Do Reduced Hospital Mortality Rates Lead to Increased Utilization of Inpatient Emergency Care?

A Population-Based Cohort Study

Mauro Laudicella, Stephen Martin, Paolo Li Donni, Peter C Smith

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

OBJECTIVES: To measure the impact of the improvement in hospital survival rates on patients' subsequent utilization of unplanned (emergency) admissions.

DATA SOURCES/STUDY SETTING: Unplanned admissions occurring in all acute hospitals of the National Health Service in England between 2000 and 2009, including 286,027 hip fractures, 375,880 AMI, 387,761 strokes, and 9,966,246 any cause admissions.

STUDY DESIGN: Population-based retrospective cohort study. Unplanned admissions experienced by patients within 28 days, 1 year, and 2 years of discharge from the index admission are modeled as a function of hospital risk-adjusted survival rates using patient-level probit and negative binomial models. Identification is also supported by an instrumental variable approach and placebo test.

PRINCIPAL FINDINGS: The improvement in hospital survival rates that occurred between 2000 and 2009 explains 37.3 percent of the total increment in unplanned admissions observed over the same period. One extra patient surviving increases the expected number of subsequent admissions occurring within 1 year from discharge by 1.9 admissions for every 100 index admissions (0.019 per admission, 95% CI, 0.016-0.022). Similar results in hip fracture (0.006[0.004-0.007]), AMI (0.006[0.04-0.007]), and stroke (0.004(0.003-0.005)).

CONCLUSIONS: The success of hospitals in improving survival from unplanned admissions can be an important contributory factor to the increase in subsequent admissions.

OriginalsprogEngelsk
TidsskriftHealth Services Research
Vol/bind53
Udgave nummer4
Sider (fra-til)2324-2345
ISSN0017-9124
DOI
StatusUdgivet - aug. 2018
Udgivet eksterntJa

Fingeraftryk

Emergency Medical Services
Hospital Mortality
Inpatients
Cohort Studies
Survival Rate
Population
Patient Admission
National Health Programs
Statistical Models
England
Emergencies
Retrospective Studies
Placebos

Citer dette

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title = "Do Reduced Hospital Mortality Rates Lead to Increased Utilization of Inpatient Emergency Care?: A Population-Based Cohort Study",
abstract = "OBJECTIVES: To measure the impact of the improvement in hospital survival rates on patients' subsequent utilization of unplanned (emergency) admissions.DATA SOURCES/STUDY SETTING: Unplanned admissions occurring in all acute hospitals of the National Health Service in England between 2000 and 2009, including 286,027 hip fractures, 375,880 AMI, 387,761 strokes, and 9,966,246 any cause admissions.STUDY DESIGN: Population-based retrospective cohort study. Unplanned admissions experienced by patients within 28 days, 1 year, and 2 years of discharge from the index admission are modeled as a function of hospital risk-adjusted survival rates using patient-level probit and negative binomial models. Identification is also supported by an instrumental variable approach and placebo test.PRINCIPAL FINDINGS: The improvement in hospital survival rates that occurred between 2000 and 2009 explains 37.3 percent of the total increment in unplanned admissions observed over the same period. One extra patient surviving increases the expected number of subsequent admissions occurring within 1 year from discharge by 1.9 admissions for every 100 index admissions (0.019 per admission, 95{\%} CI, 0.016-0.022). Similar results in hip fracture (0.006[0.004-0.007]), AMI (0.006[0.04-0.007]), and stroke (0.004(0.003-0.005)).CONCLUSIONS: The success of hospitals in improving survival from unplanned admissions can be an important contributory factor to the increase in subsequent admissions.",
keywords = "Risk adjustment for resource use or payment, health care costs, hospitals, quality of care/patient safety (measurement)",
author = "Mauro Laudicella and Stephen Martin and {Li Donni}, Paolo and Smith, {Peter C}",
note = "{\circledC} 2017 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.",
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doi = "10.1111/1475-6773.12755",
language = "English",
volume = "53",
pages = "2324--2345",
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Do Reduced Hospital Mortality Rates Lead to Increased Utilization of Inpatient Emergency Care? A Population-Based Cohort Study. / Laudicella, Mauro; Martin, Stephen; Li Donni, Paolo; Smith, Peter C.

