Health Policy Manag.  2019 Jun;29(2):220-227. 10.4332/KJHPA.2019.29.2.220.

Between-Hospital Variation in All-Cause Mortality for Potentially Avoidable Hospitalizations in Older People

Affiliations
  • 1Department of Health Administration, Dankook University College of Health Science, Cheonan, Korea.
  • 2Institute of Health Promotion and Policy, Dankook University, Cheonan, Korea.
  • 3Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea. yhlee@ajou.ac.kr
  • 4Institute on Aging, Ajou University Medical Center, Suwon, Korea.

Abstract

BACKGROUND
Potentially avoidable hospitalizations (PAH) contribute to an increased post-discharge mortality.
METHODS
To investigate the between-hospital variation and the relationship between all predictors and mortality after discharge among older adults with PAH, we studied 15,186 older patients with PAH in 2,200 hospitals included in the National Health Insurance Service-Senior claims database from 2002 to 2013. Multivariable multilevel logistic regression analyses were performed to analyze the variance at between-hospital for mortality after accounting for differences in patient characteristics.
RESULTS
The between-hospital variation in mortality that could be attributed to hospital practice variations were 37.6% at 1-week to 13.9% at 12-month post-discharge, after adjustment for individual patient characteristics and hospital-level factors. Hospital-level factors significantly explained mortality at 3 weeks after discharge. Clinics, compared with general hospitals, demonstrated a 2.75 times higher likelihood of deaths at 3-week post-discharge (p<0.001). Compared with private hospitals, public hospitals exhibited 1.61 times higher odds of 3-week mortality (p=0.01).
CONCLUSION
This study demonstrates considerable between-hospital variations in PAH-related mortality that could be attributed to hospital practices. Monitoring of hospitals to identify practice variations would be warranted to improve the survival of older patients with PAH.

Keyword

Aged; Hospitals; Practice; Variation

MeSH Terms

Adult
Hospitalization*
Hospitals, General
Hospitals, Private
Hospitals, Public
Humans
Logistic Models
Mortality*
National Health Programs
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