Children’s Hospitals Tagged With High Mortality
December 6, 2009
Posted by chcablogadmin in : Quality
- Rick Merrill
That great statistician Florence Nightingale returned from the Crimea 150 years ago and instituted the first comparative audit of deaths in London hospitals, but in 1863 she wrote resignedly: “We have known incurable cases discharged from one hospital, to which the deaths ought to have been accounted, and received into another hospital, to die there in a day or two after admission, thereby lowering the mortality rate of the first at the expense of the second.”
This Times Online article suggests adverse selection evidently isn’t anything new! This pretty much sums up the position in which children’s hospitals often find themselves. We accept transfers of very sick kids who sometimes die in our facilities. We get tagged with the mortality (or morbidity) while the transferring facility’s statistics artificially look good. Thought you would find this interesting.
Comments»
Matt Hall, our lead statistician here pointed out that the CHCA Research Group has been working on illuminating the critical limitations of measuring quality by mortality in children’s hospitals. The repercussions of sample size limitations on the robustness of statistical indicators and rankings regarding patient mortality are extremely pertinent for pediatric hospital care. Mortality rate data almost always confront a statistical problem: there are large numbers of patients but very low overall rates of mortality. This limits our ability to generate reliable inference between the mortality data observed for a given year and the underlying quality of care. We have demonstrated that when the data is analyzed properly, CHCA hospitals cannot be differentiated on mortality rates.