Hospital mortality in older patients in the Brazilian Unified Health System, Southeast region
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | eng por |
Título da fonte: | Revista de Saúde Pública |
Texto Completo: | https://www.revistas.usp.br/rsp/article/view/148323 |
Resumo: | OBJECTIVE: To evaluate factors associated with hospital death in older inpatients for specific diseases of the circulatory system in the Brazilian Unified Health System considering the riskadjusted hospital mortality as an indicator of effectiveness. METHODS: The data were extracted from the Brazilian Hospital Information System. A total of 385,784 hospitalizations of older were selected for hypertensive diseases, ischemic heart disease, congestive heart failure, and stroke in the Brazilian Southeast region between 2011 and 2012. Age, sex, emergency admission, principal diagnosis, and two comorbidity indexes were included in the logistic regression for the risk adjustment of hospital death. The analyses were developed at two levels: hospitalization and hospital. RESULTS: A greater chance of death was observed with increasing age, emergency hospitalizations, stroke, presence of comorbidities, especially pneumonia and weight loss, hospitalizations for clinical care, and use of intensive care units. The risk-adjusted hospital mortality rate was 11.1% in for-profit private hospitals, 12.3% in non-profit private hospitals, and 14.4% in public hospitals, but there was great variability among the hospitals. The hospital standardized mortality ratio (ratio between observed and predicted deaths) ranged from 103.3% in non-profit private hospitals to 118.2% in for-profit private hospitals. CONCLUSIONS: Although the information source has its shortcomings, the ability for discrimination of the risk adjustment model was reasonable. The variability in the risk-adjusted hospital mortality was great and comparatively higher in for-profit private hospitals. Despite the limits, the results favor the use of the risk-adjusted hospital mortality in the monitoring of the quality of hospital care provided to the older adult. |
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Hospital mortality in older patients in the Brazilian Unified Health System, Southeast regionMortalidade hospitalar em pacientes idosos no Sistema Único de Saúde, região SudesteIdoso. Doenças Cardiovasculares. Mortalidade Hospitalar. Fatores de Risco. Qualidade da Assistência à Saúde. Sistema Único de Saúde.Aged. Cardiovascular Diseases. Hospital Mortality. Risk Factors. Quality of Health Care. Unified Health System.OBJECTIVE: To evaluate factors associated with hospital death in older inpatients for specific diseases of the circulatory system in the Brazilian Unified Health System considering the riskadjusted hospital mortality as an indicator of effectiveness. METHODS: The data were extracted from the Brazilian Hospital Information System. A total of 385,784 hospitalizations of older were selected for hypertensive diseases, ischemic heart disease, congestive heart failure, and stroke in the Brazilian Southeast region between 2011 and 2012. Age, sex, emergency admission, principal diagnosis, and two comorbidity indexes were included in the logistic regression for the risk adjustment of hospital death. The analyses were developed at two levels: hospitalization and hospital. RESULTS: A greater chance of death was observed with increasing age, emergency hospitalizations, stroke, presence of comorbidities, especially pneumonia and weight loss, hospitalizations for clinical care, and use of intensive care units. The risk-adjusted hospital mortality rate was 11.1% in for-profit private hospitals, 12.3% in non-profit private hospitals, and 14.4% in public hospitals, but there was great variability among the hospitals. The hospital standardized mortality ratio (ratio between observed and predicted deaths) ranged from 103.3% in non-profit private hospitals to 118.2% in for-profit private hospitals. CONCLUSIONS: Although the information source has its shortcomings, the ability for discrimination of the risk adjustment model was reasonable. The variability in the risk-adjusted hospital mortality was great and comparatively