Quality Efforts for Reducing Mortality in Neurosurgery

Introduction

With recent changes in health care policy, patient health metrics and mortality rates are increasingly recognized as proxies for quality of care and determinants of hospital reimbursements. As a result, both medical and surgical specialties have begun to place increasing emphasis on mortality reduction through implementation of quality improvement initiatives. Quality improvement initiatives are especially warranted on neurosurgical services due to high baseline mortality rates and risk of adverse events. Accordingly, in the past decade, there have been various quality initiatives implemented by a few neurosurgery departments across the country to better hospital and departmental quality metrics and health care reimbursements. Reviewing the various quality initiatives targeted toward all-hospital and specifically neurosurgery patients is important to understanding optimal approaches in reducing patient mortality and improving overall patient care.

Measuring the Success of Quality Initiatives: Quantifying Mortality

University Health System Consortium Data

The University Health System (UHC) Consortium is a data assessment tool utilized by many hospitals, and especially by quality improvement initiatives, for both benchmarking and performance improvement. UHC is a member-owned consortium representing 120 academic medical centers, including over 300 hospitals, and contains self-reported data that are evaluated with risk adjustment. UHC data often serve as a proxy for Centers for Medicare & Medicaid Services (CMS) risk-adjustment data, data that are utilized by nationally recognized external rating systems, and their data serve as a tool for hospitals to compare patient metrics and identify areas of potential improvement. UHC comparison measures include health assessment metrics, such as a 1–4 rating of risk of mortality (ROM) and severity of illness (SOI) on admission and discharge, which are reflections of patients' risk of inhospital death and degree of illness, respectively. Case mix index (CMI) is a metric which assesses the complexity of care and accounts for patient comorbidities. Mortality index (MI), a measure calculated from the observed or actual mortality and expected or predicted mortality based on documentation and risk assessment, is a UHC health assessment metric emphasized across specialties as a representation of quality of care. Finally, diagnosis and treatment provided at admission is defined by a diagnosis related group (DRG) code that is generated at discharge. CMS determines reimbursement based on DRG codes, which are adjusted according to both ROM and SOI. In practice, these metrics, especially MI, are reflective of the overall success of quality improvement programs in improving patient care.

Reducing Overall Mortality of All Hospital Patients

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