Comparison of hospital mortality rates after XXXX in New York State: a risk-adjusted population-based observational study.

@entity1 @entity204 @entity130
BACKGROUND: Severity-adjusted mortality is an unequivocal measure of burn care success. Hospitals can be compared on this metric using administrative data because information required for calculating statistically adjusted risk of mortality is routinely collected on hospital admission. METHODS: The New York State Department of Health provided information on all 13,113 thermally injured @entity1 hospitalized at 1 of 194 hospitals between 2004 and 2008. We compared hospital survival rates using a random effects logistic model of mortality that incorporated age and several predictors that were present on admission and captured as International Classification of Diseases-9 codes: burn surface area, @entity130 , three measures of physiologic compromise, and four medical comorbidities. Hospitals were compared on the adjusted odds of @entity204 and the number of excess @entity204 . RESULTS: Overall mortality was 3.2%. Nine high-volume hospitals (>100 @entity1 /year) cared for 83% of @entity1 with @entity130 . Overall variability of the odds of mortality among these high-volume centers was modest (median odds ratio=1.2) and we found little evidence for differences in the adjusted odds of mortality. A secondary analysis of the 185 low-volume hospitals that cared for 2,235 @entity1 disclosed only 24 @entity204 . When examined in aggregate, these hospitals had better than predicted risk-adjusted mortality; a logical explanation is judicious case selection. CONCLUSIONS: Administrative hospital discharge data are extensive and comparably enough collected to allow comparison of the performance of burn centers. Risk-adjusted models show that @entity1 have statistically indistinguishable risk-adjusted odds of mortality regardless of which hospital in New York State cared for them.
