Killer Metric Separates Good Hospitals From Bad

Cheryl Clark, for HealthLeaders Media , June 27, 2013

The researchers' data was encompassing. It includes about 6.7 million admissions among Medicare beneficiaries at 2,322 hospitals in 2008 and 2009.

They explored 30-day mortality rates for nine conditions: stroke, arrhythmia, chronic obstructive pulmonary disease, respiratory tract infection, sepsis, urinary tract infection, gastrointestinal bleed, renal failure and esophagitis/gastroenteritis.

For a composite of 30-day mortality after surgical procedures, they chose procedures that were performed at least 10,000 times per year and which had a median mortality of more than 2%. Those included coronary artery bypass grafting, aortic valve repair, above-knee amputation, colon resection, small bowel resection, exploratory laparotomy, and pulmonary lobe resection, abdominal aortic aneurysm repair, esophagectomy, and pancreatectomy.

There was more from their conclusions.

"Top performing hospitals on the publicly reported conditions had 81% lower odds of being in the worst quartile of overall mortality." And these patterns also "persisted for the medical and surgical composites."

The correlations between low mortality hospitals versus high mortality ones were even more stark than those traditionally used, such as hospital size and teaching status.

So what is really going on? Are these hospitals' admitting physicians being secretively selective about which patients to admit for care, stealthily rejecting [moving to hospice care perhaps] those who look like they're at death's door?

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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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