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Age and Ageing 2001; 30: 27-32
© 2001, British Geriatrics Society

Research papers

Pictorial outcome measures for the hospital care of older patients—a suggested toolkit

Paul F. Findlay, D. Gwyn Seymour,1, William R. Primrose and Yvonne Gibbons

Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, UK
1 Medicine for the Elderly, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK

Abstract

Objective: to propose three pictorial methods of presenting hospital outcome data, suitable for use in older patients entering medical specialties (including rehabilitation).

Patients: 224 patients (mean age 80.6 years, 56% female, 75% emergencies) admitted to a department of medicine for the elderly.

Presentational techniques: the methods we propose for the presentation of outcome data are (i) place of discharge, using a two-dimensional diagram; (ii) ‘survival’ analyses, but using discharge from hospital rather than death as the endpoint; and (iii) ‘phase diagrams’, a novel method of charting the progress of a cohort of patients. To illustrate these methods, the relationship between admission case-mix (with patients put into tertiles on the basis of their Barthel index score) and outcome is shown graphically.

Result: each of the three techniques has different relative strengths, but their pictorial nature allows for rapid interpretation of data, showing, for example, the marked influence of case-mix. Separate analyses of subgroups of patients (such as those who die in hospital and those who survive) are also readily attainable by the three methods.

Conclusions: the three methods of presenting outcome should be of benefit in comparing the performance of different units, particularly when case-mix is taken into account. The pictorial methods are complementary both to more conventional patient-based methods (mean duration of stay, median duration of stay, percentile duration of stay, regression analyses etc) and to modelling techniques using ‘census’ data from large numbers of patients.

Keywords: aged, Barthel index, case-mix, geriatrics, length of stay, outcome assessment


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