Use of case fatality and readmission measures to compare hospital performance in gynaecology.
Mason A., Goldacre M., Meddings D., Woolfson J.
OBJECTIVE: To identify suitable outcome measures for comparing gynaecology performance between hospitals. DESIGN: Analysis of routinely collected statistics. SETTING: England. POPULATION A total of 1.45 million gynaecology admissions in 1999/2001. METHODS: The database used was a linked file of English NHS hospital admission statistics and death certificate data. Case fatality rates (CFRs)and emergency readmission (ERA) rates were calculated for different components of gynaecology workload. Funnel plots, using age-sex standardised measures, were displayed to compare the outcomes. MAIN OUTCOME MEASURES: CFRs and ERA rates. RESULTS: The CFR within 30 days after admission for patients with cancer was 5.1%. These patients accounted for only 3% of all the admissions but for 73% of all 30-day deaths. All other 30-day CFRs were extremely low-below 0.5%. The 30-day ERA rates ranged from 1.8% after day case care to 17.4% after emergency admissions for people who did not have an operation. Funnel plots showed considerable variation between hospitals for ERA after day case care but not after elective abdominal hysterectomy. CONCLUSIONS: There are no measures of mortality that could be used routinely and meaningfully to compare the performance of gynaecology units. We suggest that two suitable comparative measures of outcome, derivable from routine hospital statistics, are 30-day ERA rates after day case admissions and after elective abdominal hysterectomy, excluding those records with a cancer diagnosis. These measures are relatively homogeneous with respect to their likely rates of adverse events and have sufficient numbers to produce potentially useful comparative results.