Suchergebnisse

Objective To assess between-hospital variations in standardized in-hospital mortality ratios of community-acquired pneumonia (CAP), and identify possible leads for quality improvement. Design We used an administrative database to estimate standardized in-hospital mortality ratios for 111 Belgian hospitals, by carrying out a set of hierarchical logistic regression models, intended to disentangle therapeutic attitudes and biases. To facilitate the detection of false-negative/positive results, we added an inconclusive zone to the funnel plots, derived from the results of the study. Data quality was validated by comparison with (i) alternative data from the largest Belgian Sickness Fund, (ii) published German hospital data and (iii) the results of an on-site audit. Setting All Belgian hospital discharge records from 2004 to 2007. Study participants A total of 111 776 adult patients were admitted for CAP. Main outcome measure Risk-adjusted standardized in-hospital mortality ratios. Results Out of the 111 hospitals, we identified five and six outlying hospitals, with standardized mortality ratios of CAP consistently on the extremes of the distribution, as providing possibly better or worse care, respectively, and 18 other hospitals as having possible quality weaknesses/strengths. At the individuals' level of the analysis, adjusted odds ratios showed the paramount importance of old age, comorbidity and mechanical ventilation. The data compared well with the different validation sources. Conclusions Despite the limitations inherent to administrative data, it seemed possible to establish inter-hospital differences in standardized in-hospital mortality ratios of CAP and to identify leads for quality improvement. Monitoring is needed to assess progress in quality. ; A.B.'s participation is funded by the University of Antwerp (UA)'s concerted research action number 23405 (BOF-GOA). N.H. holds the UA Scientific Chair in Evidence Based Vaccinology, financed in 2011-2014 by a gift from Pfizer. G.M., P.B., N.H. and A.B. acknowledge support from a Methusalem research grant from the Flemish government. G.M. and N.H. received funding from IAP research Network P7/06 of the Belgian Government (Belgian Science Policy).

In 2006, Belgium was the first country in the European Union to recommend rotavirus vaccination in the routine infant vaccination schedule and rapidly achieved high vaccine uptake (86-89% in 2007). We used regional and national data sources up to 7 years post-vaccination to study the impact of vaccination on laboratory-confirmed rotavirus cases and rotavirus-related hospitalisations and deaths. We showed that (i) from 2007 until 2013, vaccination coverage remained at 79-88% for a complete course, (ii) in children 0-2 years, rotavirus cases decreased by 79% (95% confidence intervals (CI): 68-89%) in 2008-2014 compared to the pre-vaccination period (1999-2006) and by 50% (95% CI: 14-82%) in the age group >= 10 years, (iii) hospitalisations for rotavirus gastroenteritis decreased by 87% (95% CI: 84-90%) in 2008-2012 compared to the pre-vaccination period (2002-2006), (iv) median age of rotavirus cases increased from 12 months to 17 months and (v) the rotavirus seasonal peak was reduced and delayed in all post-vaccination years. The substantial decline in rotavirus gastroenteritis requiring hospitalisations and in rotavirus activity following introduction of rotavirus vaccination is sustained over time and more pronounced in the target age group, but with evidence of herd immunity. ; JB is supported by a postdoctoral grant from the Research Foundation - Flanders (FWO). BO is supported by a PhD fellowship from the Research Foundation - Flanders (FWO). AB is supported by the University of Antwerp's concerted research action number 23405 (BOF-GOA). The authors thank the sentinel laboratory network for their collaboration.