Hospital mortality in older patients in the Brazilian Unified Health System, Southeast region

OBJECTIVE: To evaluate factors associated with hospital death in older inpatients for specific diseases of the circulatory system in the Brazilian Unified Health System considering the risk-adjusted hospital mortality as an indicator of effectiveness. METHODS: The data were extracted from the Brazilian Hospital Information System. A total of 385,784 hospitalizations of older were selected for hypertensive diseases, ischemic heart disease, congestive heart failure, and stroke in the Brazilian Southeast region between 2011 and 2012. Age, sex, emergency admission, principal diagnosis, and two comorbidity indexes were included in the logistic regression for the risk adjustment of hospital death. The analyses were developed at two levels: hospitalization and hospital. RESULTS: A greater chance of death was observed with increasing age, emergency hospitalizations, stroke, presence of comorbidities, especially pneumonia and weight loss, hospitalizations for clinical care, and use of intensive care units. The risk-adjusted hospital mortality rate was 11.1% in for-profit private hospitals, 12.3% in non-profit private hospitals, and 14.4% in public hospitals, but there was great variability among the hospitals. The hospital standardized mortality ratio (ratio between observed and predicted deaths) ranged from 103.3% in non-profit private hospitals to 118.2% in for-profit private hospitals. CONCLUSIONS: Although the information source has its shortcomings, the ability for discrimination of the risk adjustment model was reasonable. The variability in the risk-adjusted hospital mortality was great and comparatively higher in for-profit private hospitals. Despite the limits, the results favor the use of the risk-adjusted hospital mortality in the monitoring of the quality of hospital care provided to the older adult.