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