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The measurement of mortality. A risk-adjusted variable time window approach
S T Fleming1, L F McMahon, S I Desharnais
1Department of Health Services Management, University of Missouri-Columbia 65211.
Medical Care
|September 11, 1991
Summary
This study developed risk-adjusted mortality indices (RAMI) to compare hospital performance. RAMI measures varied, showing teaching hospitals had higher mortality rates when including post-discharge deaths.
Area of Science:
- Healthcare Management
- Medical Statistics
- Hospital Quality Assessment
Background:
- Assessing hospital quality and patient outcomes is crucial for healthcare improvement.
- Traditional mortality measures often focus solely on in-hospital deaths, potentially underestimating true patient mortality.
- Developing robust risk-adjusted mortality indices is essential for accurate hospital performance evaluation.
Purpose of the Study:
- To develop and compare various risk-adjusted mortality indices (RAMI) using comprehensive death data.
- To analyze how different RAMI methodologies, including post-discharge deaths, affect hospital performance comparisons.
- To investigate variations in RAMI across different hospital types, such as teaching versus non-teaching institutions.
Main Methods:
- Utilized 1985 Medicare Provider Analysis and Review (MEDPAR) data from 657 hospitals.
- Adapted the RAMI methodology from the Commission on Professional and Hospital Activities.
- Developed five distinct RAMI measures, incorporating both in-hospital and post-discharge deaths within condition-specific time windows.
Main Results:
- In-hospital only RAMI was higher for non-teaching hospitals (0.95) compared to major (0.91) and minor (0.89) teaching hospitals.
- RAMI measures incorporating varying time windows for post-discharge deaths were generally higher for teaching institutions (e.g., 1.07 for major teaching hospitals).
- The inclusion of post-discharge deaths significantly altered the comparative performance of teaching versus non-teaching hospitals.
Conclusions:
- The definition of the time window and inclusion of post-discharge deaths critically influence risk-adjusted mortality index calculations.
- RAMI incorporating broader mortality definitions may provide a more comprehensive assessment of hospital quality.
- Findings suggest that teaching hospitals may have a higher observed mortality when accounting for a wider range of patient deaths post-discharge.