Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Hospital Standardized Mortality Ratio Using National Hospital Discharge Injury Data

퇴원손상심층조사 자료를 이용한 의료기관 중증도 보정 사망비 비교

  • Received : 2012.01.11
  • Accepted : 2012.04.12
  • Published : 2012.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

This study was to develop the assessment of medical service outcome using administration data through compared with hospital standardized mortality ratios(HSMR) in various hospitals. This study analyzed 63,664 cases of Hospital Discharge Injury Data of 2007 and 2008, provided by Korea Centers for Disease Control and Prevention. We used data mining technique and compared decision tree and logistic regression for developing risk-adjustment model of in-hospital mortality. Our Analysis shows that gender, length of stay, Elixhauser comorbidity index, hospitalization path, and primary diagnosis are main variables which influence mortality ratio. By comparing hospital standardized mortality ratios(HSMR) with standardized variables, we found concrete differences (55.6-201.6) of hospital standardized mortality ratios(HSMR) among hospitals. This proves that there are quality-gaps of medical service among hospitals. This study outcome should be utilized more to achieve the improvement of the quality of medical service.

본 연구는 의료서비스의 결과지표인 의료기관 중증도 보정 사망비(HSMR)를 산출하고, 비교하여 행정자료를 이용한 의료서비스 결과를 평가할 수 있는 방안을 마련하고자 수행되었다. 이를 위해서 질병관리본부의 2007-2008년의 퇴원손상환자 63,664건의 자료를 분석하였다. 중증도 보정모형 개발을 위해 데이터마이닝을 이용한 의사결정나무와 로지스틱 회귀분석을 실시하였으며, 최종 모형으로 선정된 로지스틱 회귀분석에는 성별, 재원일수, Elixhauser 상병지수, 입원경로, 주상병 변수가 포함되었다. 퇴원시 사망에 영향을 끼치는 이러한 변수를 보정 후 병원간의 중증도 보정 사망비(HSMR)를 비교한 결과 병원간의 중증도 보정 사망비(HSMR)는 차이가 있는 것으로 나타남에 따라 병원의 의료서비스 수준 차이가 있는 것이 확인되었다(HSMR 범위: 55.6-201.6). 본 연구를 통하여 병원간의 퇴원시 사망률을 비교할 수 있는 방법이 개발되었으므로 향후에 이를 이용하여 다양한 의료의 질 향상 활동을 할 수 있는 방안을 마련하여야 할 것이다.

