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Legacy Emanuel Hospital Comments on Stroke:
How is Legacy managing its quality processes?
Legacy staff regularly monitor mortality rates, along with many other indicators of care quality, in their efforts to provide the highest and safest care quality. Teams of physicians, nurses and administrators are constantly looking for new and better ways to reduce medication errors, infections, and other complications of the complex care processes provided in the hospital. Data such as these have long been part of that process and are viewed as an important part of our quality efforts.
How good a measure of quality is mortality? Reported mortality rates for hospitals represent a complex mix of factors. Most importantly, it has been shown that patient factors, such as severity of illness or pre-existing conditions, such as diabetes or heart failure, are the most powerful predictor of mortality rates. Often, institutions vary widely in what kind of patients they see and what patients are selected to undergo various treatments. A large, complex institution will tend to see sicker, more complex patients, as a rule. Thus, mortality rates for surgical procedures are often higher in tertiary care facilities. This is called patient selection bias. Severity adjustment tools help correct for this kind of bias, but they are inexact. There are a variety of risk adjustment tools in existence, and we have seen as much as a 2-fold difference in expected mortality rates, depending on which risk adjustment tool is used.
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