Variability in COVID-19 in-hospital mortality rates between national health service trusts and regions in England: A national observational study for the Getting It Right First Time Programme.
COVID-19
Coronavirus
Mortality
Unwarranted variation
Variability
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
15
02
2021
revised:
30
03
2021
accepted:
01
04
2021
entrez:
3
5
2021
pubmed:
4
5
2021
medline:
4
5
2021
Statut:
ppublish
Résumé
A key first step in optimising COVID-19 patient outcomes during future case-surges is to learn from the experience within individual hospitals during the early stages of the pandemic. The aim of this study was to investigate the extent of variation in COVID-19 outcomes between National Health Service (NHS) hospital trusts and regions in England using data from March-July 2020. This was a retrospective observational study using the Hospital Episode Statistics administrative dataset. Patients aged ≥ 18 years who had a diagnosis of COVID-19 during a hospital stay in England that was completed between March 1st and July 31st, 2020 were included. In-hospital mortality was the primary outcome of interest. In secondary analysis, critical care admission, length of stay and mortality within 30 days of discharge were also investigated. Multilevel logistic regression was used to adjust for covariates. There were 86,356 patients with a confirmed diagnosis of COVID-19 included in the study, of whom 22,944 (26.6%) died in hospital with COVID-19 as the primary cause of death. After adjusting for covariates, the extent of the variation in-hospital mortality rates between hospital trusts and regions was relatively modest. Trusts with the largest baseline number of beds and a greater proportion of patients admitted to critical care had the lowest in-hospital mortality rates. There is little evidence of clustering of deaths within hospital trusts. There may be opportunities to learn from the experience of individual trusts to help prepare hospitals for future case-surges.
Sections du résumé
BACKGROUND
BACKGROUND
A key first step in optimising COVID-19 patient outcomes during future case-surges is to learn from the experience within individual hospitals during the early stages of the pandemic. The aim of this study was to investigate the extent of variation in COVID-19 outcomes between National Health Service (NHS) hospital trusts and regions in England using data from March-July 2020.
METHODS
METHODS
This was a retrospective observational study using the Hospital Episode Statistics administrative dataset. Patients aged ≥ 18 years who had a diagnosis of COVID-19 during a hospital stay in England that was completed between March 1st and July 31st, 2020 were included. In-hospital mortality was the primary outcome of interest. In secondary analysis, critical care admission, length of stay and mortality within 30 days of discharge were also investigated. Multilevel logistic regression was used to adjust for covariates.
FINDINGS
RESULTS
There were 86,356 patients with a confirmed diagnosis of COVID-19 included in the study, of whom 22,944 (26.6%) died in hospital with COVID-19 as the primary cause of death. After adjusting for covariates, the extent of the variation in-hospital mortality rates between hospital trusts and regions was relatively modest. Trusts with the largest baseline number of beds and a greater proportion of patients admitted to critical care had the lowest in-hospital mortality rates.
INTERPRETATION
CONCLUSIONS
There is little evidence of clustering of deaths within hospital trusts. There may be opportunities to learn from the experience of individual trusts to help prepare hospitals for future case-surges.
Identifiants
pubmed: 33937732
doi: 10.1016/j.eclinm.2021.100859
pii: S2589-5370(21)00139-5
pmc: PMC8072185
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100859Informations de copyright
© 2021 The Authors.
Déclaration de conflit d'intérêts
The authors declare that there is no conflict of interest.
Références
Lancet Respir Med. 2021 Apr;9(4):349-359
pubmed: 33444539
BMJ Open. 2020 Sep 29;10(9):e039749
pubmed: 32994257
Lancet Respir Med. 2021 Apr;9(4):397-406
pubmed: 33600777
PLoS One. 2020 Dec 10;15(12):e0243126
pubmed: 33301479
N Engl J Med. 2005 Jul 21;353(3):265-74
pubmed: 16034012
Lancet Glob Health. 2020 Aug;8(8):e1018-e1026
pubmed: 32622400
Am J Epidemiol. 2011 Mar 15;173(6):676-82
pubmed: 21330339
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Nature. 2020 Aug;584(7821):430-436
pubmed: 32640463
JAMA Intern Med. 2021 Apr 1;181(4):471-478
pubmed: 33351068
JAMA Intern Med. 2020 Nov 1;180(11):1436-1447
pubmed: 32667668
BMC Health Serv Res. 2017 Jan 23;17(1):71
pubmed: 28115018
Int J Environ Res Public Health. 2020 May 31;17(11):
pubmed: 32486403
Intensive Care Med. 2020 Sep;46(9):1779-1780
pubmed: 32572526
BMJ. 2020 Sep 9;370:m3339
pubmed: 32907855
Stat Med. 2005 Apr 30;24(8):1185-202
pubmed: 15568194