Hospital stroke mortality ratings vary by type of stroke
Patient Safety and Quality
A new study has found that hospital stroke mortality ratings, which are used to profile hospital quality of stroke care, vary considerably depending on whether ischemic, hemorrhagic, or total mortality rates are used. Within any particular hospital, there was poor agreement between ischemic stroke and intracerebral hemorrhage mortality rates (adjusted for patient risk factors). The overall 30-day stroke mortality rate based on New York State data for 2005 to 2006 was 15.2 percent compared to 11.3 percent for ischemic stroke and 37.3 percent for intracerebral hemorrhage. Among the 81 New York hospitals included in the study, there were 26,218 patients with ischemic stroke and 5,411 patients with hemorrhagic stroke.
Contrary to the researchers’ expectations, hospitals with a lower proportion of hemorrhagic stroke were more likely to have worse-than-average total stroke mortality rates. Possible explanations include better performance in high-volume centers, overadjustment for intracerebral hemorrhage in the current risk-adjustment model, or different end-of-life treatment practices across hospitals. This study was supported in part by AHRQ (HS16964).
See "Challenges in assessing hospital-level stroke mortality as a quality measure," by Ying Xian, M.D., Robert G. Holloway, M.D., Wenqin Pan, Ph.D., and Eric D. Peterson, M.D., in Stroke 43, pp. 1687-1690, 2012.