Question

COLLAPSE

There are three hospitals in your town. You work for Community Hospital, and within a 25 mile radius there is also Middle Hospital and University Hospital. You are serving on a Quality Task Force at your hospital and the task force is comparing death rates for all three hospitals. The task force finds that Community Hospital has the highest death rate and some of the members are alarmed.

Does the higher death rate at Community Hospital mean that there is lower quality care? What would you bring up in this discussion at the task force meeting?

Answer 1

Does the higher death rate at Community Hospital mean that there is lower quality care?

High-quality care has been defined safe, effective, patient-centered, timely, efficient and equitable care. The hospital mortality rate (the proportion of patients who die during or shortly after admission to hospital) would be expected to reflect the safety, effectiveness and, in emergency medicine, timeliness of care and would intuitively seem to be an important measure of quality. If this changes were due to differences in healthcare, such as the treatments provided, service organization, workforce or human resource management, then higher mortality rates would reflect poor quality of care. But ,mortality rates are also determined by case mix, so high mortality rates may simply reflect a sicker patient population.

What would you bring up in this discussion at the task force meeting?

At the task force meetings, discuss on the high mortality rate and do an assessment of quality of care as well as expertise of the staff. Suggest on taking up statistical methods to produce risk-adjusted mortality estimates that take case mix into account. Misinterpretation of mortality estimates could lead to misleading conclusions being drawn about the quality of care provided. Any data that suggest that patients are dying unnecessarily due to poor quality care will inevitably attract attention. Clinicians and managers working in emergency care, have to be cautioned on the potential strengths and limitations of hospital mortality data.