利用关联数据评估将院外死亡纳入 30 天住院死亡率指标的影响：一项回顾性队列研究。

Use of linked data to assess the impact of including out-of-hospital deaths on 30-day in-hospital mortality indicators: a retrospective cohort study.

机构信息

Canadian Institute for Health Information (Syrowatka, Li, Gu, Yin, Rice, Gurevich), Ottawa/Toronto, Ont.; Division of General Internal Medicine (Syrowatka), Brigham and Women's Hospital, Boston, Mass.; Harvard Medical School (Syrowatka), Boston, Mass.; Department of Psychology (Rice), McGill University, Montreal, Que.

出版信息

CMAJ Open. 2022 Oct 11;10(4):E882-E888. doi: 10.9778/cmajo.20210264. Print 2022 Sep-Oct.

DOI:10.9778/cmajo.20210264

PMID:36220181

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9578748/

Abstract

BACKGROUND

The Canadian Institute for Health Information (CIHI) annually reports on health system performance indicators, including various 30-day in-hospital mortality rates. We aimed to assess the impact of including out-of-hospital deaths on 3 CIHI indicators: 30-day acute myocardial infarction (AMI) in-hospital mortality, 30-day stroke in-hospital mortality and hospital deaths following major surgery.

METHODS

We followed national cohorts of patients admitted to hospital in 1 of 9 Canadian provinces for AMI, stroke and major surgery for 30-day all-cause mortality in 2 fiscal years (2011/12 and 2016/17). We calculated descriptive statistics to characterize the cohorts. The CIHI Discharge Abstract Database was linked with the Canadian Vital Statistics Death Database using a probabilistic algorithm to identify out-of-hospital deaths. We calculated absolute numbers, relative proportions and 30-day mortality rates for in-hospital, out-of-hospital and all deaths. We compared results between fiscal years.

RESULTS

We found that hospital admissions increased between fiscal years for each indicator; however, cohort characteristics remained consistent. In 2016/17, the number of out-of-hospital deaths that occurred was 325 for AMI, 545 for stroke and 820 for major surgery. The relative proportions of out-of-hospital deaths ranged from 12.3% for AMI to 14.9% for major surgery in 2016/17 (an increase from 10.6% and 13.1%, respectively, from 2011/12). In-hospital mortality rates improved over time for all 3 indicators, while out-of-hospital mortality rates remained consistent between fiscal years at 0.8% for AMI, 1.9%-2.0% for stroke and 0.2%-0.3% for major surgery.

INTERPRETATION

Improvements between fiscal years were attributable to reductions in in-hospital mortality, rather than deaths occurring outside of hospitals. Trends over time were the same for each indicator irrespective of whether in-hospital mortality or all deaths were measured.

摘要

背景

加拿大健康信息研究所（CIHI）每年报告卫生系统绩效指标，包括各种 30 天住院内死亡率。我们旨在评估将院外死亡纳入 3 个 CIHI 指标（30 天急性心肌梗死（AMI）住院内死亡率、30 天卒中住院内死亡率和主要手术后医院内死亡）的影响。

方法

我们对加拿大 9 个省的住院患者进行全国队列研究，对 AMI、卒中和主要手术患者进行 2 个财政年度（2011/12 年和 2016/17 年）的 30 天全因死亡率。我们计算了描述性统计数据以描述队列特征。使用概率算法将 CIHI 出院摘要数据库与加拿大生命统计死亡数据库相链接，以识别院外死亡。我们计算了住院内、院外和所有死亡的绝对数量、相对比例和 30 天死亡率。我们比较了财政年度之间的结果。

结果

我们发现每个指标的住院人数在财政年度之间都有所增加；然而，队列特征保持一致。在 2016/17 年，发生的院外死亡人数为 AMI 325 例、卒中 545 例和主要手术 820 例。2016/17 年，院外死亡的相对比例范围为 AMI 的 12.3%至主要手术的 14.9%（分别比 2011/12 年增加了 10.6%和 13.1%）。所有 3 个指标的住院内死亡率均随时间改善，而院外死亡率在财政年度之间保持一致，AMI 为 0.8%、卒中为 1.9%-2.0%和主要手术为 0.2%-0.3%。