Mortality Measurement

There is increasing interest in deploying and publicly reporting a risk-adjusted measure of mortality as a quality indicator of hospital system-level performance. Government agencies, policymakers, health care systems, and consumers are grappling with critical issues regarding the attributes, relative merits, interpretation, and potential uses of existing measurement methods to drive improvement and inform choice. The presentations provided here are from a November 2008 meeting to discuss issues related to mortality measures.

Hospital Standardized Mortality Measurement

The Agency for Healthcare Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI) have partnered to explore the scientific controversies around using a mortality measurement methodology to improve health care quality. The mortality measures would also be used to help track and reduce mortality nationally and in individual institutions.

In November 2008, AHRQ and IHI convened a meeting in Cambridge, Massachusetts, to discuss these important issues. Presentations and discussion took place on five existing risk-adjusted mortality measures. In addition, experts reviewed issues related to:

• The lessons learned from past government efforts to publicly report mortality rates.
• The National Quality Forum's (NQF) intent to vet a national mortality measure or measures.
• The pros and cons of including deaths occurring within 30 days of hospital discharge.
• The progress in measuring diagnosis-specific mortality rates.

In addition, ongoing research to include automated clinical data in risk-adjustment methods was presented, and research needs were outlined. Invited attendees included independent measurement experts and stakeholders from major organizations, including the Centers for Medicare & Medicaid Services, Joint Commission, National Quality Forum, National Association of Public Hospitals, American Hospital Association, and Consumer's Union. 

Selected materials submitted by speakers are presented here. When a speaker has prepared articles for submission to peer-reviewed journals, related and already published articles or other resources are also posted. In addition, a paper summarizing key outputs of this meeting is being prepared.

Meeting Materials

• Final Agenda ( PDF Version [ - 136.76 KB] )
• Meeting Participants ( PDF Version [ - 286.45 KB] )

Background and Historical Perspective on Mortality Measurement

Speakers: Steve Jencks and Amy Rosen

• High Mortality Rates: Finding the Pony ( PDF Version [ - 95.92 KB] )

The Need for a National Mortality Measure: NQF's Rationale and Requirements

Speaker: Janet Corrigan

• National Priorities Partnership ( PDF Version [ - 258.41 KB] )
• About the National Priorities Partnership
• National Priorities & Goals to Transform America's Healthcare Meeting Materials

Presentation and Discussion of Individual Mortality Measures

CareScience/Premier

Contact: Eugene A. Kroch, Ph.D. (Eugene_Kroch@PremierInc.com)

• CareScience Mortality Risk Model ( PDF Version [ - 913.96 KB] )
• CareScience Risk Assessment Model: Hospital Performance Measurement ( PDF Version [ - 402.89 KB] )

Dr. Foster Unit at Imperial College London

Contact: Professor Sir Brian Jarman, OBE, FRCP, FRCGP (b.jarman@imperial.ac.uk)

• How NHS [National Health Service] Trusts Could Use Patient Safety Indicators To Help Improve Care
  Health Care Risk Report 14(6):12-14. Courtesy of the Health Care Risk Report
• Aylin P, Bottle A, Majeed A. Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models.
  BMJ 2007;334(7602):1044. (published online 23 April 2007). Select for abstract.
• Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study.
  BMJ 2006;332:947-51. Select for abstract.
• Jarman B, Bottle A, Aylin P, et al. Monitoring changes in hospital standardised mortality ratios.
  BMJ 2005;330:329. Select for abstract.
• Aylin P, Bottle B, Jarman B, et al. Paediatric cardiac surgical mortality in England after Bristol: Descriptive analysis of hospital episode statistics 1991-2002.
  BMJ 2004;329:825. Select for abstract.
• Jarman B, Gault S, Alves B, et al. Explaining differences in English hospital death rates using routinely collected data.
  BMJ 1999;318:1515. Select for abstract.

University Health Consortium

Contact: Steven J. Meurer, Ph.D., M.B.A., M.H.S (meurer@uhc.edu)

• Mortality Risk Adjustment Methodology for University Health System's Clinical Data Base ( PDF Version [ - 183.72 KB] )

3M Health Information Systems (HIS)

Contacts:
Elizabeth McCullough (ecmccullough@mmm.com; 301-281-8463)
John Hughes, M.D. (jshughes@mmm.com; 203-949-6418)

• Development of the 3M™ All Patient Refined Diagnosis Related Groups (APR DRGs) ( PDF Version [ - 487.33 KB] )
• 3M HIS APR™-DRG Classification Software—Overview ( PDF Version [ - 81.35 KB] )

Thomson Reuters

Contact: Dave Foster, Ph.D., M.D. (david.a.foster@thomsonreuters.com)

• Thomson Reuters ( PDF Version [ - 973.03 KB] ; MS PowerPoint Version [ - 709 KB] ; )

Challenges and Opportunities of a 30-Day Mortality Measure

Speakers: Harlan Krumholz and Sharon-Lise Normand

Publication of paper pending.

Aggregate Versus Diagnosis-Specific Risk-Adjusted Mortality

Speakers: David Shahian and Barry Straube

Publication of paper pending.

Mortality Measurement in the EMR Era: What Real Time Lab and Clinical Data Can Contribute to Precision and Prediction

Speakers: Gabriel Escobar and Marta Render

• Mortality Measurement in the EMR Era ( PDF Version [ - 93.36 KB] )
• The Veterans Health Affairs Experience in Measuring and Reporting Inpatient Mortality ( PDF Version [ - 187.3 KB] )

Next Steps and Potential Research Studies to Accelerate Adoption of a National Mortality Measure

Speaker/Facilitators: Evan Benjamin and Eugene Nelson

• Next Steps and Potential Research Studies to Accelerate Adoption of a National Mortality Measure ( PDF Version [ - 3.06 MB] )