Measuring In-Hospital Mortality Favors Hospitals with Short Stays Reply

As a measure of performance and quality, in-hospital mortality systematically favors hospitals with shorter length of stay (LOS) times, according to a new study published in Annals of Internal Medicine. The finding may have important implications for quality improvement initiatives that use mortality as a performance measure.

Elizabeth Drye and colleagues analyzed Medicare data from 3.5 million hospital admissions for acute MI, heart failure, and pneumonia. They observed  wide variations in the LOS for each condition and large differences between the in-hospital and 30-day mortality rates. Performance ratings were different for a substantial number of hospitals based on the mortality assessment used.

Acute MI:

  • Mean LOS varied from 2.3 to 13.7 days
  • In-hospital mortality and 30 day mortality: 10.8% and 16.1%
  • 8.2% of hospitals had a change in performance classification based on type of mortality assessment


Heart Failure:

  • Mean LOS varied from 3.5 to 11.9 days
  • In-hospital mortality and 30 day mortality: 5.2% and 11.2%
  • 10.8% of hospitals had a change in performance classification based on type of mortality assessment
Pneumonia:
  • Mean LOS varied from 3.8 to 14.8 days
  • In-hospital mortality and 30 day mortality: 6.4% and 12.2%
  • 14.7% of hospitals had a change in performance classification based on type of mortality assessment

The authors concluded:

As the United States increases its use of outcome measures to assess and reimburse for quality and to evaluate system innovations, outcomes measures with standardized follow-up periods, which are unaffected by variation in LOS or transfer patterns, should be preferred over in-hospital measures. Building national databases of key outcomes that can be readily linked to patient data, such as mortality, would make measures that use standardized outcome periods more feasible and timely.

Advertisements

What do you think?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s