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CAPC Palliative Care Discussion Forum
General Operational Topics
mortality rateAuthor: NAycock
Date: Jan 9, 2009 12:26 pm
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The answer to your question is a bit complicated. I have consulted my colleague Brian Cassel at VCU Cancer Center, and have incorporated his information in this post. In general, all hospital deaths count, with the exception of patients who are under hospice care. However, your hospital and external entities such as CMS, US News and World Report, and others will each define and compute mortality rates differently. They may also interpret the involvement of palliative care differently.
Risk adjusted mortality rates are commonly used to measure quality of care. This is based on the expected or predicted number of deaths given the severity of patient illness in the specific type of hospital. Risk adjustment is usually calculated at two levels: patient characteristics (age, ICD-9 codes) and hospital characteristics ( size, type).
Brian suggests three ways in which pallaitive care can impact mortality rates:
1. Document palliative care involvement using the Palliative Care Encounter (V66.7)ICD-9 code. Some entities, for example, Thomson/Reuters "Top Hospitals" will exclude these cases.
2. The documentation of palliative care during the index admission may impact the calculation of observed-to-expected mortality rates by some entities.
3. Involvement of palliative care may lead to identification of additional co-morbities and symptoms (new identification of delirium is an example) which could impact the severity of illness and risk of mortality.
This will be an important area to watch for future changes. The performance improvement department of your hospital may be an excellent internal resource.
Lyn Ceronsky
Director, Palliative Care
PCLC Faculty
Fairview Health Services