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ADVANCE Perspective: Nurses

Hospital Death Rates, Reality or Irrational?

Published September 5, 2008 10:17 AM by Luke Cowles

Until recently, hospital death rates were a very closely guarded secret. For decades, the data existed but remained as something only discussed in boardrooms, far out of the reach of patients. That all changed Aug. 21 when the Centers for Medicare & Medicaid Services (CMS) made that information public for the very first time.

CMS regularly compiled this kind of data in the past. An effort to release similar findings in the 1990s came under a great deal of scrutiny as the statistics didn't give allowances for how sick, poor or elderly patients were.

Instead of focusing on a hospital's overall mortality rates, CMS chose a formula that concentrates on the death rates for three conditions widely viewed as a litmus test for a facility's overall performance - heart attack, heart failure and pneumonia. The statistics cover the past 2 years. CMS is claiming the numbers are so airtight this time that they have been presented with 95 percent accuracy. Also included are two dozen measures detailing how hospitals meet a variety of other needs, including childhood asthma and patient satisfaction rates.

Patient rights advocates are heralding the data as a powerful tool for patients to make educated decisions and influence the quality of healthcare. Critics are complaining the data doesn't take into account patient variables such as poverty level, lack of education, pre-existing conditions and noncompliance with their care plan, among others.

What do you think? Does this kind of data give an accurate picture of the quality of care at your hospital? What other mitigating circumstances might come into play that would affect patient outcomes?

You can check out the CMS data for more information.

 

posted by Luke Cowles
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1 comments

The CMS measures for quality are similar to JCAHO's measures. JCAHO focuses on structural and process measures to determine quality of care in healthcare facilities. Whether these measures actually define quality is up to debate. Measures such as performance in governance, strategic planning and managing staff requests may be proxies for quality care but they do not necessarily carry over into meaureable patient outcomes. Nor do the core measures for AMI, pneumonia, CHF and postop surgical infection  (the current perfomance measures for JCAHO surveys) really reflect the care delivered at the bedside.  These measures are used to gauge hospital performance. It is calculated as a ratio of patients who received the indicated core measure of care out of all patients meeting criteria for the indicated care. That means that even if the patient didn't really need the care, the fact that they got it is measured positively. Accordingly, the patient who should have recieved the care but wasn't identified as needing it, doesn't really count. Is this a good way to measure quality of care? CMS quality data is based on hospital risk-adjusted mortality rates on Medicare beneficiaries only. Granted more than 50% of all hospitalizations are for Medicare recipients..but there are other payers out there, too.

Quality measures need to be more closely linked to patient outcomes. Organizational factors and standards that guide care reflect the hierarchical structure of a healthcare organization but not necessarily the discretionary action of the individual at the bedside. Meaningful  quality easures that are more nursing sensitive and transparent to the public are needed.

Sarah Pearce, RN, MSN September 13, 2008 12:04 PM
San Francisco CA

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