Mortality Rates at CAHs Ratcheting Higher

John Commins, for HealthLeaders Media , April 3, 2013

"They said we don't participate in quality reporting or quality initiatives. I don't know where they got that notion. We've done so much of it. We are reporting well over 100 data points now and the great bulk of the CAHs are doing that. They obviously never went out to a CAH."

"I don't need more paperwork. I've had to divert way too many staff hours to that kind of crap already. I am not really thrilled about having to do more of it."

Joynt concedes that the use of administrative data for clinical studies has limitations "but it doesn't make it useless."

"Administrative data can show us a pattern and then we need clinical and qualitative data to understand why," she says. "The wrong response to this paper would be to say there is obviously no problem. This is all a trick of administrative data. That is a little biased."

"It's not fake data. These are real people. They are dead. These are Medicare patients, someone's grandmother who died. It is true that administrative data will give you statistically significant results for very small differences because we have millions of people. That is a sample size issue. But the differences particularly for acute MI are clinically relevant. It is more than a one-third higher mortality over the last decade for heart attacks where the rest of the country has been improving care for heart attacks. That is not write-off-able," Joynt said.

"The data doesn't tell us the details about why and it doesn't tell us how we can fix it. It tells us maybe there is a problem here. Let's stop ignoring these hospitals and see if we can think creatively to help rural patients do better."

John Commins is a senior editor with HealthLeaders Media.

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