higher in for-profit private hospitals. Despite the limits, the results favor the use of the risk-adjusted hospital mortality in the monitoring of the quality of hospital care provided to the older adult.OBJETIVO: Avaliar fatores associados ao óbito hospitalar em idosos internados por doenças do aparelho circulatório específicas no Sistema Único de Saúde, considerando a mortalidade hospitalar ajustada como indicador de efetividade. MÉTODOS: As informações foram extraídas do Sistema de Informações Hospitalares. Foram selecionadas 385.784 internações de idosos por doenças hipertensivas, doença isquêmica do coração, insuficiência cardíaca congestiva e doenças cerebrovasculares, na região Sudeste entre 2011 e 2012. Idade, sexo, admissão de emergência, diagnóstico principal e dois índices de comorbidade foram incluídos na regressão logística para o ajuste do risco de óbito. As análises foram desenvolvidas em dois níveis: internação e hospital. RESULTADOS: Observou-se maior chance de morrer nas idades mais avançadas, nas internações de urgência, por doenças cerebrovasculares, com registro de comorbidade, especialmente pneumonia e perda de peso, nas internações para cuidado clínico e com uso de unidades de terapia intensiva. A taxa de mortalidade hospitalar ajustada foi 11,1% nos hospitais privados, 12,3% nos filantrópicos e 14,4% nos públicos, mas houve grande variabilidade entre hospitais. A razão de mortalidade hospitalar ajustada (razão entre óbitos observados e preditos) variou entre 103,3% nos hospitais filantrópicos e 118,2% nos hospitais privados. CONCLUSÕES: Embora haja insuficiências na fonte de informação, a capacidade de discriminação do modelo de ajuste de risco mostrou-se razoável. A variabilidade na mortalidade hospitalar ajustada foi ampla e comparativamente maior nos hospitais privados. Apesar dos limites, os resultados favorecem o uso da mortalidade hospitalar ajustada por risco no monitoramento da qualidade do cuidado hospitalar prestado ao idoso.Universidade de São Paulo. Faculdade de Saúde Pública2018-07-20info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfapplication/xmlhttps://www.revistas.usp.br/rsp/article/view/14832310.11606/S1518-8787.2018052000146Revista de Saúde Pública; Vol. 52 (2018); 69Revista de Saúde Pública; Vol. 52 (2018); 69Revista de Saúde Pública; v. 52 (2018); 691518-87870034-8910reponame:Revista de Saúde Públicainstname:Universidade de São Paulo (USP)instacron:USPengporhttps://www.revistas.usp.br/rsp/article/view/148323/141925https://www.revistas.usp.br/rsp/article/view/148323/141926https://www.revistas.usp.br/rsp/article/view/148323/148363Copyright (c) 2018 Revista de Saúde Públicainfo:eu-repo/semantics/openAccessCordeiro, PaulaMartins, Mônica2018-07-20T11:44:54Zoai:revistas.usp.br:article/148323Revistahttps://www.revistas.usp.br/rsp/indexONGhttps://www.revistas.usp.br/rsp/oairevsp@org.usp.br||revsp1@usp.br1518-87870034-8910opendoar:2018-07-20T11:44:54Revista de Saúde Pública - Universidade de São Paulo (USP)false |
dc.title.none.fl_str_mv |
Hospital mortality in older patients in the Brazilian Unified Health System, Southeast region Mortalidade hospitalar em pacientes idosos no Sistema Único de Saúde, região Sudeste |
title |
Hospital mortality in older patients in the Brazilian Unified Health System, Southeast region |
spellingShingle |
Hospital mortality in older patients in the Brazilian Unified Health System, Southeast region Cordeiro, Paula Idoso. Doenças Cardiovasculares. Mortalidade Hospitalar. Fatores de Risco. Qualidade da Assistência à Saúde. Sistema Único de Saúde. Aged. Cardiovascular Diseases. Hospital Mortality. Risk Factors. Quality of Health Care. Unified Health System. |
title_short |
Hospital mortality in older patients in the Brazilian Unified Health System, Southeast region |
title_full |
Hospital mortality in older patients in the Brazilian Unified Health System, Southeast region |
title_fullStr |
Hospital mortality in older patients in the Brazilian Unified Health System, Southeast region |
title_full_unstemmed |
Hospital mortality in older patients in the Brazilian Unified Health System, Southeast region |
title_sort |
Hospital mortality in older patients in the Brazilian Unified Health System, Southeast region |
