctionHospitalizationHospital MortalityHospitalsHospitals, SpecialHumansCardiovascular careQuality indicatorsQuality of care

Identifiers

PMID37670336
PMCPMC10481617
OpenAlexW4386461559

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.