What risks are associated with using 30-day mortality rate as a performance measure?
The challenges to using 30-day mortality rate as a performance measure relate primarily to risk-adjustment issues, and two main sentiments prevailed: 1) There was a strong desire to avoid penalizing operators for taking difficult cases. This arose from recognition that risk adjustment is less robust at the extremes of risk, as well as from acknowledgment of some of the unintended negative consequences that could result from focus on this outcome, at the individual-operator level, in terms of avoidance of difficult cases altogether or an undesirable displacement of them to nearby regions and operators subject to lesser scrutiny. 