Inpatient Mortality Metric Fails to Accurately Assess Hospital Performance in Sepsis Care

Core Concepts

Inpatient mortality is an inadequate metric for evaluating hospital performance in sepsis care, as it fails to account for differences in end-of-life care practices between safety-net and non-safety-net hospitals.

Abstract

The article discusses the limitations of using inpatient mortality as the key outcome measure for evaluating hospital performance in sepsis care. It highlights a study that found significant disparities in inpatient mortality rates between safety-net and non-safety-net hospitals, with safety-net hospitals having higher inpatient mortality rates. However, the article argues that this disparity is not due to worse care, but rather due to differences in end-of-life care practices.
The article explains that non-safety-net hospitals are more likely to transition dying sepsis patients to hospice care, which does not count towards the inpatient mortality metric. In contrast, safety-net hospitals, with fewer resources and less access to palliative care services, are more likely to have these patients die during their hospital stay, thus contributing to higher inpatient mortality rates.
The article suggests that using 30-day mortality as the outcome measure would provide a more accurate assessment of hospital performance, as it would capture the outcomes of patients regardless of where they die. The article concludes that safety-net hospitals, despite their resource constraints, are actually performing just as well as more affluent centers in treating sepsis, and deserve more respect for their efforts.

Stats

Inpatient mortality rate for sepsis patients at safety-net hospitals: 28.2%
Inpatient mortality rate for sepsis patients at non-safety-net hospitals: 26.4%
30-day mortality rates for sepsis patients were similar between safety-net and non-safety-net hospitals.

Quotes

"Any doctor who spends a lot of time in an ICU will tell you about a few archetypes of hospitalizations that happen there. There are the 24-hour folks — the patients who, within the first day in the ICU, either mount a complete recovery or simply can't be saved. And then there are the slogs, the patients in that liminal space between life and death who persist for days, even weeks."
"It turns out, if you're in a non–safety-net hospital, you involve palliative care. You talk to the family. You transition the patient to hospice. A patient who dies in hospice care, even when that hospice care is happening within an acute care hospital, does not count in the inpatient mortality metric."

Key Insights Distilled From

Inpatient Mortality Is Not a Great Way to Judge Hospitals

by F. Perry at www.medscape.com 06-03-2024

https://www.medscape.com/viewarticle/why-inpatient-mortality-not-great-way-judge-hospitals-2024a1000adi

Deeper Inquiries

How can policymakers and healthcare systems work to improve access to palliative and hospice care services, particularly in safety-net hospitals, to ensure equitable end-of-life care for all patients?

To improve access to palliative and hospice care services in safety-net hospitals, policymakers and healthcare systems can take several steps. Firstly, increasing funding and resources allocated specifically for palliative and hospice care within safety-net hospitals is crucial. This can involve financial support for training healthcare providers in palliative care, ensuring availability of necessary medications and equipment, and expanding the interdisciplinary palliative care teams within these hospitals. Additionally, establishing partnerships with community-based palliative care providers can help bridge the gap in services. Education and training programs for healthcare providers on the importance of palliative care and end-of-life discussions can also enhance access to these services. By prioritizing the integration of palliative and hospice care into the standard care protocols of safety-net hospitals, policymakers and healthcare systems can ensure that all patients, regardless of their socioeconomic status, receive equitable and compassionate end-of-life care.

What other quality metrics, beyond inpatient mortality, should be considered when evaluating hospital performance in sepsis care, and how can these metrics be standardized and implemented across the healthcare system?

In addition to inpatient mortality, other quality metrics that should be considered when evaluating hospital performance in sepsis care include 30-day mortality rates, length of hospital stay, rates of sepsis readmissions, adherence to evidence-based sepsis protocols, patient satisfaction scores, and the utilization of palliative and hospice care services. Standardizing these metrics across the healthcare system can be achieved through the development of national guidelines and protocols for sepsis care that include these quality indicators. Implementing electronic health record systems that capture and track these metrics can also facilitate standardized data collection and reporting. Regular audits and feedback mechanisms can help hospitals monitor their performance on these metrics and identify areas for improvement. By incorporating a comprehensive set of quality metrics into the evaluation of hospital performance in sepsis care, healthcare systems can ensure a more holistic assessment of the quality of care provided to sepsis patients.

Given the limitations of inpatient mortality as a quality metric, how can healthcare providers and researchers work to develop more comprehensive and meaningful measures of hospital performance that capture the full spectrum of patient outcomes and experiences?

To develop more comprehensive and meaningful measures of hospital performance that capture the full spectrum of patient outcomes and experiences, healthcare providers and researchers can collaborate on several initiatives. Firstly, conducting patient-centered research to identify outcomes that matter most to patients and their families can help prioritize the development of relevant quality metrics. Engaging patients and caregivers in the design and evaluation of these metrics can ensure that they reflect the values and preferences of those receiving care. Utilizing patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) can provide valuable insights into the impact of care on patients' quality of life and satisfaction. Additionally, incorporating qualitative data through interviews and focus groups can offer a deeper understanding of patients' experiences and outcomes beyond clinical indicators. By adopting a multidimensional approach to measuring hospital performance that considers clinical outcomes, patient-reported outcomes, and patient experiences, healthcare providers and researchers can create a more nuanced and patient-centered assessment of the quality of care delivered in hospitals.