Stop Using In-Hospital Mortality Rates to Judge Quality
"Right now, the NQF, which is supposed to be the keeper of good quality measures, is approving both kinds of measures," Drye says. "I would be happier if they put more weight on this particular downside of this hospital measure," although for some other conditions or procedures in which patients almost always die in a hospital, using in-hospital mortality statistics remains appropriate.
Drye and Krumholz found that for each of the three conditions, individual hospital mean length of stay varied between 2.3 to 3.7 days for patients with acute myocardial infarction, 3.5 to 11.9 days for those with congestive heart failure and 3.8 to 14.8 days for those with pneumonia.
The researchers found that, in looking at trends, patients are dying inside a hospital's walls much less often, from 8.2% to 4.5% between 1993-1994 and 2005-2006.
Drye notes that "the good thing about using 30-day measures is that it encourages the hospital to pay attention to what will happen to the patient afterwards. Hospitals have a big role in setting up that care: They decide where the patient is going to go, arrange follow-up appointments, communicate with the primary care provider and specialists like cardiologists, reconcile medications, and make sure the patient understands their plan."
"It's reasonable to say that hospitals have some responsibility for what happens when the patient leaves."
That responsibility will only intensify with accountable care models and as various sections of the Affordable Care Act are finalized with regulations that incentivize greater after-care attention that gives patients greater chances of survival.
"As we build more of these outcome measures," Drye added, "I think we'll see not just 30 days, but we'll be looking at other time frames as well, that will encourage the healthcare system to work more like a [cohesive] system."
Using 30-day mortality rates to compare hospital care for all non-Medicare patients with heart attack, congestive heart failure, and pneumonia seems fair, and avoids the variability that may disguise quality issues at hospitals with quicker discharge practices.
Not only will consumers get a more honest assessment of how their hospitals take care of them, but hospitals will get a better idea what they might need to improve, both while the patient is there and wherever they may end up, at least for 30 days.
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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