A study by researchers at Loyola University Health System has found that a key statistic that consumer groups and the media often use when compiling hospital report cards and national rankings can be misleading, according to a Loyola news release.
The study, which will appear in an upcoming issue of the Journal of Neurosurgery suggests that the mortality index could be a misleading indicator of hospital quality in at least two major specialties — neurology and neurosurgery —because the index fails to take into account such factors as whether a hospital treats complex cases transferred from other hospitals or whether a hospital treats lower-risk elective cases or higher-risk non-elective cases.
A mortality index above 1.0 indicates a hospital had more deaths than expected within a given specialty. A mortality index lower than 1.0 means there were fewer than the expected number of deaths.
"A hospital with a lower mortality index may not be a better hospital for patient care, but rather a place where the patient mix has been refined or limited," senior author Thomas Origitano, MD, chairman of the Department of Neurological Surgery at Loyola University Stritch School of Medicine, said in the release.
The study examined neurosurgical mortality data from 103 academic medical centers and found that hospitals with the worst mortality index tended to be Level 1 trauma centers with busy emergency rooms and a high percentage of Medicaid patients. A Level 1 trauma center with a busy ER is more likely to treat severe and complex cases such as head and spinal injuries from car accidents, injuries from falls or gunshot wounds, where death is more likely. Medicaid patients are associated with a higher mortality index due to poor access to medical care, according to the study.
The study also found that in hospitals with the lowest mortality index, at least 87 percent of the neurosurgical cases were elective in nature. In elective surgeries, patients deemed to be at too high a risk do not undergo the surgery.
By contrast, non-elective surgery for such conditions as head injuries and spine infections generally has to be done even when the risks are high.
Researchers cited several other problems with rating systems. For example, report cards typically lump neurology and neurosurgery into one category, neurosciences. "Although both services treat many of the same pathological processes, their performance at any given institution is by no means shared," researchers wrote in the study. "This can be misleading if the neurology aspects of the rating system misrepresent the neurosurgical service or vice versa."
Read the Loyola release on hospital report cards.
The study, which will appear in an upcoming issue of the Journal of Neurosurgery suggests that the mortality index could be a misleading indicator of hospital quality in at least two major specialties — neurology and neurosurgery —because the index fails to take into account such factors as whether a hospital treats complex cases transferred from other hospitals or whether a hospital treats lower-risk elective cases or higher-risk non-elective cases.
A mortality index above 1.0 indicates a hospital had more deaths than expected within a given specialty. A mortality index lower than 1.0 means there were fewer than the expected number of deaths.
"A hospital with a lower mortality index may not be a better hospital for patient care, but rather a place where the patient mix has been refined or limited," senior author Thomas Origitano, MD, chairman of the Department of Neurological Surgery at Loyola University Stritch School of Medicine, said in the release.
The study examined neurosurgical mortality data from 103 academic medical centers and found that hospitals with the worst mortality index tended to be Level 1 trauma centers with busy emergency rooms and a high percentage of Medicaid patients. A Level 1 trauma center with a busy ER is more likely to treat severe and complex cases such as head and spinal injuries from car accidents, injuries from falls or gunshot wounds, where death is more likely. Medicaid patients are associated with a higher mortality index due to poor access to medical care, according to the study.
The study also found that in hospitals with the lowest mortality index, at least 87 percent of the neurosurgical cases were elective in nature. In elective surgeries, patients deemed to be at too high a risk do not undergo the surgery.
By contrast, non-elective surgery for such conditions as head injuries and spine infections generally has to be done even when the risks are high.
Researchers cited several other problems with rating systems. For example, report cards typically lump neurology and neurosurgery into one category, neurosciences. "Although both services treat many of the same pathological processes, their performance at any given institution is by no means shared," researchers wrote in the study. "This can be misleading if the neurology aspects of the rating system misrepresent the neurosurgical service or vice versa."
Read the Loyola release on hospital report cards.