I: Health Services Research, Bind 53, Nr. 4, 08.2018, s. 2324-2345.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Do Reduced Hospital Mortality Rates Lead to Increased Utilization of Inpatient Emergency Care?

T2 - A Population-Based Cohort Study

AU - Laudicella, Mauro

AU - Martin, Stephen

AU - Li Donni, Paolo

AU - Smith, Peter C

N1 - © 2017 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.

PY - 2018/8

Y1 - 2018/8

N2 - OBJECTIVES: To measure the impact of the improvement in hospital survival rates on patients' subsequent utilization of unplanned (emergency) admissions.DATA SOURCES/STUDY SETTING: Unplanned admissions occurring in all acute hospitals of the National Health Service in England between 2000 and 2009, including 286,027 hip fractures, 375,880 AMI, 387,761 strokes, and 9,966,246 any cause admissions.STUDY DESIGN: Population-based retrospective cohort study. Unplanned admissions experienced by patients within 28 days, 1 year, and 2 years of discharge from the index admission are modeled as a function of hospital risk-adjusted survival rates using patient-level probit and negative binomial models. Identification is also supported by an instrumental variable approach and placebo test.PRINCIPAL FINDINGS: The improvement in hospital survival rates that occurred between 2000 and 2009 explains 37.3 percent of the total increment in unplanned admissions observed over the same period. One extra patient surviving increases the expected number of subsequent admissions occurring within 1 year from discharge by 1.9 admissions for every 100 index admissions (0.019 per admission, 95% CI, 0.016-0.022). Similar results in hip fracture (0.006[0.004-0.007]), AMI (0.006[0.04-0.007]), and stroke (0.004(0.003-0.005)).CONCLUSIONS: The success of hospitals in improving survival from unplanned admissions can be an important contributory factor to the increase in subsequent admissions.

AB - OBJECTIVES: To measure the impact of the improvement in hospital survival rates on patients' subsequent utilization of unplanned (emergency) admissions.DATA SOURCES/STUDY SETTING: Unplanned admissions occurring in all acute hospitals of the National Health Service in England between 2000 and 2009, including 286,027 hip fractures, 375,880 AMI, 387,761 strokes, and 9,966,246 any cause admissions.STUDY DESIGN: Population-based retrospective cohort study. Unplanned admissions experienced by patients within 28 days, 1 year, and 2 years of discharge from the index admission are modeled as a function of hospital risk-adjusted survival rates using patient-level probit and negative binomial models. Identification is also supported by an instrumental variable approach and placebo test.PRINCIPAL FINDINGS: The improvement in hospital survival rates that occurred between 2000 and 2009 explains 37.3 percent of the total increment in unplanned admissions observed over the same period. One extra patient surviving increases the expected number of subsequent admissions occurring within 1 year from discharge by 1.9 admissions for every 100 index admissions (0.019 per admission, 95% CI, 0.016-0.022). Similar results in hip fracture (0.006[0.004-0.007]), AMI (0.006[0.04-0.007]), and stroke (0.004(0.003-0.005)).CONCLUSIONS: The success of hospitals in improving survival from unplanned admissions can be an important contributory factor to the increase in subsequent admissions.

KW - Risk adjustment for resource use or payment

KW - health care costs

KW - hospitals

KW - quality of care/patient safety (measurement)

U2 - 10.1111/1475-6773.12755

DO - 10.1111/1475-6773.12755

M3 - Journal article

VL - 53

SP - 2324

EP - 2345

JO - Health Services Research

JF - Health Services Research

SN - 0017-9124

IS - 4

ER -