Why Process Measures Fail to Budge 30-Day Mortality Rates
In defense of the HQID result Premier issued a statement from vice president Blair Childs that said in part, "It's important to remember that the HQID was a first of its kind effort, predating most measures and public reporting programs in place today.
"As such, it's simply not fair to judge the measures selected 10 years ago against today's standards. Hindsight is 20/20—we won't ever be happy looking backward because the evidence will always evolve. If we were to design something today, using today's evidence, the measure set might look very different."
And Premier reiterated some of the points made by Yancy regarding the arbitrary cutoff of 30-day mortality.
"Too often, people have behaved as if the 30-day measurement of mortality is the gold standard in determining effectiveness; it is not. In many cases 30-day mortality is a very blunt measure of quality.
"First, it is in many conditions a relatively rare event. Second it comprises an extremely narrow time frame. Most studies set up to evaluate interventions, like the many of the evidence-based care processes we currently measure, evaluate long-term outcomes. No one expects these interventions will necessarily impact 30-day mortality,"
The next few years should help us know more about how improve the ultimate measure: the number of potentially preventable patient deaths.
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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