Summary
1) Health Care Financing Administration published hospital mortality rates in the 80's, only to later discontinue the practice. 2) Mortality rates are a poor proxy for quality. 3) Other measures are better to assess quality of care.
Analysis
During late 1980’s, the Health Care Financing Administration (HCFA, now known as CMS, Centers for Medicare and Medicaid Services) annually published hospital mortality rates. This practice was later discontinued due to the interpretation problems with the data by the public. Tertiary hospitals receive a greater proportion of severely ill patients. Likewise, community hospitals that accept hospice patients also admit a higher proportion of severely ill patients. The inability of HCFA to adjust the data to account for the different types of patients treated made the data useless as a measure of the quality of care a patient would receive at a particular hospital. Moreover, due to the anxiety patients have about their health, it is irresponsible to publish data that does not have scientific integrity. Below are excerpts from a British Medical Journal (BMJ) article written by Emma Dickinson in 2007. “A previous study of mortality rates for congenital heart surgery used routinely available hospital data that were misleading, according to a report published today on bmj.com which questions the validity of such data being made public. Professor Westaby and colleagues found the system of information gathering used in the study had underestimated the number of infant deaths. In the previous BMJ study, published in 2004, Oxford had been singled out as having significantly higher mortality than the national average for open heart surgery on infants. Yet this new paper, using data from a different source - the Central Cardiac Audit Database - shows that the hospitals mortality statistics were not actually different from the mean for all the centres (10 percent compared to 8 percent between 2000 and 2002). The authors looked at a report from the Dr Foster unit at Imperial College which was published in the wake of the inquiry into the Bristol congenital heart surgery deaths. That inquiry, which drew widespread publicity and had a profound effect on surgical practice in the UK, used hospital Episode Statistics (HES) to compare mortality rates among cardiac surgical units across the country. The 2004 study by Dr Aylin described these mortality statistics. The authors of the current study compared the mortality rates reported by the administrative HES database and an alternative system, the clinically based Central Cardiac Audit Database, for infants under 12 months undergoing cardiac operations. The statistics were gathered between 1st April 2000 and 31st March 2002. They found HES did not provide reliable patient numbers or 30-day mortality data. On average HES recorded 20 percent fewer cases than CCAD and only captured between 27 percent and 78 percent of 30-day deaths, with a median shortfall of 40 percent. In Centre A, with the largest number of operations, 38 percent of all patients were missed by HES and only 27 percent of the total deaths were recorded. Overall, mortality statistics were underestimated by 4 percent using HES data. The authors say publication of inaccurate statistics detracts from public confidence and that: If mortality statistics are to be released their quality must be beyond reproach. They acknowledge the media are keen to publish such statistics and pinpoint Dr Foster who have pioneered this by providing newspapers with information on heart disease, for example, in return for a fee. They conclude: Given the problems with data quality, the imprecision of risk stratification models, and the confrontational agenda in the media, we question the value of placing mortality statistics in the public domain.”A better way to assess hospital quality can be found on CMS’s web site, www.hospitalcompare.hhs.gov and from proprietary sites such as http://www.healthgrades.com. From these data sources you can find results from consumer surveys of hospitals (HCAHPS survey conducted by CMS), hospital outcome results based on certain conditions of the patient, and grades of the hospital based on the complications reported. These measures, which are based on the particular condition or disease of the patient, overcome the flaws in the mortality data as noted above. In the future, as CMS gathers data on the incurrence of medical errors that are seen as preventable, additional reports that further help define a hospital’s quality in a more meaningful way will be available. Knowing that a tertiary hospital, which receives referrals from neighboring hospitals of all the head trauma and cardiac patients, has a certain mortality rate means little to me. Knowing that this hospital has a problem with their procedures with counting sponges during surgery, and routinely needs to re-operate on patients to remove sponges, does mean something to me
