Tracking the number of patients who die in the hospital might not be the best way to gauge a hospital’s quality, researchers reported on Monday. Because different hospitals have different policies on when to send patients home, it makes more sense to look at mortality over a set window, such as whether a patient is still alive 30 days from admission, they reported on Monday in the Annals of Internal Medicine.
Throughout the health care system, analysts are increasingly focused on tracking patient outcomes and measuring quality of care. Health reform legislation will only increase that focus, Elizabeth Drye of Yale University, who led the study, said in a telephone interview.
But to measure quality, it's important to make sure to use the right data. Merely looking at who dies while in the hospital may miss important indicators, Drye said. “You’re not just capturing quality. You’re capturing that variation in length of stay,” she said.
“Our hope is that we’d be pushing our field to use a standard follow-up period," she added.
Drye’s team looked at Medicare claims data for patients who had heart attacks, heart failure, or pneumonia and who were admitted to a hospital between 2004 and 2006.The data encompassed 700,000 admissions for heart attacks, 1.3 million heart-failure cases, and 1.4 million pneumonia admissions at thousands of nonfederal hospitals nationwide. Data were adjusted to account for how sick patients were when they entered the hospital.
The study concluded that in-hospital death rates misrepresent how good a hospital is at caring for patients.
“We found that the differences between in-hospital and 30-day rates varied widely across hospitals, which confirms that in-hospital measures favor some hospitals,” Drye's team wrote. “Consistent with that finding, many hospitals had a different performance category classification with the in-hospital measure than with the 30-day measure.”
While post-discharge care may not be directly managed by a hospital, it’s still part of a course of care chosen by that hospital’s medical team, Drye said. That means that looking at a 30-day window still reflects a hospital’s quality.
“They’re setting up a course of care. They’re making choices that matter,” she said. Whether a physician sends a patient to a rehabilitation facility, assigns a patient home health aide, or recommends other follow-up care, those decisions reflect on the hospital.
One limitation to the study: It relied on Medicare claims data and thus tracked only the mortality rates of patients over age 65. Drye acknowledged that research like her team's study often relies on Medicare numbers, because Medicare claims data are comprehensive, easy to access, and tracks patients nationwide.
Lack of coordination in the health care system affects the data researchers can access: It's easy for hospitals to report in-hospital deaths, but it’s more difficult to follow patients for a month after they leave the facility. Health care reform, with its focus on record-keeping, rewarding outcomes, and coordinating care, may make it easier to figure out how hospitals are serving patients.