Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Department of Management Sciences, City University of Hong Kong, Hong Kong SAR, China.
BMC Med Res Methodol. 2022 Jul 21;22(1):197. doi: 10.1186/s12874-022-01677-8.
Linkage of public healthcare data provides powerful resources for studying from a comprehensive view of quality of care than information for a single administrative database. It is believed that positive patient experiences reflect good quality of health care and may reduce patient readmission. This study aimed to determine the relationship between patient experience and hospital readmission at a system level by linking anonymous experience survey data with de-identified longitudinal hospital administrative admissions data.
Data were obtained by linking two datasets with anonymised individual-level records from seven largest-scale acute public hospitals over seven geographical clusters in Hong Kong. Selected records in the two datasets involving patient experience survey (PES) (2013 survey dataset) and healthcare utilization (admissions dataset) were used. Following data cleaning and standardization, a deterministic data linkage algorithm was used to identify pairs of records uniquely matched for a list of identifiers (10 selected variables) between two datasets. If patient's record from the survey dataset matched with the hospitalization records in the admissions dataset, they were included in the subsequent analyses. Bivariate analyses and multivariable logistic regression models were performed to evaluate the associations between hospital readmission in the next calendar month and patient experience.
The overall matching rate was 62.1% (1746/2811) for PES participants aged 45 or above from the survey dataset. The average score for overall inpatient experience was 8.10 (SD = 1.53). There was no significant difference between matched patients and unmatched patients in terms of their score for the perception of overall quality of care received during hospitalization (X = 6.931, p-value = 0.14) and score for overall inpatient experience (X = 7.853, p-value = 0.25). In the multivariable model, readmission through the outpatient department (planned admission) in the next calendar month was significantly associated with a higher score given to the overall quality of care received (adjusted OR = 1.54, 95%CI = 1.09-2.17), while such association was absent for readmission through Accident and Emergency department (adjusted OR = 0.75, 95%CI = 0.50-1.12).
This study demonstrated the feasibility of routine record linkage, with the limited intrusion of patients' confidentiality, for evaluating health care quality. It also highlights the significant association between readmission through planned readmission and a higher score for overall quality of care received. A possible explanation might be the perceived better co-ordination between outpatient departments and inpatient service and the well-informed discharge plan given to this group of patients.
公共医疗数据的关联为从全面的角度研究医疗质量提供了强大的资源，而不仅仅是单个行政数据库的信息。人们相信积极的患者体验反映了良好的医疗质量，并可能减少患者再次入院。本研究旨在通过将匿名患者体验调查数据与去识别的纵向医院行政入院数据进行链接，确定系统层面上患者体验与医院再入院之间的关系。
通过链接两个数据集来获取数据，两个数据集的个体水平记录均来自香港七个最大规模的急性公立医疗机构的七个地理集群。使用两个数据集中涉及患者体验调查（PES）（2013 年调查数据集）和医疗保健利用（入院数据集）的选定记录。在对数据进行清理和标准化后，使用确定性数据链接算法来识别两个数据集之间的记录对列表（10 个选定变量）的唯一匹配项。如果调查数据集中患者的记录与入院数据集中的住院记录匹配，则将其纳入后续分析。进行了双变量分析和多变量逻辑回归模型分析，以评估下一个日历月的医院再入院与患者体验之间的关联。
调查数据集中年龄在 45 岁或以上的 PES 参与者的总体匹配率为 62.1%（1746/2811）。总体住院体验的平均得分为 8.10（SD=1.53）。在接受住院期间整体护理质量的感知得分（X=6.931，p 值=0.14）和总体住院体验得分（X=7.853，p 值=0.25）方面，匹配患者与不匹配患者之间没有显著差异。在多变量模型中，下一个日历月通过门诊部（计划入院）的再入院与给予整体护理质量的评分较高显著相关（调整后的 OR=1.54，95%CI=1.09-2.17），而通过急症室（急诊部）的再入院则没有这种关联（调整后的 OR=0.75，95%CI=0.50-1.12）。
本研究证明了常规记录链接的可行性，在有限侵犯患者隐私的情况下，评估医疗保健质量。它还强调了通过计划再入院和整体护理质量评分较高之间的显著关联。一种可能的解释是，门诊部和住院服务之间的协调更好，并且向这组患者提供了知情的出院计划。
