Exclusion of palliative care from hospital mortality rates: Not ready for prime time
Mortality is and will be an imperfect measure of the quality of hospital care. In particular, hospital-wide mortality measures that include myriad patients treated for a wide variety of conditions lack specificity and do not necessarily correlate with other quality outcomes.1 However, when mortality is limited to a related set of diagnoses or procedures, it can be a reasonable measure of quality and track well with other indicators. and  This, and the availability of standard methods of calculating mortality from administrative data, means that mortality ratios are likely to remain a part of quality assessment in health care.
The shortcomings of administrative data as a source of outcomes measures are well documented and apply to the use of palliative and hospice care indicators addressed by Cassel et al. in this issue. We present here clarifications concerning the methods and rationale for the approach used in the “Best Hospitals” rankings published by U.S. News & World Report. In addition, we raise a number of concerns about the use of palliative and hospice indicators and offer recommendations for future research.