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Top Hospitals Have Lowest Death Rates

Tue, 06/25/2013 - 9:38am
Charles Bankhead

Hospitals that performed well on publicly reported outcomes had a significantly lower overall mortality rate as compared with poorer performers, an analysis of data from 2,300 hospitals showed.

Top performers had a 3.6 percent lower absolute risk-adjusted mortality as compared with hospitals that ranked near the bottom (9.4 percent versus 13.0 percent, P<0.001), according to Ashish K. Jha, MD, of Harvard School of Public Health, and co-authors.

Good performers were five times more likely to rank near the top in an analysis of composite risk-adjusted mortality (OR 5.3, 95 percent CI 4.3-6.5), as compared with hospitals that ranked near the bottom for performance on three publicly reported conditions -- acute myocardial infarction (MI), congestive heart failure (CHF), and pneumonia, reported online in JAMA Internal Medicine.

Performance on the three reported conditions correlated with overall mortality rates in medical (OR 8.4, 95 percent CI 6.8-10.3) and surgical (OR 2.7, 95 percent CI 2.2-3.3) performance.

Hospital size and teaching status had weaker associations with overall hospital mortality.

"These patterns persisted when we adjusted for hospital and community characteristics using multivariable regression models," the authors noted. "Poor-performing hospitals had significantly increased odds of also being poor performers on overall risk-adjusted hospital mortality (OR 4.5, 95 percent CI 3.7-5.5)."

They said the finding has "important implications for national quality improvement efforts that have focused on these three conditions and whose utility rests on the ability of these metrics to reflect broader hospital performance."

The authors of an accompanying editorial offered a more succinct assessment of the results.

"Does it matter how a hospital does on cardiac surgery when you are going in for hip replacement surgery? Apparently, it does," wrote Mark D. Smith, MD, and Maribeth Shannon, MS, of the California HealthCare Foundation in Oakland.

"This is extremely important -- we do not have to measure every aspect of quality to get a sense of overall quality," they added.

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