Navigation Links
Mortality rates are an unreliable metric for assessing hospital quality, study finds
Date:12/22/2010

BOSTON (December 22, 2010) -- Is quality in the eye of the beholder?

Researchers at Harvard Medical School and Massachusetts General Hospital have found wide disparities among four common measures of hospital-wide mortality rates, with competing methods yielding both higher- and lower-than-expected rates for the same Massachusetts hospitals during the same year.

The findings, published Dec. 23 in a special article in the New England Journal of Medicine, stoke a simmering debate over the value of hospital-wide mortality rates as a yardstick for health care quality. The measure, which compares a hospital's actual patient death rate to statistical predictions, is reported publicly in countries including England, Canada and Denmark, but some hospitals and policy experts have questioned its value due to the complexity and variability of diagnoses.

"It's troubling that four different methods for calculating hospital mortality rates as a measure of quality should yield such different results," said lead author David M. Shahian, HMS professor of surgery at Massachusetts General Hospital. "Measurement theorynot to mention plain common sensesuggests there is a problem."

The potential of performance evaluation to improve both the quality and the cost of health care has fueled interest in provider "report cards," including mandates by state and federal law.

In 2008, the Massachusetts Division of Health Care Finance and Policy engaged researchers Shahian; Lisa I. Iezzoni, HMS professor of medicine at Mass General; and Sharon-Lise T. Normand, HMS professor of health care policy (biostatistics) and professor in the Department of Biostatistics at Harvard School of Public Health, to evaluate four vendor-created measures of hospital-wide mortality. The state was looking for a means to measure hospital quality for the public report cards mandated under its 2006 health care reform law.

The researchers compared four measures of hospital-wide mortality provided by commercial vendors. These vendors all believed that their hospital-wide mortality measures were an accurate reflection of hospital quality. Each vendor received identical datathree years of patient discharge data from all 83 general acute care hospitals in Massachusetts, representing 2.5 million dischargesand used the data to calculate each hospital's mortality rate. The researchers then compared results.

"The results of the horse race are that it's really not clear who won," said Iezzoni, who also is the director of the Mongan Institute for Health Policy at Mass General. "The problem is that we were measuring the success of each of these measures against a gold standard we simply do not have: an objective measure of hospital quality."

Without that gold standard, the researchers were left to compare vendor tools with one another. Their conclusion: Methods and results varied widely. For example, every tool excluded some discharges from its calculations based on the details of each. But where one tool excluded 5 percent of all discharges, another excluded 72 percent.

Even so, a high degree of convergencedifferent methods yielding similar final resultscould have supported the validity of this approach to estimating hospital quality. But that's not what researchers found. For example: Of 28 hospitals designated by one method as having higher-than-expected hospital-wide mortality in 2006, 12 were simultaneously classified as having lower-than-expected mortality by at least one other method.

In August, the researchers told the state that they could not recommend any of the four vendor-created tools. "But the results should not be interpreted as an indictment of any particular technique," said Normand. "Rather, they call into question the concept of measurement of hospital-wide mortality, as four different methods yielded four different results. Thus, this may not be a good way to assess hospital quality."

The authors are longtime advocates of performance assessment and public reporting to provide transparency and accountability in health care.

Normand developed the statistical models used by Medicare and Medicaid for public reporting of heart attack, heart failure and pneumonia mortality rates. Shahian has been a leader in the public reporting initiative of the Society of Thoracic Surgeons. Together, they were leaders in developing and implementing public report cards for coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) in Massachusetts.

But where mortality rates may reflect clearly the quality of care for some procedures, like coronary bypass, they may reveal less about care for other conditions, such as major trauma or advanced malignancy.

"An alternative to hospital-wide mortality rates would be to construct a more limited portfolio of mortality results for individual common conditions such as heart attack, stroke, pneumonia, CABG surgery and PCI," said Shahian. "These have the advantage of large sample sizes at most hospitals, a generally accepted association between mortality and quality of care, and credible risk models to adjust for patient severity."

Iezzoni, an internationally recognized expert in risk adjustment, has edited Risk Adjustment for Measuring Health Care Outcomes, now in its third edition.

"Underlying this finding is the more fundamental and as yet unanswered question about whether hospital-wide mortality rates provide meaningful insight into hospital quality," she said.


'/>"/>

Contact: Katie DuBoff
communications@hms.harvard.edu
617-432-0442
Harvard Medical School
Source:Eurekalert

Related medicine news :

1. Vitamin D and parathyroid hormone levels may not affect cardiovascular mortality
2. No difference in nonsuicide mortality between 2 anti-psychotic drugs
3. Helical CT scans reduce lung cancer mortality by 20% compared to chest X-rays
4. Mayo researchers find mortality rates from liver diseases underestimated
5. Chicago racial disparities in breast cancer mortality significantly higher than national average
6. Hormone therapy increases invasive breast cancer and mortality, WHI 11-year follow up finds
7. Henry Ford Hospital study: hVISA linked to high mortality
8. Award-winning study: Hardening of the arteries doubles the risk of mortality
9. Estrogen not associated with lung cancer incidence and mortality among postmenopausal women
10. Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births
11. Minor kidney damage in people with type 1 diabetes leads to increased mortality
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/11/2016)... ... February 11, 2016 , ... Student-doctors from Western University ... Match Program Tuesday, February 9, taking one of the final steps in their ... education positions across the country. Of the 103 student-doctors who comprise the College ...
(Date:2/11/2016)... ... February 11, 2016 , ... Image One USA ... new market, and it’s the buildings of Nashville that will benefit. , “I’ve enjoyed ... to relocate to Nashville, there was no question that I would bring my business ...
(Date:2/11/2016)... ... 11, 2016 , ... Thermi™, a world leader in thermistor-regulated ... the promotions of Allison Kelly to executive vice president of the company’s new ... of North American capital sales, and Wendy Oseas to vice president of global ...
(Date:2/11/2016)... Australia (PRWEB) , ... February 11, 2016 , ... ... potential ?" motivational speaker, trainer and author Ray Clarke poses a question as ... personal fulfillment . In his book, "Being in the Being" (published by Partridge ...
(Date:2/11/2016)... ... February 11, 2016 , ... AccuVein Inc. announces the ... Standards of Practice, to include vascular visualization as a standard practice. AccuVein ( ... of the market, facilitates adherence to this standard with its easy to use, ...
Breaking Medicine News(10 mins):
(Date:2/11/2016)... Feb. 11, 2016  Kindred Biosciences, Inc. (NASDAQ: ... improving the lives of pets, today announced the submission ... New Animal Drug Application (NADA) for Zimeta™ (dipyrone injection, ... (KB0120) of Zimeta for the control of pyrexia (fever) ... --> --> The Chemistry, ...
(Date:2/11/2016)... Potrero Medical, Inc., the developer of the Accuryn™ ... of George M. Rapier, III , MD, to its ... , WellMed is one of the nation,s largest physician owned ... in Texas and Florida ... own internal medicine practice, he has been instrumental to the ...
(Date:2/11/2016)... Feb. 11, 2016  AfterPill.com is reporting that this ... abstinence for all women who are at risk of ... each year and raises the risks of unprotected sex ... --> According to the Guttmacher Institute, there are ... of child-bearing age, who have sex without the intention ...
Breaking Medicine Technology: