Mixed messages
Is quality in the eye of the beholder? Researchers at Harvard Medical School (HMS) and Massachusetts General Hospital (MGH) have found wide disparities among four common measures of hospital-wide mortality rates, with competing methods yielding both higher- and lower-than-expected rates for the same Massachusetts hospitals during the same year. The findings, published Dec. 23 in a special article in the New England Journal of Medicine, stoke a simmering debate over the value of hospital-wide mortality rates as a yardstick for health care quality. The measure, which compares a hospital’s actual patient death rate with statistical predictions, is reported publicly in countries including England, Canada, and Denmark, but some hospitals and policy experts have questioned its value due to the complexity and variability of diagnoses. “It’s troubling that four different methods for calculating hospital mortality rates as a measure of quality should yield such different results,” said lead author David M. Shahian, HMS professor...