title: Assessment of hospital performance with a case-mix standardized mortality model using an existing administrative database in Japan.
abstract: BACKGROUND
  Few studies have examined whether risk adjustment is evenly applicable to hospitals with various characteristics and case-mix. In this study, we applied a generic prediction model to nationwide discharge data from hospitals with various characteristics.
  
  
  METHODS
  We used standardized data of 1,878,767 discharged patients provided by 469 hospitals from July 1 to October 31, 2006. We generated and validated a case-mix in-hospital mortality prediction model using 50/50 split sample validation. We classified hospitals into two groups based on c-index value (hospitals with c-index > or = 0.8; hospitals with c-index < 0.8) and examined differences in their characteristics.
  
  
  RESULTS
  The model demonstrated excellent discrimination as indicated by the high average c-index and small standard deviation (c-index = 0.88 +/- 0.04). Expected mortality rate of each hospital was highly correlated with observed mortality rate (r = 0.693, p < 0.001). Among the studied hospitals, 446 (95%) had a c-index of >/=0.8 and were classified as the higher c-index group. A significantly higher proportion of hospitals in the lower c-index group were specialized hospitals and hospitals with convalescent wards.
  
  
  CONCLUSIONS
  The model fits well to a group of hospitals with a wide variety of acute care events, though model fit is less satisfactory for specialized hospitals and those with convalescent wards. Further sophistication of the generic prediction model would be recommended to obtain optimal indices to region specific conditions.
authors.affiliation: Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Japan. h-m@umin.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.forename: Hideki
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D019992:Databases as Topic; D003953:Diagnosis-Related Groups; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D010351:Patient Discharge; D011787:Quality of Health Care; D015203:Reproducibility of Results; D020379:Risk Adjustment / Q000379:methods*