Mortality as a Measure of Quality
Implications for Palliative and End-of-Life Care
- Robert G. Holloway, MD, MPH;
- Timothy E. Quill, MD
- Author Affiliations: Department of Neurology (Dr Holloway), Department of Medicine (Dr Quill), and Center for Ethics, Humanities, and Palliative Care (Drs Holloway and Quill), University of Rochester Medical Center, Rochester, New York.
- Corresponding Author: Robert G. Holloway, MD, MPH, Department of Neurology, University of Rochester, 601 Elmwood Ave, Box 673, Rochester, NY 14642 (robert_holloway{at}urmc.rochester.edu).
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- DECISION MAKING
- HOSPITALIZATION
- MORTALITY
- PALLIATIVE CARE
- QUALITY INDICATORS, HEALTH CARE
- TERMINAL CARE
Mortality as a measure of quality has made a comeback. In 1986, the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services [CMS]) released hospital-specific mortality rates to the public, but abandoned those efforts in 1993 given concerns about the validity of the comparisons. In 2002, the Agency for Healthcare Research and Quality released 15 administratively driven inpatient mortality indicators. Twenty-nine report cards now contain information about hospital mortality.1 In addition, the Institute of Medicine in 2006 endorsed the inclusion of disease-specific mortality as 1 of the 2 outcome measures for consideration in developing a national system for performance measurement.2
The addition of mortality to the measures publicly reported by CMS and the looming reality of pay-for-performance have catapulted mortality back into national focus. In June 2007, CMS began reporting hospital-specific risk-standardized 30-day mortality rates for acute myocardial infarction and congestive heart failure with reporting …
