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?


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.


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).


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.


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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