Global comparators project: international comparison of hospital outcomes using administrative data

Abstract

Objective: To produce comparable risk-adjusted outcome rates for an international sample of hospitals in a collaborative project to share outcomes and learning.

Data sources: Administrative data varying in scope, format, and coding systems were pooled from each participating hospital for the years 2005-2010.

Study design: Following reconciliation of the different coding systems in the various countries, in-hospital mortality, unplanned readmission within 30 days, and "prolonged" hospital stay (>75th percentile) were risk-adjusted via logistic regression. A web-based interface was created to facilitate outcomes analysis for individual medical centers and enable peer comparisons. Small groups of clinicians are now exploring the potential reasons for variations in outcomes in their specialty.

Principal findings: There were 6,737,211 inpatient records, including 214,622 in-hospital deaths. Although diagnostic coding depth varied appreciably by country, comorbidity weights were broadly comparable. U.S. hospitals generally had the lowest mortality rates, shortest stays, and highest readmission rates.

Conclusions: Intercountry differences in outcomes may result from differences in the quality of care or in practice patterns driven by socio-economic factors. Carefully managed administrative data can be an effective resource for initiating dialog between hospitals within and across countries. Inclusion of important outcomes beyond hospital discharge would increase the value of these analyses.

Keywords: Administrative data; hospitals; quality of care.

Figure 1

Screenshot of Opening Page of Project Tool, Summarizing the Participant Hospital's Outcome Measures by Patient Group. (Red bells indicate significantly poorer than average and green bells significantly better than average performance on the given measure; split-color bells show that performance changed over the time period. White means not significantly different from the average)

Figure 2

Funnel Plot for AMI Mortality for 2008–2010 from Web Tool, with Hospitals in each of the three Country Groups in Different Colors (England in dark purple, United States in blue, the rest in yellow)