Methodological development and evaluation of 30-day mortality as quality indicator for Norwegian hospitals
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Key message
Indicators of the quality of health care are often used as a means of evaluation and monitoring trends in health care quality, identifying patients having received varying care and evaluating treatment methods. In this context, a quality indicator is defined as a statistical value, for fixed and current time-periods, indicating how certain processes function or whether specific outcomes have been achieved. One of the suggested outcome quality indicators is probability of death after 30 days (or 30-day mortality (30D), which seems to be the most commonly, used term in the literature, although 30- day case fatality is a more proper term). Evaluating hospital health care quality includes not only evaluating treatment of diseases, but also evaluating administrative routines and processes, such as number of days at hospital, delay to operation, not enough capacity for patients, etc.
A difficulty in using quality indicators is the challenge of comparing hospitals and health care institutions receiving patients with different risk profiles. It is necessary in comparing health care institutions, to account for differences in risk profiles such that hospitals admitting only low risk patients do not compare more favorably than deserved, to hospitals also accepting high-risk patients.
Three disease categories have been selected for evaluation of 30-day mortality as a quality indicator: acute myocardial infarction (AMI), hip fracture and stroke. These three disease categories were chosen as three major causes of death in the Norwegian population.