Article Figures & Tables
Figures
- Figure 1:
Comparison of values for observed-to-expected ratios for death or urgent readmission within 30 days determined for 162 hospitals using 4 different methods of calculation. The Spearman correlation coefficient is presented in the top left corner of each plot. The panels are aligned as rows and columns by categories.
- Figure 2:
Comparison of hospital rankings determined using 4 different methods of calculating observed-to-expected ratios for death or urgent readmission within 30 days for the 162 hospitals included in the study. The Spearman correlation coefficient is presented in the top left corner of each plot. The panels are aligned as rows and columns by categories.
Tables
Characteristic per hospital Hospital-specific average Median (IQR)* Minimum Maximum Hospital volume Annual no. of discharges 1142.8 (427.8–5192.3) 69.0 24 341.8 Patients Age, yr, mean 63.5 (60.9–67.0) 19.8 75.4 Male sex, % 46.8 (45.2–48.4) 33.7 69.0 Charlson Comorbidity Index score14 ≥ 1, % 34.4 (29.3–39.8) 10.5 62.6 Visits to emergency department in previous 6 mo, % 55.4 (46.5–63.9) 19.8 76.8 Elective admissions in previous yr, % 9.4 (8.4–11.3) 5.6 35.3 Emergent admissions in previous yr, % 32.1 (27.0–37.7) 12.9 50.1 Admissions Emergent, % 82.4 (70.2–90.0) 19.4 98.8 Length of stay, d, mean 6.0 (5.4–7.2) 2.4 16.9 Admissions with any alternate level of care, % 2.2 (1.4–3.6) 0.0 38.7 Admissions with case-mix group score‡ > 0, % 28.0 (20.7–33.2) 2.9 45.5 LACE+§ score, mean 49.0 (43.8–54.6) 18.2 63.1 Outcomes following discharge Death or urgent readmission within 30 d, % 13.2 (11.0–15.4) 4.6 20.0 Death within 30 d, % 1.9 (1.5–2.4) 0.2 4.3 Urgent readmission within 30 d, % 12.2 (10.2–14.1) 4.1 19.3 Note: IQR = interquartile range.
↵* The values are medians of percentages or means for each hospital.
↵‡ Risk of death within 30 days or unplanned readmission, independent of factors known to influence this outcome;15 higher scores indicate higher risk.
↵§ Risk of death within 30 days or unplanned readmission;11 higher scores indicate higher risk.
- Table 2:
Observed-to-expected ratios for death or urgent readmission within 30 days for the 162 hospitals included in the study, calculated using 4 different measures*
Measure Observed-to- expected ratio, mean ± SD Observed-to- expected ratio, median (range) All admissions, adjusted for patient age and sex 1.11 ± 0.21 1.10 (0.45–1.77) Single admission per patient, adjusted for patient age and sex 1.14 ± 0.23 1.13 (0.44–1.83) All admissions, adjusted for all measurable factors 0.94 ± 0.11 0.93 (0.71–1.39) Single admission per patient, adjusted for all measurable factors 0.94 ± 0.12 0.94 (0.63–1.40) Note: SD = standard deviation.
↵* The number of expected events was calculated by use of logistic regression models. Age- and sex-adjusted ratios calculated the expected number of events after adjustment for patient age and sex; completely adjusted ratios used the LACE+ model to determine the expected numbers of events.
- Table 3:
Variation in hospital-specific observed-to-expected ratios for death or urgent readmission within 30 days and their associated rankings
Variation Standardized ranges* for observed-to-expected ratios (%) Hospital rankings based on observed-to-expected ratios† Mean ± SD Median (IQR) Minimum Maximum Mean ± SD Median (IQR) Minimum Maximum Among measures within specific years 2005 32.5 ± 22.8 28 (18–42) 7 232 43.3 ± 30.0 35 (20–61) 0 143 2006 30.0 ± 18.7 29 (14–44) 2 96 52.5 ± 32.9 49 (26–74) 0 136 2007 31.8 ± 23.4 28 (14–41) 2 157 54.4 ± 33.3 48 (30–75) 3 159 2008 30.5 ± 18.7 28 (15–42) 3 80 50.8 ± 32.0 45.5 (28–68) 2 145 2009 31.9 ± 22.8 28 (17–41) 4 212 49.5 ± 31.8 42.5 (26–70) 0 151 2010 32.0 ± 23.8 27 (15–42) 1 141 47.9 ± 32.8 43 (23–68) 1 151 All years 31.5 ± 21.8 28 (16–42) 1 232 47.4 ± 32.2 43.5 (23–66) 2 148 Among years within specific measures Age-, sex-adjusted, all admissions 27.5 ± 19.7 22 (15–35) 4 154 45.2 ± 31.4 38 (22–62) 1 155 Age-, sex-adjusted, single admission/patient 49.8 ± 35.3 43 (26–66) 8 273 61.0 ± 38.7 51.5 (31–81) 1 161 Complete adjustment, all admissions 26.0 ± 18.4 21 (14–33) 3 131 62.8 ± 37.0 57 (34–87) 4 161 Complete adjustment, single admission/patient 47.8 ± 37.0 38 (24–59) 7 288 75.8 ± 40.2 72 (44–103) 3 161 Note: IQR = interquartile range, SD = standard deviation.
↵* Range in observed-to-expected ratios for readmission within each hospital as a percentage of the overall readmission ratio for that hospital. The overall ratio was calculated using a fixed-effects model that weighted observations by each ratio’s variance, which were calculated using Byar’s approximation.14
↵† The maximum range in rankings is 162 (i.e., the total number of hospitals included in the study).
- Table 4:
Comparison of hospital rankings using different measures of death or urgent readmission within 30 days
Method 1 Method 2 Ranking Weighted κ† (95% CI) Agreement among measures* Disagreement among measures (%), n = 162 Top 10%, n = 16 Middle 80%, n = 130 Bottom 10%, n = 16 Age-, sex-adjusted, all admissions Age-, sex-adjusted, single admission/ patient 13 125 13 12 (7.4) 0.79 (0.64–0.94) Complete adjustment, all admissions 6 115 11 30 (18.5) 0.62 (0.43–0.80) Complete adjustment, single admission/patient 6 114 9 34 (21.0) 0.49 (0.29–0.69) Age-, sex-adjusted, single admission/patient Complete adjustment, all admissions 7 113 8 34 (21.0) 0.44 (0.23–0.64) Complete adjustment, single admission/patient 7 115 10 30 (18.5) 0.56 (0.37–0.75) Complete adjustment, all admissions Complete adjustment, single admission/patient 9 117 9 27 (16.7) 0.51 (0.31–0.71) Note: CI = confidence interval.
↵* Determined for ranking categories (top 10%, middle 80% and bottom 10%) and the proportion of hospitals having different categorizations using the 2 methods.
↵† Presents the agreement beyond that expected by chance, taking into account the degree of disagreement between the measures.
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