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Mortality rates as a quality indicator: a simple answer to a complex question.

W B Credé¹, W J Hierholzer

¹Department of Quality Assurance, Yale-New Haven Hospital, New Haven, Connecticut 06509.

Infection Control and Hospital Epidemiology

|July 1, 1988

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Mortality rates are unreliable quality indicators due to data limitations and administrative issues. Improving healthcare quality assessment requires objective criteria and clinician involvement, not just automated data screening.

Area of Science:

Healthcare Quality Assessment
Medical Informatics
Health Services Research

Background:

Mortality rates are frequently used as a quality indicator in healthcare.
Current methods for identifying high-risk institutions using abstracted discharge data are insufficient.
Healthcare quality is under scrutiny from diverse groups with varying levels of clinical expertise.

Purpose of the Study:

To review clinical, administrative, and information factors affecting the reliability of mortality rates as a quality indicator.
To assess the limitations of current technology in identifying high-risk healthcare institutions.
To propose improvements for accurate and fair quality assessment processes.

Main Methods:

Review of clinical, administrative, and information issues impacting mortality rate sensitivity.

Related Experiment Videos

Analysis of the capabilities and limitations of abstracted discharge data for identifying high-risk institutions.

Discussion of the necessity for detailed chart review in quality problem verification.

Main Results:

Current technology using abstracted discharge data cannot reliably identify high-risk institutions.
Verification of quality issues necessitates comprehensive chart review, even with improved screening.
Objective, outcome-based criteria are needed for evaluating high-quality care across various clinical scenarios.

Conclusions:

Mortality rates alone are not sensitive enough for quality assessment without considering clinical context.
Enhanced screening capabilities still require manual chart review for accurate quality verification.
Developing objective criteria and ensuring clinician involvement are crucial for fair and accurate healthcare quality assessment.