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Hospital-Wide Quality Assessment Using All-Condition Versus Summed-Condition Risk Adjustment.

Valérie Gopinath1, Kelsey Chalmers1, Vikas Saini1

  • 1Lown Institute, Needham, Massachusetts, USA.

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|April 16, 2026
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Summary
This summary is machine-generated.

Comparing hospital mortality models, the all-condition and summed-condition methods showed high correlation for risk-adjusted 30-day mortality rates. For large hospitals, the covariate selection method (RSI vs. HCC) had a greater impact than the mortality model approach.

Keywords:
hospital performancehospital rankingrisk adjustment

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Area of Science:

  • Health Services Research
  • Health Outcomes
  • Medical Informatics

Background:

  • Risk-adjusted mortality rates are crucial for hospital quality assessment.
  • Existing methods for calculating these rates vary, potentially impacting comparative performance evaluations.
  • The all-condition and summed-condition approaches represent two distinct methodologies for hospital-wide risk adjustment.

Purpose of the Study:

  • To compare the hospital-wide risk-adjusted 30-day mortality rates derived from an all-condition model versus a summed-condition model.
  • To evaluate the impact of different covariate selection methods (Risk Stratification Index [RSI] and Hierarchical Condition Categories [HCC]) within these mortality models.
  • To identify hospital characteristics associated with discrepancies in mortality estimates between the two approaches.

Main Methods:

  • Utilized Medicare fee-for-service claims data for patients aged 65-94 years from 2019-2021.
  • Developed and validated risk-adjustment models for 30-day mortality using both all-condition and summed-condition approaches.
  • Employed Risk Stratification Index (RSI) and Hierarchical Condition Categories (HCC) for covariate selection, analyzing model performance and correlation of results.

Main Results:

  • High correlation was observed between the all-condition and summed-condition mortality methods (0.87-0.89).
  • The Risk Stratification Index (RSI) demonstrated slightly higher model performance (C-statistic) compared to Hierarchical Condition Categories (HCC).
  • Small hospitals and those with high proportions of non-surgical pulmonary admissions showed lower estimated mortality rates with the summed-condition method. For large hospitals, the choice of RSI vs. HCC had a greater impact on mortality estimates than the choice of all- vs. summed-condition.

Conclusions:

  • The all-condition and summed-condition risk-adjusted mortality rate (RSMR) methods demonstrate high correlation, particularly when using the RSI covariate selection.
  • Hospital characteristics influence the comparative RSMR results between the all-condition and summed-condition approaches.
  • For large hospitals, the selection of the covariate method (RSI vs. HCC) is a more significant determinant of RSMR than the choice between all-condition or summed-condition models.