Killer Metric Separates Good Hospitals From Bad

Cheryl Clark, for HealthLeaders Media , June 27, 2013

So, what's going on at these good hospitals, I asked.

Joynt explains that the finding "seems to have something to do with leadership and culture in a hospital, beyond [the performance] of any individual physician or service line."

She adds that unlike the three main conditions now publicly reported, the other conditions they studied don't come with a high chance of post-discharge death.

"If you think about the people we're including in this analysis—for example surgical patients and medical patients—they are coming in for things where death rates are not that high, 1% or 2%, like arrhythmia or chest pain, or some of the gastrointestinal disorders," Joynt says. "The majority of patients that you bring in to do an elective surgical procedure shouldn't be ones that you would expect would end badly."

Hospitals that, do well on 30-day mortality for one of the three conditions, say pneumonia, are likely to do well in the other two. This much was already known.

See Also: Best and Worst Hospitals for 30-Day Mortality

But I wondered if that might not be simply because hospitals have been aware for the last three years that those conditions were ripe to be targeted for measurement.

What we didn't know, until now, is that performance is largely extendable.

"Top-performing hospitals on the publicly reported conditions had more than a five-fold higher odds of being in the best quartile of overall risk-adjusted hospital mortality compared with other hospitals," the report says. "Odds ratios remained statistically significant when we considered medical and surgical mortality separately."

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1 comments on "Killer Metric Separates Good Hospitals From Bad"

Mary K (6/27/2013 at 3:07 PM)
Unfortunately, I don't have access to the JAMA article to review possible answers to my questions, but I wonder if some of the 30-day mortality could be attributed to health literacy levels of the patients, access to medications, and gaps in access to follow-up care. These would indicate less of a problem with the hospital (and culture) and a bigger issue with society and aid organizations to alleviate care gaps.




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