Hospital Mortality Is Not the Way to Judge Quality

Cheryl Clark, for HealthLeaders Media , April 22, 2010

Instead of mortality rates, the authors propose these adjustments to better reflect hospital quality:

  • Mortality rates associated with high risk procedures that are heavily dependent on technical skill, such as intrauterine transfusion and heart surgery will detect poor practice quickly.
  • Non-mortality outcomes, such as rates of hospital acquired bloodstream infections, are "heavily influenced by quality of care.
  • Greater use of monitoring of clinical processes known to affect quality of care. "For example, if (an) audit of clinical processes shows that anticoagulants are not being given before hip replacement surgery, then it is clear where the hospital should direct its attention."

In an accompanying editorial, Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine, agreed that mortality should not be so heavily weighted as a measure of quality.

"Hospitals have taken on the role of providing a place for people to die," he said. "This makes it perverse to use a hospital's mortality statistics to judge its quality of care, given that deaths are often an expected and accepted outcome."

And, he said, mortality in a hospital "is exacerbated by geographical variation in the proportion of deaths that occur in a hospital, (40-65%) which reflect not only the availability of alternative forms of end of life care, such as hospices and community palliative services, but also cultural, religious, and socioeconomic characteristics of the local population."

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