Mortality for Publicly Reported Conditions and Overall Hospital Mortality Rates

Study Questions:

How do mortality rates for publicly reported medical conditions—acute myocardial infarction, congestive heart failure, and pneumonia—correlate with hospitals’ overall performance?

Methods:

This was an analysis of national Medicare data, in which the final sample included 2,322 hospitals, which provided 90.3% of all acute care for Medicare fee-for-service patients in the United States. The authors compared 30-day risk-adjusted mortality, aggregated across the three publicly reported conditions (acute myocardial infarction, congestive heart failure, and pneumonia), with performance on a composite risk-adjusted mortality rate across nine other common medical conditions, a composite mortality rate across 10 surgical conditions, and both composites combined.

Results:

Hospitals in the top quartile of performance 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% confidence interval [CI], 4.3-6.5). Compared to smaller hospitals, large hospitals (those with ≥400 beds) had higher odds of being a top performer (OR, 1.9; 95% CI, 1.5-2.4), as did teaching hospitals (vs. nonteaching hospitals, OR, 2.4; 95% CI, 1.8-3.2).

Conclusions:

Thirty-day mortality rates for Medicare’s three publicly reported conditions correlate well with overall hospital mortality rates across other common medical and surgical conditions.

Perspective:

The authors of this analysis have made a valuable contribution by establishing that performance on a small set of publicly reported conditions—acute myocardial infarction, congestive heart failure, and pneumonia—is predictive of overall risk-adjusted mortality. These findings should assuage potential concerns that high performance on these three conditions may be an inadequate indication of a hospital’s overall performance.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Risk, Myocardial Infarction, Pneumonia, Hospital Mortality, Cardiology, Heart Failure, Medicare, United States


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