Surgery/Hospitalization

Published reports of in-hospital deaths for certain conditions may not accurately portray outcomes of hospital care

In-hospital deaths from five major conditions declined once Cleveland hospitals and physicians began to publicly report in-hospital deaths from those conditions. However, deaths within 30 days of hospital discharge declined for only two of the conditions and increased significantly for another, according to a study supported by the Agency for Healthcare Research and Quality (HS09969). Using in-hospital mortality rates to monitor trends in outcomes for hospitalized patients may lead to misleading conclusions, according to David W. Baker, M.D., M.P.H., of Case Western Reserve University.

Dr. Baker and his colleagues examined mortality trends from 1991-1997 for Medicare patients hospitalized with acute myocardial infarction (AMI, heart attack), congestive heart failure (CHF), gastrointestinal hemorrhage (GIH), chronic obstructive pulmonary disease (COPD), pneumonia, or stroke during the Cleveland Health Quality Choice program. This program shared information on hospitals' mortality rates and length of stay (adjusted for level of patient risk) with coalition members (businesses, hospitals, and physicians) and published it in two data reports per year.

During the study period, risk-adjusted in-hospital mortality declined significantly for all conditions except stroke and GIH, with absolute declines ranging from -2.1 percent for COPD to -4.8 percent for pneumonia. However, mortality rates in the early postdischarge period rose significantly for all conditions except COPD, with increases ranging from 1.4 percent for GIH to 3.8 percent for stroke. As a result, 30-day mortality was fairly flat, and for stroke, the risk-adjusted 30-day mortality rate actually increased by 4.3 percent. The researchers conclude that use of published hospital report cards for hospital profiling remains an unproven strategy for improving outcomes of care for medical conditions.

See "Mortality trends during a program that publicly reported hospital performance," by Dr. Baker, Doug Einstadter, M.D., M.P.H., Charles L. Thomas, B.A., and others, in the October 2002 Medical Care 40(10), pp. 879-890.

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