Capturing the trends in hospital standardized mortality ratios for pneumonia: a retrospective observational study in Japan (2010 to 2018)

Abstract

Background: Pneumonia has a high human toll and a substantial economic burden in developed countries like Japan, where the crude mortality rate was 77.7 per 100,000 people in 2017. As this trend is going to continue with increasing number of the elderly multi-morbid population in Japan; monitoring performance over time is a social need to alleviate the disease burden. The study objective was to determine the characteristics of hospital standardized mortality ratios (HSMRs) for pneumonia in Japan from 2010 to 2018 to describe this trend. Methods: Data of the DPC (Diagnostic Procedures Combination) database were used, which is an administrative claims and discharge summary database for acute care in-patients in Japan. HSMRs were calculated using the actual and expected numbers of in-hospital deaths, the latter of which was calculated using logistic regression model, with a number of explanatory variables, e.g., age, sex, urgency of admission, mode of transportation, patient volume per month in each hospital, A-DROP score, and Charlson comorbidity index (CCI). We constructed two HSMR models: a single-year model, which included hospitals with > 10 in-patients per month and, a 9-year model, which included those hospitals with complete 9-year data. Predictive accuracy of the logistic models was assessed using c-index (area under receiver operating curve). Results: Total 230,372 patients were included for the analysis over the 9-year study period. Calculated HSMRs showed wide variation among hospitals. The proportion of hospitals with HSMR less than 100 increased from 36.4% in 2010 to 60.6% in 2018. Both models showed good predictive ability with a c-statistic of 0.762 for the 9-year model, and no less than 0.717 for the single-year model. Conclusion: This study denoted that HSMRs of pneumonia can be calculated using DPC data in Japan and revealed significant variations among hospitals with comparable case-mixes. Therefore, HSMR can be used as yet another measure to help improve quality of care over time if other indicators are examined in parallel and to get a clear picture of where hospitals excel and lack.

Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany

“…Despite the achievements of the last decades, compliance and proper execution of hygiene practices are of unabated interest even in developed countries. The reasons for this are (i) the emergence of novel pathogens as currently experienced with SARS-CoV-2 [ 5 ], (ii) the selection and global spread of multidrug-resistant organisms (MDROs) [ 6 , 7 , 8 , 9 , 10 ], (iii) the medical progress characterized by the increased application of immune system-impairing procedures and colonization-vulnerable devices [ 11 , 12 , 13 , 14 , 15 , 16 ], (iv) the demographic changes leading to higher susceptibility of subpopulations to infectious diseases, such as the increase of older and multi-morbid individuals [ 17 , 18 , 19 ] and (v) the migration and lifestyle aspects leading to the transmission and distribution of MDROs [ 20 , 21 , 22 ]. Emerging clonal lineages of notorious MDROs with changed epidemiology and host spectra (e.g., community- and livestock-associated MRSA and hypervirulent, multi-resistant Klebsiella pneumoniae lineages) also add to the burden of diseases, necessitating health behavior programs [ 6 , 9 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

Shen-ling-bai-zhu-san ameliorates inflammation and lung injury by increasing the gut microbiota in the murine model of Streptococcus pneumonia-induced pneumonia

“…Pneumonia, which is an inflammatory disease caused by bacteria, viruses, fungi, or other microorganisms, mainly affects children and the elderly and has high morbidity and mortality worldwide, and the morbidity and mortality of pneumonia is increasing [1][2][3]. Streptococcus pneumoniae (Spn), a gram-positive bacterium with over 90 serotypes, is the most common bacterial pneumoniacausing pathogen [4].…”

Characteristics and Trends of the Hospital Standardized Readmission Ratios for Pneumonia: A Retrospective Observational Study Using Japanese Administrative Claims Data from 2010 to 2018

“…All hospital admissions with principal diagnosis of pneumonia from 2010 to 2018 were identified from the DPC database. The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes (J12–18, J69, B01.2, B05.2, B59) were used to determine the diagnosis [ 26 ]. Hospitals with no discharged pneumonia patients in a year in the 9-year analysis or no readmission for pneumonia in each 3-year period were excluded.…”

“…The patient data included age, sex, urgency of admission, Charlson comorbidity index (CCI), A-DROP score, length of stay (LOS), discharge destination, and readmission. Age, sex, urgency of admission, and CCI were used in a previous HSMR study [ 26 ]. Age was categorized according to the DPC/PDPS category: 15–64, 65–74, 75 and over.…”

“…The DPC/PDPS is a reimbursement system for acute care hospitals introduced in 2003, and the DPC database is a national administrative claim and discharge abstract database for inpatient acute care [ 23 , 24 ]. Administrative data, such as DPC data, have been used in designing health policies, disease management, and analysis of healthcare processes and patient outcomes [ 25 , 26 ]. Each hospital can analyze its own quality of care using DPC data.…”