1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

VARIATION IN HOSPITAL MORTALITY REFLECTS MORE THAN CHANCE.

The use of hospital mortality rates to measure quality of care has been controversial, in part because of concern that the variability is due to chance. To determine whether mortality differences reflect true differences in quality, these investigators analyzed risk-adjusted mortality rates for patients undergoing coronary-artery bypass grafting (CABG) in 115 California hospitals from 1983 to 1989.

All hospitals performed at least five CABG procedures in any year. After adjustment for clinical risk factors determined from discharge data (including comorbidities, the timing of surgery after admission, and additional procedures), some hospitals had consistently lower-than- expected inpatient mortality, while others had higher-than- expected mortality. Both low- and high-mortality hospitals tended to stay in those categories over time. The authors concluded that channeling high-risk patients away from high- mortality hospitals could lower risk-adjusted mortality by 54 percent.

Comment: The fact that differences in adjusted mortality persisted over time suggests that there are true quality differences between hospitals. These data support the use of hospital mortality rates to evaluate health care.

— THL

Published in Journal Watch General Medicine July 27, 1993

Citation(s):

Luft HS; Romano PS. Chance, continuity, and change in hospital mortality rates: coronary artery bypass graft patients in California hospitals, 1983 to 1989. JAMA 1993 Jul 21 270 331-337.

• Medline abstract (Free)

2011 Year in Review