A Different (Better?) Way to Measure Hospital Mortality
The study compared two widely used approaches to assessing hospital quality. One approach uses mortality rates of patients who die during their initial hospitalization, and the other uses rates of patients who die within 30 days, whether or not they have been discharged.
Drye and colleagues focused on mortality rates for patients with heart attack, heart failure, and pneumonia. For these conditions, one-third to one-half of deaths within 30 days occur after the patient leaves the hospital, but this proportion often varies by hospital…..
Drye and her colleagues found that quality at many U.S. hospitals looked quite different using the two different accounting methods. The team also found that measures looking only at deaths in the hospital favor hospitals that keep their patients for a shorter length of time.
Hospitals that more aggressively discharge sick patients (whose DRG reimbursement is maxed out) might look good on paper but have poor quality in reality.
This is just another life-threatening consequence of the perverse health incentives created by the current system of reimbursement.
“The study compared two widely used approaches to assessing hospital quality….”
Is there another approach?
I’m a little wary. I understand the hospital’s conflict of interest if you only measure mortality when the patients are still admitted. Nevertheless, if you include 30 days whether admitted or separated from the hospital, it introduces other uncontrolled variables.
Who the heck knows what is going on woth a patient once he’s been discharged? Patients with fewer social suuports would die earlier (I guess) but that is not the hospital’s fault.
When we take into account the fact that hospitals have a financial incentive to keep patients admitted, I think that (on balance) the older way (measuring mortality amongst inpatients alone) is marginally better.