An aggregated hospital quality index based on traditional available activity data, a metric exposing change

Introduction: Considering two of the major pillars of performance comparison, theoretically (principles and feasibility) and practically (standardized and comparative indicators, and what our reporting possibilities are), a pyramid can be conceived. The apex is reserved for the few best hospitals, while the base is shared by other hospitals, which can serve as a common ground of comparison for all hospitals. We use three hospital metrics from Tirana University Hospital Center: ALOS (Average Length of Stay), BOR (Bed Occupancy Rate), and CM (Crude Mortality). The final dataset resulted in 730 observations over 51 clinics, ranging from January 2005 to December 2019. Method: All data were represented as the rate of the present year to the mean of all previous years in the database. ALOS rate, BOR rate, and CMR rate were the new standardized metrics used for comparison of clinics to each other through evaluation of each clinic to its historical self. The sum of the three metrics creates the Aggregated Rate, a unique value for each clinic comparable with others. The highest value is associated with lower performance. Results: Aggregated Rate, year 2019 as reference, classifies clinics in a quality scale, ranging from 1.54 to 5.9. The same calculation is performed for important ICD-9 three-digit diagnoses, ranging from 0.48 for ‘Other forms of chronic ischemic heart disease’ to 1.38 for ‘Acute appendicitis’. Conclusions: We recommend the construction of an Aggregated Rate interactive app as a hospital metrics quality indicator tool.