Risk-Adjusted hospital mortality rates for stroke

Evidence from the Australian Stroke Clinical Registry (AuSCR)

Dominique A. Cadilhac, Monique F. Kilkenny, Christopher R. Levi, Natasha A. Lannin, Amanda G. Thrift, Joosup Kim, Brenda Grabsch, Leonid Churilov, Helen M. Dewey, Kelvin Hill, Steven G. Faux, Rohan Grimley, Helen Castley, Peter J. Hand, Andrew Wong, Geoffrey K. Herkes, Melissa Gill, Douglas Crompton, Sandy Middleton, Geoffrey A. Donnan & 1 others Craig S. Anderson

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: Hospital data used to assess regional variability in disease management and outcomes, including mortality, lack information on disease severity. We describe variance between hospitals in 30-day risk-adjusted mortality rates (RAMRs) for stroke, comparing models that include or exclude stroke severity as a covariate.

Design: Cohort design linking Australian Stroke Clinical Registry data with national death registrations. Multivariable models using recommended statistical methods for calculating 30-day RAMRs for hospitals, adjusted for demographic factors, ability to walk on admission, stroke type, and stroke recurrence.

Setting: Australian hospitals providing at least 200 episodes of acute stroke care, 2009–2014.

Main outcome measures: Hospital RAMRs estimated by different models. Changes in hospital rank order and funnel plots were used to explore variation in hospital-specific 30-day RAMRs; that is, RAMRs more than three standard deviations from the mean.

Results: In the 28 hospitals reporting at least 200 episodes of care, there were 16 218 episodes (15 951 patients; median age, 77 years; women, 46%; ischaemic strokes, 79%). RAMRs from models not including stroke severity as a variable ranged between 8% and 20%; RAMRs from models with the best fit, which included ability to walk and stroke recurrence as variables, ranged between 9% and 21%. The rank order of hospitals changed according to the covariates included in the models, particularly for those hospitals with the highest RAMRs. Funnel plots identified significant deviation from the mean overall RAMR for two hospitals, including one with borderline excess mortality.

Conclusions: Hospital stroke mortality rates and hospital performance ranking may vary widely according to the covariates included in the statistical analysis.
Original languageEnglish
Pages (from-to)345-350
Number of pages6
JournalMedical Journal of Australia
Volume206
Issue number8
DOIs
Publication statusPublished - 1 May 2017

Cite this

Cadilhac, Dominique A. ; Kilkenny, Monique F. ; Levi, Christopher R. ; Lannin, Natasha A. ; Thrift, Amanda G. ; Kim, Joosup ; Grabsch, Brenda ; Churilov, Leonid ; Dewey, Helen M. ; Hill, Kelvin ; Faux, Steven G. ; Grimley, Rohan ; Castley, Helen ; Hand, Peter J. ; Wong, Andrew ; Herkes, Geoffrey K. ; Gill, Melissa ; Crompton, Douglas ; Middleton, Sandy ; Donnan, Geoffrey A. ; Anderson, Craig S. / Risk-Adjusted hospital mortality rates for stroke : Evidence from the Australian Stroke Clinical Registry (AuSCR). In: Medical Journal of Australia. 2017 ; Vol. 206, No. 8. pp. 345-350.
@article{c3475623009449258e60a7ac84bc9900,
title = "Risk-Adjusted hospital mortality rates for stroke: Evidence from the Australian Stroke Clinical Registry (AuSCR)",
abstract = "Objectives: Hospital data used to assess regional variability in disease management and outcomes, including mortality, lack information on disease severity. We describe variance between hospitals in 30-day risk-adjusted mortality rates (RAMRs) for stroke, comparing models that include or exclude stroke severity as a covariate.Design: Cohort design linking Australian Stroke Clinical Registry data with national death registrations. Multivariable models using recommended statistical methods for calculating 30-day RAMRs for hospitals, adjusted for demographic factors, ability to walk on admission, stroke type, and stroke recurrence.Setting: Australian hospitals providing at least 200 episodes of acute stroke care, 2009–2014.Main outcome measures: Hospital RAMRs estimated by different models. Changes in hospital rank order and funnel plots were used to explore variation in hospital-specific 30-day RAMRs; that is, RAMRs more than three standard deviations from the mean.Results: In the 28 hospitals reporting at least 200 episodes of care, there were 16 218 episodes (15 951 patients; median age, 77 years; women, 46{\%}; ischaemic strokes, 79{\%}). RAMRs from models not including stroke severity as a variable ranged between 8{\%} and 20{\%}; RAMRs from models with the best fit, which included ability to walk and stroke recurrence as variables, ranged between 9{\%} and 21{\%}. The rank order of hospitals changed according to the covariates included in the models, particularly for those hospitals with the highest RAMRs. Funnel plots identified significant deviation from the mean overall RAMR for two hospitals, including one with borderline excess mortality.Conclusions: Hospital stroke mortality rates and hospital performance ranking may vary widely according to the covariates included in the statistical analysis.",
author = "Cadilhac, {Dominique A.} and Kilkenny, {Monique F.} and Levi, {Christopher R.} and Lannin, {Natasha A.} and Thrift, {Amanda G.} and Joosup Kim and Brenda Grabsch and Leonid Churilov and Dewey, {Helen M.} and Kelvin Hill and Faux, {Steven G.} and Rohan Grimley and Helen Castley and Hand, {Peter J.} and Andrew Wong and Herkes, {Geoffrey K.} and Melissa Gill and Douglas Crompton and Sandy Middleton and Donnan, {Geoffrey A.} and Anderson, {Craig S.}",
year = "2017",
month = "5",
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doi = "10.5694/mja16.00525",
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journal = "Medical Journal of Australia",
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Cadilhac, DA, Kilkenny, MF, Levi, CR, Lannin, NA, Thrift, AG, Kim, J, Grabsch, B, Churilov, L, Dewey, HM, Hill, K, Faux, SG, Grimley, R, Castley, H, Hand, PJ, Wong, A, Herkes, GK, Gill, M, Crompton, D, Middleton, S, Donnan, GA & Anderson, CS 2017, 'Risk-Adjusted hospital mortality rates for stroke: Evidence from the Australian Stroke Clinical Registry (AuSCR)', Medical Journal of Australia, vol. 206, no. 8, pp. 345-350. https://doi.org/10.5694/mja16.00525

