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Hospital Performance for Gastrointestinal Bleeding Mortality, Length of Stay, and Complication Rates in the USA

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Abstract

Background

Hospitals are held accountable for quality metrics, through public reporting programs and by payers. However, little is known about hospital performance in GIB nationally.

Methods

A retrospective longitudinal analysis utilizing Vizient’s database was performed to identify GIB hospitalizations across 349 hospitals from 2016 to 2018. The primary outcome was risk-adjusted mortality; secondary outcomes included risk-adjusted length of stay and complication rate. Trends in performance were characterized using quintiles, with analysis of concordance within hospitals and across hospitals over time. Pearson’s correlation coefficients were performed to assess the relationship among metrics.

Results

28.1% of hospitals had a steadily improving risk-adjusted mortality index from 2016 to 2018, while 15.5% were steadily worsening in mortality. For LOS, 25.2% of hospitals were improving, while 22.4% deteriorated. For complication rate, 22.9% of hospitals steadily improved, while 19.2% of hospitals deteriorated. Although many hospitals improved substantially in one outcome, they did not necessarily improve in all outcomes. Of the 98 hospitals that steadily improved in mortality from 2016 to 2018, only 8 out of 98 steadily improved in all three outcomes (8.3%). Across all 3 years, mortality was weakly correlated with LOS (r = 0.22, p < 0.001), but not with the rate of complications (r = 0.08, p = 0.12).

Conclusion

Hospital performance metrics for GIB, such as mortality, length of stay, and complication rate, are weakly correlated and thus likely measure different aspects of care. While many hospitals improved over time, few hospitals improved in all three metrics. Additionally, many hospitals are deteriorating over time, and further research is needed to determine which care processes are associated with better outcomes.

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Abbreviations

GIB:

Gastrointestinal bleeding

LOS:

Length of stay

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Acknowledgements

None.

Funding

NIH-NIDDK: K08DK120902-02.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, University of Pennsylvania, 3400 Civic Center Blvd, 7th floor Gastroenterology, Philadelphia, PA, 19104, USA

    Shazia Mehmood Siddique, Shivan J. Mehta, Afshin Parsikia & James D. Lewis

  2. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA

    Shazia Mehmood Siddique, Shivan J. Mehta, Mark D. Neuman & James D. Lewis

  3. Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA

    Mark D. Neuman

  4. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA

    James D. Lewis

Authors
  1. Shazia Mehmood Siddique
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  2. Shivan J. Mehta
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  3. Afshin Parsikia
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  4. Mark D. Neuman
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  5. James D. Lewis
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Contributions

SS wrote the manuscript; AP prepared the figures; All authors critically reviewed and edited the manuscript.

Corresponding author

Correspondence to Shazia Mehmood Siddique.

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The authors declare that there is no Conflict of interest.

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Appendix

Appendix

See Table 3.

Table 3 ICD-10 codes for GI bleeding
Full size table

For Appendix Tables 4, 5 and 6:

Category:

Improve = Change in outcome from 2016 to 2018 is >2 S.E.s improved

Steady = Change in outcome from 2016 to 2018 is within 2 S.E.s

Deteriorate = Change in outcome from 2016 to 2018 is >2 S.E.s worse

Pattern:

Steady: Directionality of change from 2016 to 2018 has a steady slope

Up-Down: Directionality of change from 2016 to 2017 is “up”/improved, and “down”/worse in 2018. Ultimately, how far away 2018 is from 2016 is captured by “category” as above.

Down-Up: Directionality of change from 2016 to 2017 is “down”/improved, and then “up”/improved in 2018. Ultimately, how far away 2018 is from 2016 is captured by “category” as above.

Table 4 Mortality index trends 2016–2018
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Table 5 Length of stay index trends 2016–2018
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Table 6 Complication rate trends 2016–2018
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See Figs. 4, 5 and 6.

Fig. 4
figure 4

Mortality heat map. Each row represents an individual hospital, and the heat map shows the quintile over time

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Fig. 5
figure 5

Length of stay heat map. Each row represents an individual hospital, and the heat map shows the quintile over time

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Fig. 6
figure 6

Complication rate heat map. Each row represents an individual hospital, and the heat map shows the quintile over time

Full size image

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Siddique, S.M., Mehta, S.J., Parsikia, A. et al. Hospital Performance for Gastrointestinal Bleeding Mortality, Length of Stay, and Complication Rates in the USA. Dig Dis Sci 67, 4678–4686 (2022). https://doi.org/10.1007/s10620-021-07345-z

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  • DOI: https://doi.org/10.1007/s10620-021-07345-z

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