Medicare mortality rates and hospital quality: are they related?

In 1987, the Health Care Financing Administration (HCFA) compiled and released mortality information for 1986 Medicare admissions to 5,971 United States hospitals. Full triennial accreditation surveys were conducted by the Joint Commission on Accreditation of Healthcare Organizations in 1,628 of these institutions in 1986. This report examines the relationship between 1986 Medicare mortality rates and hospital quality, as measured by accreditation survey performance. Hospitals with higher-than-expected and lower-than-expected mortality rates were compared on three measures of accreditation survey performance. These comparisons were made for three mortality groups: overall, stroke, and acute heart disease. No statistically significant (p = 0.05) differences were found in survey performance for any of the mortality groups compared. This lack of association between mortality and hospital quality, as measured by accreditation performance, reinforces concern about the use of mortality rates as measures of quality for public policy or patient decision-making purposes.