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Calculating & Reporting Healthcare Statistics Second Edition Chapter 6 Death (Mortality) Rates
©2006 All rights reserved. Death (Mortality) Rates The hospital death rate is the proportion of inpatient hospitalizations that end in death, usually expressed as a percentage A synonymous term for hospital death rate is gross death rate
©2006 All rights reserved. Death (Mortality) Rates Important information for health agencies and hospitals in evaluating the quality of medical care Death rate information is also used by a variety of other industries –Researchers use death rates to show causes of death in certain populations
©2006 All rights reserved. Death (Mortality) Rates Formula for Calculating Gross Death Rate –Number of inpatient deaths (including NB) in a period x 100/ Number of discharges (including deaths) in the period
©2006 All rights reserved. Death (Mortality) Rates Death is a type of discharge or disposition –Any data representing total discharges include deaths for that period. Thus, deaths are always assumed to be included in the total discharges in the denominator unless otherwise specified. If deaths of newborn inpatients are included in the numerator, all discharges of newborn inpatients must be included in the denominator. –Ordinarily, newborns are included in the gross death rate unless a facility chooses to calculate their rate separately.
©2006 All rights reserved. Death (Mortality) Rates Patients who are dead on arrival (DOA) are not included in the gross death rate because DOAs are not admitted to the hospital. Patients who die in the Emergency Services Department (ESD) are not included in the gross death rate because they were not admitted to the hospital. Patients who die in the hospital while as an outpatient are not included in the gross death rate.
©2006 All rights reserved. Death (Mortality) Rates Fetal deaths are not included in the gross death rate but are calculated separately Because death rates are ordinarily small, the calculation should be carried out to two decimal places –It is a good idea to put a zero in front of the decimal (for example, 0.23%) to show the casual observer that the rate is less than one percent
©2006 All rights reserved. Net Death Rate The net death rate excludes deaths under 48 hours and is less than the gross death rate Requested by various reporting or accrediting agencies Also referred to as the Institutional Death Rate
©2006 All rights reserved. Net Death Rate Formula –Total number of inpatient deaths (including NB) minus deaths < 48 hours for a given period x 100 / Total number of discharges (including deaths) minus deaths < 48 hours from the same period
©2006 All rights reserved. Postoperative Death Rate Refers to the number of deaths occurring after an operation has been performed –Within 10 days after surgery Also may be referred to as the Surgical Death Rate
©2006 All rights reserved. Postoperative Death Rate This involves the ratio of deaths within ten days after surgery to the total number of patients operated on during the period –Surgical operation = “one or more surgical procedures performed at one time for one patient via a common approach or for a common purpose” –Surgical procedure =“any single, separate, systematic process upon or within the body that can be complete in itself; is normally performed by a physician, dentist, or other licensed practitioner; can be performed either with or without instruments; and is performed to restore disunited or deficient parts, remove diseased or injured tissues, extract foreign matter, assist in obstetrical delivery, or aid in diagnosis”
©2006 All rights reserved. Postoperative Death Rate This may also be calculated by specific operations –For example: Coronary artery bypass grafts Bowel resection Cholecystectomy
©2006 All rights reserved. Postoperative Death Rate Formula –Total number of deaths (within 10 days of surgery) x 100 / Total number of patients who were operated on for the period
©2006 All rights reserved. Anesthesia Death Rate The ratio of deaths caused by anesthetic agents during a period to the number of anesthetics administered Because anesthesia deaths occur infrequently, some hospitals might choose, instead, to evaluate the relationship between a death and a specific anesthetic for a special study
©2006 All rights reserved. Anesthesia Death Rate Three major types of anesthesia –General Puts the entire body to sleep –Regional Removes the ability to feel any pain or sensations in a specific region of the body –Spinal and epidural anesthesia are examples –Local Numbs a small area of the body
©2006 All rights reserved. Anesthesia Death Rate Formula –Total deaths caused by anesthetics agents x 100/Total number of anesthetics administered
©2006 All rights reserved. Maternal Death Rate The death of any woman, from any cause, related to or aggravated by pregnancy or its management (regardless of duration or site of pregnancy, but not from accidental or incidental causes) –An example of an accidental death could include a motor vehicle accident or a fall down a flight of stairs –An incidental death could include a suicide or homicide
©2006 All rights reserved. Maternal Death Rate Direct versus Indirect obstetric death –Direct obstetric death is directly related to the pregnancy For example, a patient died after a C-section because of a nick to the uterine artery which resulted in hemorrhage –An indirect obstetric death is not directly due to obstetric causes, even though the physiologic effects of pregnancy are partially responsible for the death For example, diabetes
©2006 All rights reserved. Maternal Death Rate When this rate is computed, hospitals usually classify only direct obstetric deaths as maternal deaths and include only those deaths that occur during hospitalization
©2006 All rights reserved. Maternal Death Rate Formula –Number of direct maternal deaths for a period x 100/Number of obstetrical discharges (including deaths) for the period
©2006 All rights reserved. Maternal Death Rate Includes prepartum not delivered and postpartum cases –Prepartum = occurring prior to childbirth For example, a patient who comes into the hospital in labor, but does not deliver and is discharged home –Postpartum = occurring after childbirth For example, a patient who comes into the hospital after delivery with an infection of the C-section incision site
©2006 All rights reserved. Newborn Mortality Rate The following definitions apply to infant deaths –Neonatal death The death of a liveborn infant within the period of 27 days, 23 hours, and 59 minutes from the moment of birth –Postneonatal death The death of a liveborn infant from 28 days of birth to the end of the first year of life (through 364 days, 23 hours, 59 minutes from the moment of birth)
©2006 All rights reserved. Newborn Mortality Rate –Infant death The death of a liveborn infant at any time from the moment of birth to the end of the first year of life (through 364 days, 23 hours, 59 minutes from the moment of birth) –Perinatal death An all-inclusive term referring to both stillborn infants and neonatal deaths
©2006 All rights reserved. Newborn Mortality Rate Formula –Total number of newborn deaths for a period x 100/Total number of newborn discharges (including deaths) for the period
©2006 All rights reserved. Fetal Death Rate A death prior to the complete expulsion or extraction from the mother (in a hospital facility) of a product of human conception (fetus and placenta) regardless of the duration of pregnancy –The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles –The reporting of fetal deaths varies according to individual state laws, statutes, and regulations
©2006 All rights reserved. Fetal Death Rate –Fetal deaths are not considered patient deaths –They are not included in any calculation of deaths but calculated separately –Determination of whether to include fetal death data in a specific hospital’s statistics requires an investigation of the facility’s needs by hospital administration, medical staff, and reporting agencies
©2006 All rights reserved. Fetal Death Rate –Fetal deaths may be classified as Early death –Fewer than 20 weeks of gestation and a weight of 500 grams or less Intermediate death –Twenty completed weeks of gestation (but less than 28 weeks) and a weight of 501 to 1,000 grams Late death –Twenty-eight completed weeks of gestation and a weight of 1,001 grams or more –Both intermediate and late fetal deaths constitute what is commonly termed a stillbirth
©2006 All rights reserved. Fetal Death Rate Formula –Total number of intermediate and/or late fetal deaths for a period x 100/Total number of live births + Intermediate and late fetal deaths for the period
©2006 All rights reserved. Cancer Mortality Rate Measures the risk of death for the cause under study in a defined population during a given time period Formula –Number of cancer deaths during a period x 100,000/Total number in population at risk
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