Analyzing hospital mortality: the consequences of diversity in patient mix

Article Abstract:

To determine which hospitals are providing good health care, focus quality assurance reviews, and aid patients in making informed choices about health care facilities, the Health Care Financing Administration (HCFA) has published the death rates of hospitalized Medicare patients at more than 5,000 hospitals each year since 1987. Insurance companies, hospital associations, and other private groups also offer comparisons of expected and actual mortality. However, whether hospitals designated ''high-mortality outliers'' (that is, hospitals reported to have high death rates) offer substandard care or serve higher-risk populations is not clear, although the models used for analysis try to account for these variations. To determine whether the HCFA adjustment procedure was adequate, 187 ''high-mortality outliers'' were compared with 5,373 other hospitals. The results indicate that the HCFA analysis is biased against hospitals with a disproportionate number of elderly and long-term care patients. In addition, the case mix variable is poorly constructed, and often fails to identify nursing home transfer patients as well as clinical risk categories. Hospitals serving the very old are at a disadvantage because patients are often admitted for comfort care during a terminal illness. Many of these patients specify ''do not resuscitate'' (DNR) orders. However, every death within 30 days of a hospital admission is considered a negative event, and will reflect badly on the hospital. Once adjustments were made for severity of illness and DNR orders, almost half of the hospitals labelled ''high-mortality outliers'' no longer deserved the designation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

---

Hospital leaders' opinions of the HCFA mortality data

Article Abstract:

The opinions of hospital leaders were surveyed for their reactions to a study conducted by the Health Care Financing Administration (HCFA) on hospital mortalities. The HCFA publishes an annual report that compares predicted and actual rates of hospital mortalities. Much controversy has been generated by these reports and the results have been questioned, based on the assertion that the HCFA uses a flawed prediction model. A nationwide survey was distributed and 195 hospital executives participated. No correlations were found between the HCFA rating of specific hospitals and the opinions of these hospitals; all respondents reported negative views on the results of this study. Generally, hospital leaders found the HCFA report to be inaccurate, flawed in interpretation, and useless. Seventy percent of the respondents felt the data obtained was of no use to the hospital, 54 percent felt the accuracy was poor, and 85 percent believed the data was also useless to the consumer. The hospitals with the highest mortality rates (according to the HCFA report) were more likely to utilize the data and reported the highest rates of problems generated from the report. This response reflects the high degree of mistrust of the HCFA by hospital leaders. Efforts towards mutual cooperation and better communication should be encouraged. It is probable that the attitudes of these hospital leaders indicate resistance against efforts to report hospital mortalities and monitor the quality of patient care in this country's hospitals.

United States, Hospital administrators

---

The importance of severity of illness in assessing hospital mortality

Article Abstract:

The Health Care Financing Administration (HCFA) publishes an annual report that compares predicted and actual rates of hospital mortalities. Much controversy has been generated by these reports and the accuracy of the results has been questioned, based on the assertion that the HCFA uses a flawed prediction model. A quantitative comparison was made of the methodology used by the HCFA and a similar model which also includes severity of illness as a measure. Thirteen hospitals were used to obtain data on 34,252 Medicare patients who fell into one of five diagnostic categories and who had various risk statuses. The severity measure used was the Severity of Illness Index from which a Stage of Principal Diagnosis at Admission was derived. Use of this measure significantly changed the results of predicted mortality rates; it was capable of differentiating among patients based on their health status at the time of admission, which the HCFA model could not do. In addition, the HCFA report did not differentiate between hospitals that had high percentages of low-severity admissions and those that had many high-severity admissions. The HCFA has provided momentum toward the goal of developing accurate measures for the quality of hospital care. However, their yearly mortality study does not utilize a model that provides for wide variations in the conditions of patients and is not sensitive enough to be considered an accurate representation of the quality of hospital care in this country.

Hospitals, Hospital admission and discharge

Similar abstracts:

• Abstracts: Low blood-sugar blues: the consequences of crash diets. Get the most out of milk. Sweet or sour
• Abstracts: A clinical trial of the effects of dietary patterns on blood pressure. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet
• Abstracts: Physical fitness and all-cause mortality: a prospective study of healthy men and women. Changes in physical fitness and all-cause mortality: a prospective study of healthy and unhealthy men
• Abstracts: Fetal biometry as a screening tool for the detection of chromosomally abnormal pregnancies. Sonographically measured nuchal skinfold thickness as a screening tool for Down syndrome: results of a prospective clinical trial
• Abstracts: Prevalence of antiphospholipid antibodies in patients with fetal loss. Risk factors for thrombosis in lupus patients

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.