What are the challenges to 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 2 main sentiments prevailed: 1) There was a strong desire to avoid penalizing operators for taking difficult cases; and 2) It was recognized that 30-day mortality rate would have to be carefully risk-adjusted to account for differences in patient characteristics. Other issues discussed included the possibility of introducing a bias due to the inclusion of patients who had died outside the hospital and, conversely, the possibility of excluding patients who died shortly after discharge. The writing committee concluded that, while 30-day mortality rate has a strong intuitive appeal, the risk-adjustment issues were too complex to be addressed adequately within the scope of the present document.