Original Investigation | Health Care Reform

Mortality for Publicly Reported Conditions and Overall Hospital Mortality Rates

Marta L. McCrum, MD1,3; Karen E. Joynt, MD, MPH1,5,7; E. John Orav, PhD2,4; Atul A. Gawande, MD, MPH1,3,6; Ashish K. Jha, MD, MPH1,4,7
[+] Author Affiliations
1Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
2Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
3Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
4Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
5Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
6Departments of Medicine and Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
7VA Boston Healthcare System, Boston, Massachusetts
JAMA Intern Med. 2013;173(14):1351-1357. doi:10.1001/jamainternmed.2013.7049.
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Importance  Federal efforts about public reporting and quality improvement programs for hospitals have focused primarily on a small number of medical conditions. Whether performance on these conditions accurately predicts the quality of broader hospital care is unknown.

Objective  To determine whether mortality rates for publicly reported medical conditions are correlated with hospitals’ overall performance.

Methods  Using national Medicare data, we compared hospital performance at 2322 US acute care hospitals on 30-day risk-adjusted mortality, aggregated across the 3 publicly reported conditions (acute myocardial infarction, congestive heart failure, and pneumonia), with performance on a composite risk-adjusted mortality rate across 9 other common medical conditions, a composite mortality rate across 10 surgical conditions, and both composites combined. We also examined the relationship between alternative surrogates of quality (hospital size and teaching status) and performance on these composite outcomes.

Results  Our sample included 6 670 859 hospitalizations for Medicare fee-for-service beneficiaries from 2008 through 2009. Hospitals in the top quartile of performance on publicly reported conditions had a 3.6% lower absolute risk-adjusted mortality rate on the combined medical-surgical composite than those in the bottom quartile (9.4% vs 13.0%; P < .001). These top performers on publicly reported conditions had 5 times greater odds of being in the top quartile on the overall combined composite risk-adjusted mortality rate (odds ratio [OR], 5.3; 95% CI, 4.3-6.5). Mortality rates for the index condition were predictive of medical (OR, 8.4; 95% CI, 6.8-10.3) and surgical (2.7; 2.2-3.3) performance when these groups were considered separately. In comparison, large size (OR, 1.9; 95% CI, 1.5-2.4) and teaching status (2.4; 1.8-3.2) showed weaker relationships with overall hospital mortality rates.

Conclusions and Relevance  Hospital performance on publicly reported conditions can potentially be used as a signal of overall hospital mortality rates.

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Figure 1.
Absolute Mortality Rates Across Quartiles of Publicly Reported Condition Mortality
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Figure 2.
Odds Ratios for Being a Top-Performing Hospital

Hospitals that performed well on publicly reported conditions were more likely to perform well on broader hospital mortality measures than large or teaching hospitals. Error bars indicate 95% confidence intervals.

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