Does Hospital Mortality Predict Quality?

To the Editor: In their study of the relation between inpatient mortality rates and the quality of care, Dubois et al. (Dec. 24 issue)* suggested that the hospitals with death rates higher than expected (high outliers) may have provided poorer care than low outliers. Part of the excess mortality was attributable to a sicker patient population. However, even after adjustment for the severity of illness, the high-outlier hospitals had an excess of preventable deaths due to stroke and pneumonia in elderly or immunocompromised patients, but not due to myocardial infarction. A death was designated as preventable by experts who reviewed . . . No extract is available for articles shorter than 400 words.