author |
Cordeiro, Paula |
author_facet |
Cordeiro, Paula Martins, Mônica |
author_role |
author |
author2 |
Martins, Mônica |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Cordeiro, Paula Martins, Mônica |
dc.subject.por.fl_str_mv |
Idoso. Doenças Cardiovasculares. Mortalidade Hospitalar. Fatores de Risco. Qualidade da Assistência à Saúde. Sistema Único de Saúde. Aged. Cardiovascular Diseases. Hospital Mortality. Risk Factors. Quality of Health Care. Unified Health System. |
topic |
Idoso. Doenças Cardiovasculares. Mortalidade Hospitalar. Fatores de Risco. Qualidade da Assistência à Saúde. Sistema Único de Saúde. Aged. Cardiovascular Diseases. Hospital Mortality. Risk Factors. Quality of Health Care. Unified Health System. |
description |
OBJECTIVE: To evaluate factors associated with hospital death in older inpatients for specific diseases of the circulatory system in the Brazilian Unified Health System considering the riskadjusted hospital mortality as an indicator of effectiveness. METHODS: The data were extracted from the Brazilian Hospital Information System. A total of 385,784 hospitalizations of older were selected for hypertensive diseases, ischemic heart disease, congestive heart failure, and stroke in the Brazilian Southeast region between 2011 and 2012. Age, sex, emergency admission, principal diagnosis, and two comorbidity indexes were included in the logistic regression for the risk adjustment of hospital death. The analyses were developed at two levels: hospitalization and hospital. RESULTS: A greater chance of death was observed with increasing age, emergency hospitalizations, stroke, presence of comorbidities, especially pneumonia and weight loss, hospitalizations for clinical care, and use of intensive care units. The risk-adjusted hospital mortality rate was 11.1% in for-profit private hospitals, 12.3% in non-profit private hospitals, and 14.4% in public hospitals, but there was great variability among the hospitals. The hospital standardized mortality ratio (ratio between observed and predicted deaths) ranged from 103.3% in non-profit private hospitals to 118.2% in for-profit private hospitals. CONCLUSIONS: Although the information source has its shortcomings, the ability for discrimination of the risk adjustment model was reasonable. The variability in the risk-adjusted hospital mortality was great and comparatively higher in for-profit private hospitals. Despite the limits, the results favor the use of the risk-adjusted hospital mortality in the monitoring of the quality of hospital care provided to the older adult. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018-07-20 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/rsp/article/view/148323 10.11606/S1518-8787.2018052000146 |
url |
https://www.revistas.usp.br/rsp/article/view/148323 |
identifier_str_mv |
10.11606/S1518-8787.2018052000146 |
dc.language.iso.fl_str_mv |
eng por |
language |
eng por |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/rsp/article/view/148323/141925 https://www.revistas.usp.br/rsp/article/view/148323/141926 https://www.revistas.usp.br/rsp/article/view/148323/148363 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2018 Revista de Saúde Pública info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2018 Revista de Saúde Pública |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/pdf application/xml |
dc.publisher.none.fl_str_mv |
Universidade de São Paulo. Faculdade de Saúde Pública |
publisher.none.fl_str_mv |
Universidade de São Paulo. Faculdade de Saúde Pública |
dc.source.none.fl_str_mv |
Revista de Saúde Pública; Vol. 52 (2018); 69 Revista de Saúde Pública; Vol. 52 (2018); 69 Revista de Saúde Pública; v. 52 (2018); 69 1518-8787 0034-8910 reponame:Revista de Saúde Pública instname:Universidade de São Paulo (USP) instacron:USP |
instname_str |
Universidade de São Paulo (USP) |
instacron_str |
USP |
institution |
USP |
reponame_str |
Revista de Saúde Pública |
collection |
Revista de Saúde Pública |
repository.name.fl_str_mv |
Revista de Saúde Pública - Universidade de São Paulo (USP) |
repository.mail.fl_str_mv |
revsp@org.usp.br||revsp1@usp.br |
_version_ |
1800221799825276928 |