Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort studyBMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4416 (Published 29 July 2019) Cite this as: BMJ 2019;366:l4416
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Re: Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study
The quality of medical care is an intertemporal but also timely topic because outcomes can vary widely among hospitals and physicians. This has generated the need for more accurate hospital and medical quality indicators, especially among patients suffering from complex medical conditions. Thus, there is a current belief that individual outcome measures, such as mortality, morbidity, length of stay (LOS), and readmission, should be substituted by more complete composite benchmarks that will reflect multiple domains of overall medical outcome and hospital quality.
There is an ongoing interest regarding a relatively new concept, the textbook outcomes (TO), which provides a comprehensive summary of patient hospital performance. TO are considered desirable outcomes that, when achieved, represent the ideal ‘’textbook’’ hospitalization. The theoretical advantage of this concept is that it practically defines an overall quality index across all domains framing in-hospital performance. Another advantage might be the easier interpretation of outcomes physicians and patients. The latter is of great interest since the TO concept might generate a more patient-centered perspective of ideal outcomes after any hospitalization.
So far, TO outcomes have been evaluated in multiple surgical settings. To my knowledge, the use of TO to define quality among patients with acute pulmonary embolism has not been evaluated. The use of multi-institutional databases to address clinical questions has obvious advantages regarding administrative biases of national or institutional ones. I was wondering whether the authors could use their database to define and describe TO in patients with acute pulmonary embolism, including all parameters defining TO for acute pulmoary embolism, such as 30 day mortality, any complication, readmission in 30 days, prolonged length of stay (>50th percentile), ICU admission, non compliance with anticoagulants, bleeding and unexpected interventions. In this way they could also assess hospital volume variation associated with the TO composite measure.
More and more opinion leaders qualify TO as a reliable quality index of care. In particular, data on a single indicator do not reflect the whole medical process and may not reliably measure overall hospital quality. Composite measures combine information from multiple domains into a single summary measure and therefore may be superior to individual measures for the analysis of hospital performance.
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Competing interests: No competing interests