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Should hospitals calculate mortality figures differently?

In a pay-for-performance environment, hospital mortality figures can signal positive or negative consequences. Should standardized mortality ratios be used to judge a hospital's performance? With this in mind, a recent study focused on whether mortality figures are, as they are currently calculated, a good quality measure for hospitals.1

Using the national Hospital Discharge Register of the Netherlands, researches were able to access a database to examine the variables (early post-discharge, average length of hospital stay, and average transfer rate to other medical facilities) associated with in-hospital mortality.

The study found a correlation between low intramural mortality in hospitals that have high post-discharge mortality rates, and vice versa. As such, many hospitals have a hospital standardized mortality ratio (HSMR) that takes into account 30-day mortality rates(deaths that occur within the first 30 days after hospital admission) instead of just accounting for deaths that occur during hospitalization.

“A lower HSMR, which is currently being interpreted as a rough indication for a good quality of care, may partially be the result of a shorter hospital stay and a relatively higher mortality rate after discharge. A hospital’s responsibility doesn't stop after the patient has been discharged. This is why it is important that mortality shortly after the discharge is incorporated when calculating the HSMR”, says Prof. Cor Kalkman, Professor of Anaesthesiology at UMC Utrecht and co-author of the BMJ publication.

Reference: 1. Pouw ME, et al. Including post-discharge mortality in the calculation of hospital standardized mortality ratios: a retrospective analysis of hospital episode statistics. British Medical Journal 2013;347:f5913