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Hospital Responses to Mortality Measures

A Survey of Hospital Administrative Leaders

Soelch, Luke A., BS; Repp, Allen B., MD, MSc

Quality Management in Healthcare: April/June 2019 - Volume 28 - Issue 2 - p 78–83
doi: 10.1097/QMH.0000000000000209
Original Research

Background: Standardized hospital mortality ratios (SHMRs) are widely used for quality improvement, hospital ratings, and health care payment.

Objectives: (1) To characterize the programs implemented at hospitals in response to SHMRs.

(2) To describe hospital leaders' perceptions of SHMRs as indicators of care quality.

Methods: Electronic survey of administrative leaders at US academic medical centers who subscribed to Vizient leadership networks.

Results: Forty-seven administrative leaders from 37 US academic medical centers completed the survey. Respondents reported that SHMRs had the largest role in the decision to implement inpatient hospice programs, electronic early warning systems, and clinical documentation specialist programs at their institution. Respondents perceived clinical documentation specialist programs and condition-specific care pathways as the most effective programs to improve performance on SHMRs. Only 29% of respondents agreed that SHMRs accurately reflect the number of preventable deaths in hospitals, but 78% agreed that SHMRs have helped their hospital reduce preventable deaths.

Conclusions: Hospitals have employed various strategies in response to SHMRs—including clinical programs that focus on reducing preventable deaths and other programs that target improvement in SHMR performance without reducing preventable deaths. Hospital administrative leaders identify significant benefits and flaws of SHMRs as quality indicators.

Larner College of Medicine, The University of Vermont, Burlington (Mr Soelch); Department of Medicine, Larner College of Medicine, The University of Vermont, Burlington (Dr Repp); and University of Vermont Medical Center, Burlington (Dr Repp).

Correspondence: Allen B. Repp, MD, MSc, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401 (

The authors thank Kate FitzPatrick, DNP, RN, NEA-BC, FAAN, Stephen Leffler, MD, and Anna Noonan, MS, BSN, RN, for their assistance in testing and refining the survey instrument.

The authors declare no conflicts of interest.

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