Inpatient hospital death rates are often used as a way to measure the quality of care of hospitals and are a determining factor in whether a hospital is investigated regarding its level of service. However, this method is being called into question as a way to judge the performance of a health care facility.
The reason for this is due to the fact that hospital mortality rates measure all deaths that occur on the premises, including the ones that might not have been preventable because the individual was too sick or injured at the time of admission. In light of this, a recent paper, published in the British Medical Journal, argues that this is not an actual measure of how well a hospital functions. In light of this, the facility in question should not be held accountable for these cases and they should not be a determining factor to judge a hospital’s performance. By some estimates, only 1 in 20 hospital deaths in the United States is actually preventable.
Currently, hospitals are judged to be “good” or “bad” based on what is known as standardized mortality ratios. A hospital is considered bad if more patients die than expected, and good if there are fewer deaths than expected. The value of the ratio is used by certain governments and watchdog agencies to evaluate a hospital and in some cases call for investigative measures.
The controversy arises from the fact that the ratios fail to account for variability among the patient population as well as the differences in patient care at each facility. Nonetheless, mortality is a commonly employed standard that is widely accepted. One reason for its appeal may be due to its convenience and simplicity. After all, mortality is easy to determine, and rather than find a more accurate means to measure performance, mortality ratios may simply be “good enough.”
However, the value of the ratio can have profound consequences on a hospital’s standing, and because of this, some experts are calling for the use of what they see as a more valid gauge of performance.
The authors of the study stress that they believe hospitals should be held accountable for the quality of care that they deliver, and that mortality is an important consideration. They simply feel that a more accurate measure should be employed that factors in conditions that are within a hospitals controls. This is especially important in light of the fact that the value of these mortality ratios may be used to issue punitive actions against the party under scrutiny.
One suggestion for a better way to gauge success is to look at blood infection rates in the intensive care unit, which leads to 31,000 deaths every year in this country. These deaths might be preventable through simple and cost effective steps that would reduce the rate of infections, including the use of a checklist.
And, in certain instances, death rates are a measure of quality, especially where death was potentially preventable, like after a heart attack or elective surgery.
The situation is a complicated one because it involves the lives of patients. With this in mind, more work needs to be done in order to investigate the issue and possibly find a more accurate way to determine a hospital’s performance and standing.
This post was in included in the latest blog carnival Health Wonk Review.