Two new CHE research papers

Understanding the differences in in-hospital mortality between Scotland and England

Maria Jose Aragon,Martin Chalkley 

We describe differences in in-hospital mortality between Scotland and England and test whether these differences are robust to controlling for the case-mix of patients. In spite of Scotland and England having much in common in regard to their hospital systems and populations we observe trends in-hospital mortality – the percentage of elective and emergency Continuous Inpatient Spells (CIS) that ended in death – that are different: England’s in-hospital mortality rates have decreased faster than Scotland’s for both types of admissions. CHE Research Paper 104 (PDF , 1,821kb)

The impact of hospital financing on the quality of inpatient care in England 

Stephen Martin, Andrew Street, Lu Han and John Hutton

We assess the impact of the English version of prospective payment, termed Payment by Results (PbR), on hospital quality, as measured by in-hospital mortality and 28-day emergency readmission. To do this, we exploit the phased introduction of PbR across hospitals and across three treatments (hip replacement, hernia repair and stroke) which were exposed to PbR at different times. We estimate regression models to analyse factors associated with patient survival and readmission for all those admitted for hip replacement (n=499,555), hernia repair (n=414,959) or following stroke (n=487,040) between 2002/3 and 2007/8. Factors include patient and hospital characteristics and the proportion of hospital income derived from PbR. We find that the probability of survival improved over time while changes in crude readmission rates varied by condition. Patient characteristics are important at explaining survival and readmission, and hospital size and specialisation also appear significant, though not consistently so across conditions or time. The
probability of surviving stroke is lower for those admitted over the weekend. Given the high mortality rate for stroke, it is critical to account for the probability of surviving the initial admission when evaluating readmissions. PbR does not appear to have influenced the probability of survival or readmission. CHE Research Paper 105 (PDF , 1,930kb)‌

Other papers in this series can be found at: In house publications