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Patel S, Olivero L, Sinclair De Frias J, Anderson SS, Pollock BD, Lee MD, Chirila RM, Murthy HS, Guru PK, Taylor R, Moreno Franco P, Menser T. Rethinking Measures and Mortality Attribution in Health Care: The ENT Example. Otolaryngol Head Neck Surg 2024. [PMID: 39396155 DOI: 10.1002/ohn.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 10/14/2024]
Abstract
National performance metrics ultimately enhance patient decision-making and promote meaningful improvements in health care delivery, which makes having valid and reliable measures essential. This study examined US News and World Report metrics from 2019 to 2012 and used electronic health record data, combined with detailed chart review across 3 in-system hospitals, to assess the provision of care compared to the attribution of patients assigned to the ear, nose, and throat (ENT) mortality group. Of the initial 47 ENT-attributed deaths, 23 of those were verified, dimensioning the mortality rate from 1.7% to just 0.8%. These results underscore the necessity of rethinking measures and mortality attribution methodologies to be more accurate. Current methods use Medicare Severity Diagnosis Related Group billing coding to map the attribution. We suggest transitioning away from specialty ranking approaches and towards a procedure and condition "rating" approach to ensure that these ranking types capture data about the provision of care within a given encounter.
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Affiliation(s)
- Samip Patel
- Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, Florida, USA
| | - Lorenzo Olivero
- Department of Critical Care, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Stephanie S Anderson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Ben D Pollock
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Marian D Lee
- Department of Quality, Mayo Clinic, Jacksonville, Florida, USA
| | - Razvan M Chirila
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Hemant S Murthy
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Pramod K Guru
- Department of Critical Care, Mayo Clinic, Jacksonville, Florida, USA
| | - Richard Taylor
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Pablo Moreno Franco
- Department of Critical Care, Mayo Clinic, Jacksonville, Florida, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Terri Menser
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
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Olivero L, Sinclair J, Singh T, Khanijo AA, Mundhra G, Chindris AM, Menser T, Franco PM, Pollock BD, Chirila RM. Rethinking Measures and Mortality Attribution in Health Care: The Diabetes and Endocrinology Example. Mayo Clin Proc Innov Qual Outcomes 2024; 8:475-479. [PMID: 39297061 PMCID: PMC11408135 DOI: 10.1016/j.mayocpiqo.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 08/05/2024] [Accepted: 08/09/2024] [Indexed: 09/21/2024] Open
Abstract
This study investigated the accuracy of mortality attributions assigned by the US News and World Report (USNWR) to the diabetes and endocrinology specialty. We reviewed medical records of all consecutive Medicare fee-for-service inpatients at Mayo Clinic, Florida (Jacksonville, Florida) with a Medicare Severity Diagnosis Related Group included in the USNWR Diabetes & Endocrinology specialty cohort admitted from November 2018 to April 2022, with documented mortality in our institution's electronic health record within 30 days of the index admission. A clinician adjudicated the primary cause of death, categorizing it as diabetes or endocrine, cancer, failure to thrive, or other. Among 49 deceased patients, only 7 (14.3%) had diabetes or an endocrine-related cause of death. Cancer (49.0%) and failure to thrive (30.6%) were the leading causes. This substantial discrepancy (86% misattribution) suggests USNWR's methodology might not precisely reflect the quality of care, potentially misleading patients and impacting hospital rankings.
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Affiliation(s)
- Lorenzo Olivero
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
- Department of Internal Medicine, Jacobi Medical Center, New York, NY
| | - Jorge Sinclair
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
- Department of Internal Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Trisha Singh
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, TX
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | | | - Gunjan Mundhra
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
- Department of Internal Medicine, HCA Florida Orange Park Hospital, Jacksonville, FL
| | - Ana-Maria Chindris
- Department of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Jacksonville, FL
| | - Terri Menser
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - Pablo Moreno Franco
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Benjamin D Pollock
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - Razvan M Chirila
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
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Xu LJ, Rathi VK, Johns MM, Agarwala AV, Varvares MA, Naunheim MR. Representativeness of U.S. News & World Report Outcome and Volume Measures for Otolaryngology. Laryngoscope 2024; 134:3881-3882. [PMID: 38973594 DOI: 10.1002/lary.31623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/24/2024] [Accepted: 06/17/2024] [Indexed: 07/09/2024]
Abstract
Although outcomes account for 45% of the total ranking score in otolaryngology in the 2023-2024 U.S. News Best Hospitals rankings, little attention has been paid to the representativeness of their outcomes or volume analyses. Through retrospective review of finance data from an academic otolaryngology department, we found the overall 2023-2024 USNWR volume estimate accounted for only 10.0% (n = 2, usw 024/20,334) of all adult admissions and outpatient procedures and did not adequately represent the overall case mix or caseload.
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Affiliation(s)
- Lucy J Xu
- Department of Otolaryngology - Head and Neck Surgery, Mass Eye and Ear, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Vinay K Rathi
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Michael M Johns
- Caruso Department of Otolaryngology, Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Aalok V Agarwala
- Department of Otolaryngology - Head and Neck Surgery, Mass Eye and Ear, Boston, Massachusetts, U.S.A
- Department of Anesthesiology, Mass Eye and Ear, Boston, Massachusetts, U.S.A
| | - Mark A Varvares
- Department of Otolaryngology - Head and Neck Surgery, Mass Eye and Ear, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Matthew R Naunheim
- Department of Otolaryngology - Head and Neck Surgery, Mass Eye and Ear, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
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Chan Y, Ellison J. What the editors are reading: Quality improvement and patient safety. J Pediatr Urol 2022; 18:700-703. [PMID: 36244900 DOI: 10.1016/j.jpurol.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Jonathan Ellison
- Medical College of Wisconsin, Department of Urology, Milwaukee, USA.
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Chaulk D, Tran T, Neeley A, Giardino A. Children's hospital quality ratings: where are we and can we do better? Hosp Pract (1995) 2022; 49:405-412. [PMID: 35253559 DOI: 10.1080/21548331.2022.2050650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hospital quality ratings are intended to guide patients and payers to the highest quality hospitals. Their success in achieving this goal has been limited by inconsistencies between ratings and questionable data collection methods. Despite these shortcomings, their popularity and their importance are increasing. There is little published on how these quality rankings pertain to children's hospitals. The majority of what is available analyzes the US News and World Report's Best Children's Hospitals Survey and the Leapfrog Group's Pediatric Care survey. We provide a narrative review of the literature and our interpretation of the relative strengths and weaknesses of these tools, including a letter grade comparison. Based on our analysis, we provide potential improvements to these rating systems that may benefit both the patient, payer, and the hospital.
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Affiliation(s)
- David Chaulk
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Theresa Tran
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Allison Neeley
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Angelo Giardino
- Department of Pediatrics Chair, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Rathi VK, Kozin ED, Naunheim MR, Varvares MA. Misestimating Misattribution of Mortality to Otolaryngology Departments in US News & World Report Rankings. Otolaryngol Head Neck Surg 2022; 166:403. [PMID: 35138978 DOI: 10.1177/01945998211008910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Carey RM, Shah AA, Brant JA, Tasian GE, Ziemba JB. Response to Letter to the Editor Regarding "An Analysis of the US News & World Report Methodology for Attribution of Specialty Care in Otolaryngology and Urology". Otolaryngol Head Neck Surg 2022; 166:403-404. [PMID: 35138979 DOI: 10.1177/01945998211008913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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