My next question refers to the number of years saved by patients from being treated in high-performing hospitals as opposed to low-performing ones (Table 2). It was quite a finding that regardless of hospital case-mix strata (whether patients were the healthiest or sickest), patients in high-performing hospitals saved from 0.83—1.07 years of life compared to low-performing hospitals. Interestingly, adjusting for clinical characteristics and treatment increased the years of life saved for the “healthiest” patients in case-mix 1 (from 1.07 to 1.20 and 1.14 years of life saved, respectively) but decreased the years of life saved for sicker patients in case-mix 2-4. For example, in case-mix 2, the adjustment for clinical characteristics decreased the years of life saved from 0.98 to 0.89, and the adjustment for treatment decreased the years from 0.98 to 0.74 (Table 2). Could the authors and experts comment on this result and provide potential explanations for why accounting for certain clinical characteristics and treatment would actually decrease the years of life saved for certain hospital case-mix strata.
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