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Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis.
Hogan H, Zipfel R, Neuburger J, Hutchings A, Darzi A, Black N. BMJ. 2015;351:h3239.
Challenges in measuring hospital quality persist despite multiple public efforts. A commonly used measure of hospital quality is all-cause mortality. In this study, researchers examined whether two measures of the standardized mortality ratio, which represent differences from expected mortality, are associated with avoidable deaths, defined as those deaths linked to errors. Adjudicators found that less than 5% of deaths were avoidable, and that this proportion was not associated with hospitals' standardized mortality ratios. The authors conclude that the standardized mortality ratio is unlikely to reflect hospital quality, and argue for using condition-specific indicators focused on severe conditions with well-established care pathways. A previous AHRQ WebM&M interview explored the development of hospital standardized mortality ratios and their role in monitoring safety and quality.