Avaliação do cuidado hospitalar pelo risco de óbito / Evaluation of hospital care by risk of death

A taxa de mortalidade hospitalar é tradicionalmente usada para medir a qualidade do cuidado nas unidades hospitalares, no entanto a mesma não consegue discriminar o risco de óbito proveniente da assistência oferecida e da carga de comorbidades que o paciente tem no momento da internação. A Razão de Mortalidade Hospitalar Padronizada (RMHP) é um índice que possibilita avaliar a qualidade do cuidado de acordo com o perfil dos pacientes atendidos pelo hospital. Resultados da RMHP < 1 indica uma qualidade melhor que a esperada e resultados > 1 apontam qualidade pior que a esperada. Assim este estudo propôs avaliar a qualidade da assistência hospitalar prestada no âmbito da Secretaria de Estado da Saúde de Goiás, considerando seu perfil assistencial e os tipos de pacientes atendidos, no período de 2014 a 2019. O cálculo da RMHP foi baseado na metodologia de Jarman et al., no Índice de Comorbidades de Charlson (ICC) E Índice de Elixhauser para avaliar o risco de óbito, e posterior aplicação da curva ROC (para encontrar o modelo de ajuste de risco) e da regressão linear logística multivariada. A qualidade da assistência prestada no Estado de Goiás, considerando o perfil dos pacientes atendidos, foi pior que o esperado nos anos de 2014 a 2016, dentro do esperado no ano 2017 e melhor que o esperado nos anos de 2018 e 2019. Observou-se uma melhora gradativa na qualidade do cuidado nos últimos três anos

The hospital mortality rate is traditionally used to measure the quality of care in hospital units, however it cannot discriminate the risk of death resulting from the assistance provided and the burden of comorbidities that the patient has at the time of hospitalization. The Standardized Hospital Mortality Ratio (RMHP) is an index that makes it possible to assess the quality of care according to the profile of patients treated by the hospital. RMHP results < 1 indicate better quality than expected and results > 1 indicate worse quality than expected. Thus, this study proposed to assess the quality of hospital care provided by the State Health Department of Goiás, considering its care profile and the types of patients cared for, in the period from 2014 to 2019. The RMHP calculation was based on Jarman's methodology et al., in the Charlson Comorbidity Index (ICC) and Elixhauser Index to assess the risk of death, and subsequent application of the ROC curve (to find the risk adjustment model) and multivariate logistic linear regression. The quality of care provided in the State of Goiás, considering the profile of the patients cared for, was worse than expected in the years 2014 to 2016, within expectations in 2017 and better than expected in the years 2018 and 2019. A gradual improvement in the quality of care in the last three years

Morbimortalidad de recién nacidos con menos de 1500 gramos asistidos en hospitales públicos de la ciudad de Buenos Aires / Mortality and morbidity of very low birth weight newborn infants assisted in Buenos Aires public hospitals

Introducción. La red neonatal de los hospitales públicos porteños desarrolla una estrecha vigilancia de la evolución de los neonatos con menos de 1500 g (RNMBPN), pues contribuyen en gran medida a la morbimortalidad neonatal. Objetivo. Analizar la morbimortalidad de los RNMBPN y determinar la mortalidad ajustada por riesgo utilizando el puntaje de la Red Neonatal de los países del cono sur de América (NEOCOSUR). Material y métodos. Se incluyeron todos los recién nacidos vivos en hospitales de la red con peso de 500-1500 g desde 2008 a 2010. Los datos se registraron prospectivamente con metodología estandarizada. Se calcularon las tasas de mortalidad, morbilidad y la mortalidad ajustada por riesgo según puntaje de NEOCOSUR. Resultados. En el período del estudio nacieron 92 698 niños de los cuales 1,26% pesó menos de 1500 g. Sólo 40,4% recibió corticoides antenatales completos. Un 62,7% desarrolló síndrome de difcultad respiratoria, 5,4% enterocolitis, 10,1% hemorragia endocraneana y 13,4% retinopatía grave. La sepsis precoz fue del 5,6%, la tardía de 9,6%. Un 10,7% presentó displasia broncopulmonar. La mortalidad neonatal fue del 29,2% y la ajustada sin malformados graves, 25,4%. La supervivencia de niños con peso =750 g y edad gestacional =26 semanas fue de 50%. El cociente mortalidad observada/esperada fue de 1,04, con gran variabilidad. Conclusiones. El porcentaje de RNMBP que recibió corticoides antenatales es bajo. La incidencia de sepsis y la proporción de niños con ROP grave son elevadas. La mortalidad ajustada por riesgo es superior a la esperada.

Introduction. The Neonatal Network of Public Hospitals in the city of Buenos Aires closely monitors the progress of newborn infants with a birth weight less than 1500 g (very low birth weight, VLBW) because it largely contributes to neonatal morbidity and mortality. Objective. To analyze the morbidity and mortality of VLBW infants and determine their riskadjusted mortality using the score of the South American Neonatal Network (Red Neonatal de los países del Conosur de América, NEOCOSUR). Material and Methods. Live infants born in the network hospitals with a birth weight of 500-1499 g between 2008 and 2010 were included in the study. Data was recorded prospectively using a standardized methodology. Mortality, morbidity and risk-adjusted mortality rates according to the NEOCOSUR score were estimated. Results. There were 92,698 infants born during the study period. Of them, 1.26% weighed less than 1500 g at birth. Only 40.4% of these received a full course of antenatal corticosteroids. A total of 62.7% of these developed respiratory distress syndrome, 5.4% enterocolitis, 10.1% intracranial hemorrhage, and 13.4% severe retinopathy. Early sepsis was observed in 5.6%, and late sepsis in 9.6%. Bronchopulmonary dysplasia was present in 10.7% of the cases. Neonatal mortality was 29.2%, and the adjusted mortality with no major malformations was 25.4%. Survival of infants with a birth weight of =750 g and a gestational age of =26 weeks was 50%. The observed/expected mortality ratio was 1.04, with a large variability. Conclusions. The percentage of VLBW infants who received antenatal corticosteroids was low. The incidence of sepsis and the rate of infants with severe retinopathy of prematurity are high. The risk-adjusted mortality is higher than expected.

The variation in risk adjusted mortality of intensive care units / 대한마취과학회지

BACKGROUND: This study aimed to estimate risk adjusted mortality rate in the ICUs (Intensive care units) by APACHE (Acute Physiology And Chronic Health Evaluation) III for revealing the performance variation in ICUs. METHODS: This study focused on 1,090 patients in the ICUs of 18 hospitals. For establishing risk adjusted mortality predictive model, logistic regression analysis was performed. APACHE III, surgery experience, admission route, and major disease categories were used as independent variables. The performance of each model was evaluated by c-statistic and goodness-of-fit test of Hosmer-Lemeshow. Using this predictive model, the performance of each ICU was tested as ratio of predictive mortality rate and observed mortality rate. RESULTS: The average observed mortality rate was 24.1%. The model including APACHE III score, admission route, and major disease categories was signified as the fittest one. After risk adjustment, the ratio of predictive mortality rate and observed mortality rate was distributed from 0.49 to 1.55. CONCLUSIONS: The variation in risk adjusted mortality among ICUs was wide. The effort to reduce this quality difference is needed.