Comparison of 30-Day Mortality Models for Profiling Hospital Performance in Acute Ischemic Stroke With vs Without Adjustment for Stroke Severity

Abstract

Increasing attention has been given to defining the quality and value of health care through reporting of process and outcome measures.^1,2 National quality profiling efforts have begun to report hospital-level performance for Medicare beneficiaries, including 30-day mortality rates, for common medical conditions, including acute myocardial infarction, heart failure, and community-acquired pneumonia.^3-5 These outcome measures have been adopted by accreditation organizations, the Centers for Medicare & Medicaid Services (CMS), and other payers, and rewards based on risk-adjusted outcomes have been included in health care reform legislation.^6,7 Because stroke is among the leading causes of death, disability, hospitalizations, and health care expenditures in the United States,⁸ there is increasing interest in also reporting outcomes for Medicare beneficiaries hospitalized with acute ischemic stroke.^9,10