Comparison of Hospital Mortality Rates After Burn Injury in New York State: A Risk-Adjusted Population-Based Observational Study
ABSTRACT Severity-adjusted mortality is an unequivocal measure of burn care success. Hospitals can be compared on this metric using administrative data because information required for calculating statistically adjusted risk of mortality is routinely collected on hospital admission.
The New York State Department of Health provided information on all 13,113 thermally injured patients hospitalized at 1 of 194 hospitals between 2004 and 2008. We compared hospital survival rates using a random effects logistic model of mortality that incorporated age and several predictors that were present on admission and captured as International Classification of Diseases-9 codes: burn surface area, inhalation injury, three measures of physiologic compromise, and four medical comorbidities. Hospitals were compared on the adjusted odds of death and the number of excess deaths.
Overall mortality was 3.2%. Nine high-volume hospitals (>100 patients/year) cared for 83% of patients with burn injuries. Overall variability of the odds of mortality among these high-volume centers was modest (median odds ratio=1.2) and we found little evidence for differences in the adjusted odds of mortality. A secondary analysis of the 185 low-volume hospitals that cared for 2,235 patients disclosed only 24 deaths. When examined in aggregate, these hospitals had better than predicted risk-adjusted mortality; a logical explanation is judicious case selection.
Administrative hospital discharge data are extensive and comparably enough collected to allow comparison of the performance of burn centers. Risk-adjusted models show that patients have statistically indistinguishable risk-adjusted odds of mortality regardless of which hospital in New York State cared for them.
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ABSTRACT: OBJECTIVE: To analyze trends in incidence and treatment of thermal injuries over the last two decades. METHODS: We retrospectively reviewed our local single center database of patients with thermal injuries admitted to the burn intensive care unit (BICU) of the Cologne-Merheim Medical Center (University Hospital of Witten/Herdecke). The cohort was divided into two groups according to the decade of admission and the epidemiology and clinical course of the patient sample admitted during the period 1991-2000 (n=911) was compared to that of 2001-2010 (n=695). RESULTS: The following variables were significantly different in the bivariate analysis: mean age (39.8 years vs. 44.0 years), burn size of total body surface area (23.2% vs. 18.0%) and size of 3rd degree burns (9.6% vs. 14.9%). The incidence of inhalation injury was significantly lower in the last decade (33.3% vs. 13.7%) and was associated with a shorter duration of mechanical ventilation (10.8 days vs. 8.5 days). The ABSI-score as an indicator of burn severity declined in the second period (6.3 vs. 6.0) contributing partially to the decline of BICU length of stay (19.1 days vs. 18.8 days) and to the mortality rate decrease (18.6% vs. 15.0%). CONCLUSION: The severity of burn injuries during the last two decades declined, probably reflecting the success of prevention campaigns. Concerning mortality, the chance of dying for a given severity of injury has decreased.Burns: journal of the International Society for Burn Injuries 06/2012; 39(1). DOI:10.1016/j.burns.2012.05.003 · 1.84 Impact Factor
Article: Die standardisierte primäre Sectiorate (SPSR) und ihre Anwendung im Qualitätsmanagement und für Krankenhausvergleiche. Prädiktoren der primären Sectio als Beitrag zur Versachlichung einer komplexen Diskussion: Standardised primary Caesarean section rate (SPSR) and how it can be applied in Quality Management and for Hospital Ranking. Predictors for primary Caesarean sections as a contribution towards rendering the debate more objective
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ABSTRACT: The US government has mandated that, in a catastrophic event, metropolitan areas need to be capable of caring for 50 burn-injured patients per million population. In New York City, this corresponds to 400 patients. There are currently 140 burn beds in the region which can be surged up to 210. To care for additional patients, hospitals without burn centers will be used to stabilize patients until burn beds become available. In this work, we develop a new system for prioritizing patients for transfer to burn beds as they become available and demonstrate its superiority over several other triage methods. Based on data from previous burn catastrophes, we study the feasibility of being able to admit 400 patients to burn beds within the critical 3 to 5 day time frame. We find that this is unlikely and that the ability to do so is highly dependent on the type of event and the demographics of the patient population. This work has implications for how disaster plans in other metropolitan areas should be developed.Manufacturing & Service Operations Management 05/2013; 15(2). DOI:10.1287/msom.1120.0412 · 1.45 Impact Factor