Impact of early death recording on international comparison of acute myocardial infarction mortality – administrative hospital data study using the example of Germany and the United States

Background In-hospital mortality from acute myocardial infarction (AMI) is widely used in international comparisons as an indicator of health system performance. Because of the high risk of early death after AMI, international comparisons may be biased by differences in the recording of early death...

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Bibliographic Details
Published in:BMC health services research Vol. 24; no. 1; pp. 593 - 10
Main Authors: Nimptsch, Ulrike, Mansky, Thomas, Busse, Reinhard
Format: Journal Article
Language:English
Published: London BioMed Central 07.05.2024
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Acute myocardial infarction
Administrative data
Adult
Aged
Aged, 80 and over
Comparative analysis
Diagnosis related groups
Diagnosis-Related Groups - statistics & numerical data
DRGs
Emergency medical care
Emergency Service, Hospital - statistics & numerical data
Fatalities
Female
Germany - epidemiology
Health Administration
Health care policy
Health Informatics
Health insurance
Heart attack
Heart attacks
Hospital
Hospital Mortality
Hospitals
Humans
International aspects
International comparisons
Length of stay
Male
Medical care
Medical coding
Medical records
Medicare
Medicine
Medicine & Public Health
Middle Aged
Mortality
Myocardial Infarction - mortality
Nursing Research
Patient outcomes
Patients
Public Health
Quality indicator
Quality management
Statistics
United States - epidemiology
United States
Germany
Serbia
United States > US
Administrative data
Hospital
Acute myocardial infarction
Mortality
Quality indicator
ISSN:1472-6963, 1472-6963
Online Access:Get full text
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Summary:Background In-hospital mortality from acute myocardial infarction (AMI) is widely used in international comparisons as an indicator of health system performance. Because of the high risk of early death after AMI, international comparisons may be biased by differences in the recording of early death cases in hospital inpatient data. This study examined whether differences in the recording of early deaths affect international comparisons of AMI in-hospital mortality by using the example of Germany and the United States, and explored approaches to address this issue. Methods The German Diagnosis-Related Groups Statistics (DRG Statistics), the U.S. National Inpatient Sample (NIS) and the U.S. Nationwide Emergency Department Sample (NEDS) were analysed from 2014 to 2019. Cases with treatment for AMI were identified in German and U.S. inpatient data. AMI deaths occurring in the emergency department (ED) without inpatient admission were extracted from NEDS data. 30-day in-hospital mortality figures were calculated according to the OECD indicator definition (unlinked data) and modified by including ED deaths, or excluding all same-day cases. Results German age-and-sex standardized 30-day in-hospital mortality was substantially higher compared to the U.S. (in 2019, 7.3% vs. 4.6%). The ratio of German vs. U.S. mortality was 1.6. After inclusion of ED deaths in U.S. data this ratio declined to 1.4. Exclusion of same-day cases in German and U.S. data led to a similar ratio. Conclusions While short-duration treatments due to early death are generally recorded in German inpatient data, in U.S. inpatient data those cases are partially missing. Excluding cases with short-duration treatment from the calculation of mortality indicators could be a feasible approach to account for differences in the recording of early deaths, that might be existent in other countries as well.
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ISSN:1472-6963
1472-6963
DOI:10.1186/s12913-024-11044-6