We discuss how policy makers could improve quality of care in Australian hospitals. There are marked variations in adverse event rates across hospitals in Victoria, even after risk adjusting. We find comparably high adverse events rates for surgical patients in Australian hospitals, possibly because our data allow identification of a larger number of adverse events than data used in previous studies. Risk adjustment makes a significant difference to most hospitals. Selected non-teaching hospitals have relatively high rates, in particular hospitals in rural and socially disadvantaged areas. Suburban and rural hospitals have lower rates of 17.4% and 17%, and 16.1% and 15.7%, respectively. Teaching hospitals have average risk-adjusted adverse event rates of 24.3% for elective and 19.7% for emergency surgical patients. We estimate adverse event rates for 87,790 elective and 43,771 emergency episodes in 34 public hospitals over the financial year 2005/06 with a complementary log-log model, using patient level administrative hospital data and controlling for patient complexity with a range of covariates. We identify hospitals with below or above average performance in comparison to their peers, and show for which types of hospitals risk adjusting makes biggest difference. We use a unique hospital dataset that routinely records adverse events which arise during the admission. Objective of this study is to analyse patient-complexity adjusted adverse events rates to compare the performance of hospitals in Victoria, Australia. Providers requiring further auditing can be effectively identified with funnel plots used routinely in quality control programs.Īdverse event or complication rates are increasingly advocated as measures of hospital quality and performance. The study has emphasized the need to closely monitor individual performance, for hospitals and surgeons. Despite some limitations, Belgian administrative hospital discharge databases can be used to assess the volume outcome relationship for orthopaedic surgery. Patients treated by small volume surgeons (respectively medium volume surgeons) had a 43% higher odds of complications than patients operated by high volume surgeons (respectively 37%). After adjustment for age, sex, principal diagnosis and comorbidity, surgeon volume was much more predictive of short term complications than centre volume. Hospitals were classified in low-volume (110). The relationship between provider volume and short term complications after an elective total hip replacement was studied on Belgian hospital discharge administrative database from 2004.
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March 2023
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