Variability in the Measurement of Hospital-wide Mortality Rates

David M. Shahian, M.D., Robert E. Wolf, M.Sc., Lisa I. Iezzoni, M.D., Leslie Kirle, M.P.H., and Sharon-Lise T. Normand, Ph.D.

N Engl J Med 2010; 363:2530-2539December 23, 2010

Abstract

Article

References

Hospital-performance metrics are increasingly used for value-based purchasing and public reporting. For example, Section 3001 of the Patient Protection and Affordable Care Act mandates incentive payments to hospitals that meet quality performance standards, which remain unspecified.

In 2008, the Massachusetts Health Care Quality and Cost Council1 directed the Division of Health Care Finance and Policy (DHCFP) to study various approaches to estimating hospital-wide mortality rates as performance metrics. Medicare released hospital-wide mortality rates for its beneficiaries beginning in 1986 but suspended publication of the rates in 1993 because of methodologic concerns.2,3 The United Kingdom, various European countries, and Canada currently publish variants of such metrics, but questions remain regarding their clinical rationale, their usefulness for informing consumers and practitioners, and statistical methods for calculating them.4-6

In response to the council's mandate, the DHCFP initiated systematic evaluations of various methods for calculating hospital-wide mortality rates.7 At the DHCFP's request, we studied four such commercial methods./.../