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In a paper just published in the journal BMJOpen,Dr. Chong and his co-authors acknowledged that hospitals could have reduced their death rates somewhat, and that new guidelines for coding palliative-care patients explain some of the increase in those cases. But they argue “gaming” of the numbers is likely a factor, too.
Patients are coded as palliative-care — generally meaning their disease is terminal — either during their hospital stay or on discharge. Those cases are not included in mortality statistics, the assumption being the hospital could not have prevented their deaths.
If gaming occurred, it is possible that hospitals deliberately included some patients as palliative who simply did not fit the definition, said Dr. Chong. Or they could have altered their coding practices after the mortality project started to reflect more accurately the number of palliative cases. Even changing for that reason, however, would skew the death ratio, which is meant to be tracked over time.
The most recent results were released last December, indicating there had been a significant decrease in the mortality number since 2004 for 53% of the acute-care hospitals surveyed, while almost none had higher rates.
Over the same period, the average rate of patients coded as palliative care soared almost 50%, they found.