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Fig. 4 | BMC Medicine

Fig. 4

From: Hospital Mortality – a neglected but rich source of information supporting the transition to higher quality health systems in low and middle income countries

Fig. 4

The sensitivity of outcomes of LMIC hospital care to improved quality. This figure seeks to represent hypothetical relationships between the proportion of all mortality (Y Axis) that occurs outside and inside hospitals (blue and red lines respectively) as the strength of a health system and life expectancy increase (X axis). Here we assume that a proportion of all mortality is sensitive to quality of hospital care (dashed line) that first increases as access improves and then decreases as quality improves in parallel with an increase in the strength of a health system. In this simplified model the relationship between the distances represented by A and C is a measure of access that may be particularly important for conditions for which hospital based care might improve outcomes (eg. trauma; acute myocardial infarction; complications of childbirth; preterm birth). If the distance B represents the proportion of mortality that may be averted by better access to higher quality hospital care then in LMIC it is possible that the ratio of B:C (avoidable mortality) is considerably higher than in high income countries (located at the right extreme of the Y axis). With appropriate case-mix and case-severity adjustment mortality may therefore, be a better global metric of quality in LMIC hospitals than it is in high income countries

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