Quality control of hospitals and its effect on hospitalized fatality rate of COVID-19

The reported fatality rate of COVID-19 was significantly differ between different countries, provinces in a country, and hospitals in a province. It is important to find and analysed the source of variation in fatality rates to control future epidemics of infection disease. This study propose an approach to investigates the hospital quality of care and its impact on the in-hospital fatality rates of COVID-19 among over 30 years old patients in Iran. The study included 78,217 COVID-19 hospitalized patients over 30 years old from 34 hospitals in Razavi Khorasan province between January 20, 2020, and June 20, 2021. Attribute control charts were employed to evaluate the quality of care in hospitals during four peaks of COVID-19. To account for the impact of hospital quality on in-hospital fatality rates by adjusting on patient characteristics, two predictive models; Poisson and Binomial regression were utilized. The adjusted odds ratio of COVID-19 fatality in no quality confirmed (NQC) hospitals to the quality confirmed (QC) hospitals is 3.48 C.I.95% (2.38, 5.10) at the first peak among patients without other risk factors. The significant negative interactions with QC and peaks indicates that the provision of quality care serves to mitigate the risk of fatality in NQC hospitals during these peaks. The significant negative interaction between diabetes and QC demonstrated that the relative risk in NQC hospitals for no diabetes patient is higher than diabetic patients. There is no significant interaction between age, SaO2, and ARDS with QC; it means that the odds of fatality in NQC hospitals is not depends to these factors. The use of attribute control charts facilitated timely identification of trends and outliers, enabling proactive interventions to enhance patient care. This research underscores the critical role of hospital quality in managing patient outcomes during the COVID-19 pandemic and emphasizes the necessity for continuous monitoring and quality improvement initiatives in healthcare settings. The findings advocate for collaborative efforts among healthcare providers to implement best practices, particularly during surges in cases, to optimize resource allocation and improve overall quality of care.