Abstract | OBJECTIVE: DESIGN: Retrospective, observational, quality management study using administrative data to compare in-hospital mortality rates (pre and post an external peer review process that included adoption of improvement protocols) with reference values. SETTING: German general hospitals of a large, private group. PARTICIPANTS: Hospitals with mortality rates higher than reference values. INTERVENTIONS: Peer review of medical records by experienced, outside physicians triggered by in-hospital mortality rates higher than expected. Inadequacies were identified, improvement protocols enforced and mortality rates subsequently re-examined. MAIN OUTCOME MEASURES: Mortality rates 1 year before and 1 year after peer review and protocol use. RESULTS: For AMI, CHF, pneumonia, stroke, MV and colorectal surgery, the mortality rates 1 year post-peer review were significantly decreased as compared to pre-peer review mortality rates. The standardized mortality ratio for all of the above diagnoses was 1.45, 1 year before peer review, and 0.97, 1 year after peer review. The absolute risk reduction of 7.3% translates into 710 deaths in this population which could have been prevented. CONCLUSIONS: Peer review triggered and conducted in the manner described here is associated with a significant lowering of in-hospital mortality rates in hospitals that previously had higher than expected mortality rates.
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Authors | W Krahwinkel, E Schuler, M Liebetrau, A Meier-Hellmann, J Zacher, R Kuhlen, For the HELIOS Medical Board and HELIOS Working Group on Peer Reviewing |
Journal | International journal for quality in health care : journal of the International Society for Quality in Health Care
(Int J Qual Health Care)
Vol. 28
Issue 5
Pg. 594-600
(Oct 2016)
ISSN: 1464-3677 [Electronic] England |
PMID | 27424326
(Publication Type: Journal Article)
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Copyright | © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. |
Topics |
- Germany
(epidemiology)
- Humans
- Mortality
(trends)
- Peer Review
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