Mortality rate reflects patient preference, not quality

Mortality rates for stroke patients are not necessarily the best way to assess a hospital's quality of care, according to a study in the journal Neurology. That's because physicians may be holding back on providing aggressive care.

Of 37 stroke-related deaths at New York's Strong Memorial Hospital in 2009, researchers found 36 occurred due to patient and family decisions to withdraw life-sustaining care.

According to the study findings, 41 percent of the patients could have been kept alive longer if aggressive intervention had not been withheld. That, in turn, would have lowered the hospital's mortality rate by 3.2 percent, according to a University of Rochester Medical Center (URMC) research announcement.

"It is clear that a significant component of the overall mortality score as currently constructed does not tell the whole story and is predicated on the preference of patients and their families," lead author and URMC neurologist Adam Kelly said.

The study raises questions about the Centers for Medicaid & Medicare Services proposed 30-day risk adjusted stroke mortality quality measure--an indicator already widely used by healthcare rating websites to gauge a hospital's performance.

Moreover, using 30-day risk adjusted stroke mortality to determine quality of care conflicts with patient-centered care, which calls for physicians to respect patients' wishes, such as wanting to withdraw life-sustaining care, Kelly noted.

Earlier this month, healthcare leaders also expressed misgivings about other CMS quality indicators. For instance, two hospital executives questioned whether hospital readmission rates accurately reflect quality care.

To learn more:
- here's the study abstract
- read research announcement