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首页> 外文期刊>Zeitschrift fur Arznei- und Gewurzpflanzen >Capturing the trends in hospital standardized mortality ratios for pneumonia: a retrospective observational study in Japan (2010 to 2018)
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Capturing the trends in hospital standardized mortality ratios for pneumonia: a retrospective observational study in Japan (2010 to 2018)

机译：捕捉医院的趋势标准化肺炎的死亡率比：日本的回顾性观测研究（2010年至2018年）

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Background Pneumonia has a high human toll and a substantial economic burden in developed countries like Japan, where the crude mortality rate was 77.7 per 100,000 people in 2017. As this trend is going to continue with increasing number of the elderly multi-morbid population in Japan; monitoring performance over time is a social need to alleviate the disease burden. The study objective was to determine the characteristics of hospital standardized mortality ratios (HSMRs) for pneumonia in Japan from 2010 to 2018 to describe this trend. Methods Data of the DPC (Diagnostic Procedures Combination) database were used, which is an administrative claims and discharge summary database for acute care in-patients in Japan. HSMRs were calculated using the actual and expected numbers of in-hospital deaths, the latter of which was calculated using logistic regression model, with a number of explanatory variables, e.g., age, sex, urgency of admission, mode of transportation, patient volume per month in each hospital, A-DROP score, and Charlson comorbidity index (CCI). We constructed two HSMR models: a single-year model, which included hospitals with > 10 in-patients per month and, a 9-year model, which included those hospitals with complete 9-year data. Predictive accuracy of the logistic models was assessed using c-index (area under receiver operating curve). Results Total 230,372 patients were included for the analysis over the 9-year study period. Calculated HSMRs showed wide variation among hospitals. The proportion of hospitals with HSMR less than 100 increased from 36.4% in 2010 to 60.6% in 2018. Both models showed good predictive ability with a c-statistic of 0.762 for the 9-year model, and no less than 0.717 for the single-year model. Conclusion This study denoted that HSMRs of pneumonia can be calculated using DPC data in Japan and revealed significant variations among hospitals with comparable case-mixes. Therefore, HSMR can be used as yet another measure to help improve quality of care over time if other indicators are examined in parallel and to get a clear picture of where hospitals excel and lack.
机译：背景，肺炎在日本等发达国家的人类收费和大量经济负担，2017年，原油死亡率为每10万人77.7人。由于这种趋势将继续越来越多的日本老年人多病态人口;随着时间的推移监测性能是社会需要缓解疾病负担。研究目标是从2010年到2018年确定日本肺炎的医院标准化死亡率比（HSMR）的特征来描述这一趋势。方法使用DPC（诊断程序组合）数据库的数据，这是日本急性护理的行政权利要求和排放汇总数据库。使用实际和预期的医院死亡人数来计算HSMR，其中后者使用逻辑回归模型计算，具有许多解释性变量，例如，年龄，性别，入场的紧急程度，运输方式，患者每位医院，A次分数和查理合并症指数（CCI）。我们构建了两台HSMR型号：一年的模型，包括每月> 10个患者中的医院，并为9年的模型包括完整的9年数据。使用C折射率（接收器操作曲线下的区域）评估逻辑模型的预测精度。结果在9年的研究期间，包括分析230,372名患者。计算的HSMRS在医院中显示出广泛的变化。 HSMR小于100的医院的比例从2010年的36.4％增加到2018年的36.4％至60.6％。对于9年模型的C统计而言，这两种模型都显示出良好的预测能力，单一的单一的C统计学表现为0.762，而单个年模型。结论本研究表明，肺炎的HSMR可以使用日本的DPC数据计算，并在具有可比案例混合的医院中显示出显着变化。因此，如果并行检查其他指标，可以使用HSMR作为另一个措施，以帮助改善其他指标随时间提高护理质量。

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