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To the Editor: The study by Dr Kernisan and colleagues¹ analyzed the association between hospital mortality and Leapfrog Hospital Survey results for hospital self-reported use of the National Quality Forum (NQF) Safe Practices for Better Healthcare. Although the authors concluded that survey scores were not significantly associated with risk-adjusted inpatient mortality, these results should be interpreted cautiously.

First, mortality as a single outcome measure does not accurately reflect the multifaceted components related to the processes of patient care or causes of death. Attempting to further correlate survey results with self-reported use of the safe practices only exacerbates inaccuracy. For the safe practices referred to in the study,² only a few may have a close correlation with mortality (eg, identifying high-alert medications). Of the remaining safe practices, 4 are related to health care–associated infection; a more relevant measure would have been health care–associated infection rates, since there may only be an . . . [Full Text of this Article]

Peter B. Angood, MD
pangood@qualityforum.org

Helen Burstin, MD, MPH
National Quality Forum
Washington, DC

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Association Between Hospital-Reported Leapfrog Safe Practices Scores and Inpatient Mortality
Leslie P. Kernisan, Sei J. Lee, W. John Boscardin, C. Seth Landefeld, and R. Adams Dudley
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Hospital Mortality and Leapfrog Hospital Survey Results—Reply
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