Using In-Hospital Mortality as a Quality Metric Unfairly Penalizes Safety-net Hospitals

Anica Law, MD, MS

Assistant Professor Anica Law has led a team demonstrating that safety net hospitals have 30-day sepsis mortality rates that do not differ from 30-day sepsis mortality rates in other (non-safety net) hospitals. This may seem surprising, since safety net hospitals report higher in-hospital sepsis mortality compared to non-safety net hospitals, confirmed in this study. Patients who were admitted to safety net hospitals were less likely to be discharged to hospice. The differences between hospital types reflect where sepsis patients die, not whether they die. This is important because in-hospital sepsis mortality influences national hospital rankings. Measures of hospital quality that rely on in-hospital mortality, rather than for example the less-biased 30-day mortality rate, may misrepresent hospital performance, inappropriately impacting rankings and leading to unfair penalties for safety net hospitals. The study was published in JAMA Network Open and includes Assistant Professor Nick Bosch and Adjunct Professor Allan Walkey as co-authors.


Figure: Unadjusted outcomes of patients with sepsis are shown on the left. Adjusted odds ratios for the association between admission to safety-net hospitals and patient outcomes are shown on the right. Hierarchical multivariable regression models (with hospital of admission as random effect) are adjusted for all characteristics listed in the Table, except for race.

Read the full BMC press release here.