Risk-Adjusted hospital mortality rates for stroke : Evidence from the Australian Stroke Clinical Registry (AuSCR). / Cadilhac, Dominique A.; Kilkenny, Monique F.; Levi, Christopher R.; Lannin, Natasha A.; Thrift, Amanda G.; Kim, Joosup; Grabsch, Brenda; Churilov, Leonid; Dewey, Helen M.; Hill, Kelvin; Faux, Steven G.; Grimley, Rohan; Castley, Helen; Hand, Peter J.; Wong, Andrew; Herkes, Geoffrey K. ; Gill, Melissa; Crompton, Douglas ; Middleton, Sandy; Donnan, Geoffrey A.; Anderson, Craig S.

In: Medical Journal of Australia, Vol. 206, No. 8, 01.05.2017, p. 345-350.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Risk-Adjusted hospital mortality rates for stroke

T2 - Evidence from the Australian Stroke Clinical Registry (AuSCR)

AU - Cadilhac, Dominique A.

AU - Kilkenny, Monique F.

AU - Levi, Christopher R.

AU - Lannin, Natasha A.

AU - Thrift, Amanda G.

AU - Kim, Joosup

AU - Grabsch, Brenda

AU - Churilov, Leonid

AU - Dewey, Helen M.

AU - Hill, Kelvin

AU - Faux, Steven G.

AU - Grimley, Rohan

AU - Castley, Helen

AU - Hand, Peter J.

AU - Wong, Andrew

AU - Herkes, Geoffrey K.

AU - Gill, Melissa

AU - Crompton, Douglas

AU - Middleton, Sandy

AU - Donnan, Geoffrey A.

AU - Anderson, Craig S.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Objectives: Hospital data used to assess regional variability in disease management and outcomes, including mortality, lack information on disease severity. We describe variance between hospitals in 30-day risk-adjusted mortality rates (RAMRs) for stroke, comparing models that include or exclude stroke severity as a covariate.Design: Cohort design linking Australian Stroke Clinical Registry data with national death registrations. Multivariable models using recommended statistical methods for calculating 30-day RAMRs for hospitals, adjusted for demographic factors, ability to walk on admission, stroke type, and stroke recurrence.Setting: Australian hospitals providing at least 200 episodes of acute stroke care, 2009–2014.Main outcome measures: Hospital RAMRs estimated by different models. Changes in hospital rank order and funnel plots were used to explore variation in hospital-specific 30-day RAMRs; that is, RAMRs more than three standard deviations from the mean.Results: In the 28 hospitals reporting at least 200 episodes of care, there were 16 218 episodes (15 951 patients; median age, 77 years; women, 46%; ischaemic strokes, 79%). RAMRs from models not including stroke severity as a variable ranged between 8% and 20%; RAMRs from models with the best fit, which included ability to walk and stroke recurrence as variables, ranged between 9% and 21%. The rank order of hospitals changed according to the covariates included in the models, particularly for those hospitals with the highest RAMRs. Funnel plots identified significant deviation from the mean overall RAMR for two hospitals, including one with borderline excess mortality.Conclusions: Hospital stroke mortality rates and hospital performance ranking may vary widely according to the covariates included in the statistical analysis.

AB - Objectives: Hospital data used to assess regional variability in disease management and outcomes, including mortality, lack information on disease severity. We describe variance between hospitals in 30-day risk-adjusted mortality rates (RAMRs) for stroke, comparing models that include or exclude stroke severity as a covariate.Design: Cohort design linking Australian Stroke Clinical Registry data with national death registrations. Multivariable models using recommended statistical methods for calculating 30-day RAMRs for hospitals, adjusted for demographic factors, ability to walk on admission, stroke type, and stroke recurrence.Setting: Australian hospitals providing at least 200 episodes of acute stroke care, 2009–2014.Main outcome measures: Hospital RAMRs estimated by different models. Changes in hospital rank order and funnel plots were used to explore variation in hospital-specific 30-day RAMRs; that is, RAMRs more than three standard deviations from the mean.Results: In the 28 hospitals reporting at least 200 episodes of care, there were 16 218 episodes (15 951 patients; median age, 77 years; women, 46%; ischaemic strokes, 79%). RAMRs from models not including stroke severity as a variable ranged between 8% and 20%; RAMRs from models with the best fit, which included ability to walk and stroke recurrence as variables, ranged between 9% and 21%. The rank order of hospitals changed according to the covariates included in the models, particularly for those hospitals with the highest RAMRs. Funnel plots identified significant deviation from the mean overall RAMR for two hospitals, including one with borderline excess mortality.Conclusions: Hospital stroke mortality rates and hospital performance ranking may vary widely according to the covariates included in the statistical analysis.

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U2 - 10.5694/mja16.00525

DO - 10.5694/mja16.00525

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JO - Medical Journal of Australia

JF - Medical Journal of Australia

SN - 0025-729X

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