Assessment of quality of care for heart failure patients with standardized in-hospital mortality

Objective To assess the quality of care for heart failure patients with standardized in-hospital mortality.Methods Data were extracted from the medical records of 1 862 heart failure admissions between January 2009 and October 2010 in 20 tertiary hospitals in Heilongjiang province.Two-level logistic model was used to develop the risk adjustment model of in-hospital mortality for patients with heart failure and the area under the curve of receiver operation characteristic(ROC)was applied to assess the goodness of fit of risk adjustment model.Results Of the 1 862 patients, 87 died during the hospital stay and the in-hospital mortality was 4.67%.The differences in the in-hospital mortality among the patient groups with different nationality, clinical status at hospital admission, length of stay, heart rate and whether having respiratory disease, renal disease, myocardiopathy, and low sodium syndrome were statistically significant(all P<0.05).The results of two-level logistic model showed that the patients at older age and with the history of renal disease or low sodium syndrome had a higher risk of in-hospital mortality and those with longer length of hospital stay, with relatively minor illness status at hospital admission, and with hypertension had a lower risk of in-hospital mortality.The area under the curve of ROC of risk adjustment model was 0.80(95% confidence interval=0.75-0.85)(P<0.001).The in-hospital mortality across the 20 hospitals ranged from 0% to 12.82% before risk adjustment.The order of the in-hospital mortality for the 20 hospitals changed after risk adjustment and the in-hospital mortality ranged from 2.59% to 7.62%.Conclusion The variation in the in-hospital mortality of heart failure patients across hospitals reduced after risk-adjustment.The order sorted by crude in-hospital mortality was inconsistent with that sorted by standardized in-hospital mortality and the latter could be reasonably used in the assessment of quality of care.