Indicators used to rank hospitals are skewed against ones that treat the sickest, neediest patients, according to an article published in the Journal of Neurosurgery.

Doctors at Loyola University Hospital in Maywood, IL, just outside Chicago, say different factors -- such as having a busy emergency room, having a trauma center that treats difficult, critical injuries, or working with those on Medicaid -- could make hospitals seem riskier than they really are by significantly influencing one of the main indicators used for hospital quality: the mortality index.

"One of the straightforward [hospital] quality indicators is: Did you die or not?" Thomas Origitano, M.D., Ph.D., lead author of the study and a neurosurgeon at Loyola, tells DOTmed News.

A mortality index of over 1.0 means the hospital has more deaths than predicted in that specialty; less than 1.0, means it has fewer deaths than expected.

Dr. Origitano says he noticed that some hospitals with a low mortality index would often transfer to other hospitals patients suffering dire illnesses or injuries they were unequipped to treat. As these patients were more likely to die, he suspected this process could artificially deflate the transferring hospital's mortality score.

This study was conducted in two parts. In the first leg, Dr. Origitano and his colleagues looked at the neurosurgery mortality rates of his own hospital, Loyola. Out of the 3,650 operations performed in a three-year period, Dr. Origitano discovered that patients were six times more likely to die if they were transferred in from another hospital that couldn't treat them or if they showed up in the emergency room needing immediate care.

In the second leg of the study, he and the other researchers combed through the University Healthsystem Consortium's database drawing from 103 medical centers during a two-year period.

What Dr. Origitano found is that "if you have a hospital with a very busy emergency room, that has a trauma center, and has a high Medicaid population, you're going to have a higher mortality index," he says.

While half of all hospitals with the worst mortality scores were designated Level 1 trauma centers, a certification granted in most states by the American College of Surgeons, which indicates the hospital performs specialized treatment of tricky cases like complex head injuries, only a quarter of all hospitals with the best death ratings were, Dr. Origitano says.

Equally telling, half of all hospitals with the highest death rates had more than one in ten patients on Medicaid, whereas only a third of those hospitals with the lowest rates did.

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