PT  - JOURNAL ARTICLE
AU  - Syrowatka, Ania
AU  - Li, Mingyang
AU  - Gu, Jing
AU  - Yin, Ling
AU  - Rice, Danielle
AU  - Gurevich, Yana
TI  - Use of linked data to assess the impact of including out-of-hospital deaths on 30-day in-hospital mortality indicators: a retrospective cohort study
AID  - 10.9778/cmajo.20210264
DP  - 2022 Sep 01
TA  - CMAJ Open
PG  - E882--E888
VI  - 10
IP  - 4
4099  - http://www.cmajopen.ca/content/10/4/E882.short
4100  - http://www.cmajopen.ca/content/10/4/E882.full
SO  - CMAJ2022 Sep 01; 10
AB  - Background: The Canadian Institute for Health Information (CIHI) annually reports on health system performance indicators, including various 30-day in-hospital mortality rates. We aimed to assess the impact of including out-of-hospital deaths on 3 CIHI indicators: 30-day acute myocardial infarction (AMI) in-hospital mortality, 30-day stroke in-hospital mortality and hospital deaths following major surgery.Methods: We followed national cohorts of patients admitted to hospital in 1 of 9 Canadian provinces for AMI, stroke and major surgery for 30-day all-cause mortality in 2 fiscal years (2011/12 and 2016/17). We calculated descriptive statistics to characterize the cohorts. The CIHI Discharge Abstract Database was linked with the Canadian Vital Statistics Death Database using a probabilistic algorithm to identify out-of-hospital deaths. We calculated absolute numbers, relative proportions and 30-day mortality rates for in-hospital, out-of-hospital and all deaths. We compared results between fiscal years.Results: We found that hospital admissions increased between fiscal years for each indicator; however, cohort characteristics remained consistent. In 2016/17, the number of out-of-hospital deaths that occurred was 325 for AMI, 545 for stroke and 820 for major surgery. The relative proportions of out-of-hospital deaths ranged from 12.3% for AMI to 14.9% for major surgery in 2016/17 (an increase from 10.6% and 13.1%, respectively, from 2011/12). In-hospital mortality rates improved over time for all 3 indicators, while out-of-hospital mortality rates remained consistent between fiscal years at 0.8% for AMI, 1.9%–2.0% for stroke and 0.2%–0.3% for major surgery.Interpretation: Improvements between fiscal years were attributable to reductions in in-hospital mortality, rather than deaths occurring outside of hospitals. Trends over time were the same for each indicator irrespective of whether in-hospital mortality or all deaths were measured.