Keywords

References

  1. Agency for Healthcare Research and Quality (AHRQ), "National health care Quality Report", 2007.
  2. National Evidence-based Healthcare Collaborating Agency(NECA), "Conceptual framework of and develop National Healthcare Quality Indicators", 2009.
  3. Sung-Hong Kang, Wong-Jung Kim, Sang-Gun Song, "A Study on Methods to Improve the Quality of Medical Care Services", 보건정보관리학회지 Vol 8, 2004.
  4. Rubin, H. R., Pronovost, P. & Diette, G. B., "The advantages and disadvantages of process-based measure of health care quality", International Journal for Quality in Health Care, 13, 469-474.
  5. Yoon Ju Young, Lee Ji Yun, "Development of Outcome Indicators of Urinary Incontinence for Quality Evaluation in Long Term Care Hospitals", J Korean Acad Nurs 2010, 40(1): 110-118. https://doi.org/10.4040/jkan.2010.40.1.110
  6. Health Insurance Review & Assessment Service, Institute of Health Policy and Management, Seoul National University Medical Research Center, "A Study on the ways of the improvement for Quality assessment service, 2010.
  7. Sung-Soo Kim, Won-Joong Kim, Sung-Hong Kang, "A study on the variation of severity adjusted LOS on Injry inpatient in Korea", Journal of the Korea Academia- Industrial cooperation Society 2011, 12(6): 2668-2676. https://doi.org/10.5762/KAIS.2011.12.6.2668
  8. Chul-Hwan Kang, Yong-Ik Kim, Eun-Jung Lee, Kunhee Park, Jin-Seok Lee, Yoon Kim, "The variation in risk adjusted mortality of intensive care units", Korean J Anesthesiol 2009 Dec; 57(6): 698-703. https://doi.org/10.4097/kjae.2009.57.6.698
  9. Yoo Mi Kim, Yun-Kyoung Choi, Sung-Hong Kang, Won-Joong Kim, "A Study on analysis of severityadjustment length of stay in hospital for communityacquired pneumonia", Journal of the Korea Academia- Industrial cooperation Society 2011, 12(3), 1234-1243. https://doi.org/10.5762/KAIS.2011.12.3.1234
  10. Dong-seok Kim, Soo-won Kang, Ji-won Park, "Mortality and Potential Years of Life Lost comparison of lung cancer between Korea and OECD countries", Journal of the Korea Academia-Industrial cooperation Society 2010, 11(7), 2515-2521. https://doi.org/10.5762/KAIS.2010.11.7.2515
  11. Moon-Hee Nam, Sung-Soo Kim, Il-Su Park, Sung-Hong Kang, Won-Joong Kim, Soon-Ho Choi, Hye-Kyung Jo, Young-Taek Kim, Sung-Ok Hong, "A Study on Utilization of non-residential areal in Operation patient", Journal of the Korea Academia-Industrial cooperation Society 2010, 11(6), 2078-2087. https://doi.org/10.5762/KAIS.2010.11.6.2078
  12. Sung-Hong Kang, "Analysis of LOS variance -The results of Korean National Hospital Discharge In-depth Injury Survey 2004-2006", Public health weekly report, KCDC, 2, 587-866, 2009.
  13. Yoo Mi Kim, "A study on analysis of factors on in-hospital mortality for community-acquired pneumonia", Journal of the Korean Data & Information Science Society 2011, 22(3), 389-400.
  14. Canadian Institute for Health Information, "HSMR : A New Approach for Measuring Hospital Mortality Trend in Canada", 2007.
  15. Australian Institute of Health and Welfare, "Measuring and reporting mortality in hospital patients", 2009.
  16. Li B, Evans D, Faris P, Dean S, Quan H., "Risk adjustment performance of Charlson and Elixhauser comorbidities in ICD-9 and ICD-10 administrative databases", BMC Health Serv Res. 2008 Jan 14;8:12.
  17. Min Ho Kyung, Seok-Jun Yoon, Hyeong-Sik Ahn, Se-min Hwang, Hyun-Ju Seo, Kyoung-Hoon Kim, Hyeung-Keun Park, "Prognostic Impact of Charlson Comorbidity Index Obtained from Medical Records and Claims Data on 1-year Mortality and Length of Stay in Gastric Cancer Patients", J Prev Med Public Health 2009, 42(2): 117-122. https://doi.org/10.3961/jpmph.2009.42.2.117
  18. Alex Bottle, Brian Jarman, Paul Aylin, "Strengths and weaknesses of hospital standardised mortality ratios", BMJ 2010;341:c7116 doi: 10.1136/bmj.c7116.
  19. Richard Heijink, Xander Koolman, Daniel Pieter, André van der Veen, Brian Jarman and Gert Westert, "Measuring and explaining mortality in Dutch hospitals; The Hospital Standardized Mortality Rate between 2003 and 2005", .BMC Health Services Research 2008, 8:73 doi:10.1186/1472-6963-8-73.
  20. Dr foster intelligence, "Inside your hospital, Dr foster hospital guide, 2001-2011", 2011.
  21. Jarman B, Gault S, Alves B, Hider A, Dolan A, Cook A, Hurwitz B, Iezzoni LI., "Explaining differences in English hospital death rates using routinely collected data", BMJ 1999;318:1515-20. https://doi.org/10.1136/bmj.318.7197.1515
  22. http://www.cihi.ca/cihi-ext-portal/internet/en/doc ument/health+system+performance/quality+of+care+and +outcomes/hsmr/hsmr_results_canada
  23. Institute for Healthcare Improvement. "Move Your Dot-Measuring, evaluating, and reducing hospital mortality rates(Part 1). IHI", 2003.
  24. Institute for Healthcare Improvement. "Reducing hospital mortality rates (Part 2). IHI", 2005.

Cited by

  1. Complex relationship between Hospital management performance and the degree of the regional competition (Focusing on the Regional Public Hospital) vol.13, pp.10, 2015, https://doi.org/10.14400/JDC.2015.13.10.405
  2. Factors affecting the hospital profitability (Focusing on the convergence of differences in financial performance of the surplus and deficit hospital) vol.13, pp.11, 2015, https://doi.org/10.14400/JDC.2015.13.11.267
  3. A Convergence Study in the Severity-adjusted Mortality Ratio on inpatients with multiple chronic conditions vol.13, pp.12, 2015, https://doi.org/10.14400/JDC.2015.13.12.245