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

ality."

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.


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

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