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

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

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