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Casemix factors may not have been considered sufficiently
EDITOR,--The results of C J Todd and colleagues' audit report on 90 day mortality after admission to hospitals in East Anglia with fractured hip seem to suggest an impressive survival advantage if a patient is admitted to one particular hospital (hospital 6).1 The authors state that this is probably due to factors associated with the care provided at that hospital.
How can the authors be sure that other casemix factors did not account for the observed differences in 90 day mortality? The favourable "process" measures reported for hospital 6 (low rates of pressure sores and wound infections and the early mobilisation of patients) may have reflected excellent care but could equally have been a result of less sick patients being admitted in the first place and this not being detected with the casemix measures used in the multivariate analysis. For instance, could social class factors (smoking history, body mass index)
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- Differences in mortality after fracture of hip: the East Anglian audit
- C J Todd, C J Freeman, C Camilleri-Ferrante, C R Palmer, A Hyder, C E Laxton, M J Parker, B V Payne, and N Rushton
BMJ 1995 310: 904-908.[Abstract] [Full Text]
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