Calculating and Reporting Healthcare Stats Chp 6: Death (Mortality) Rates

When calculating death rates, the following guidelines should be considered:
1. Because death rates are ordinarily small, the calculation is usually carried out to three decimal places and rounded down to two places.
2. 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.
3. 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 death rate separately.
4. Patients who are dead on arrival (DOA) are not included in the gross death rate because DOAs are not admitted to the hospital.
5. Patients who die in the emergency services department are not included in the gross death rate because they were not admitted to the hospital.
6. Patients who die in the hospital while outpatients are not included in the gross death rate.
Anesthesia death rate
The ratio of deaths caused by anesthetic agents to the number of anesthetics administered during a specified period of time. Because anesthesia deaths occur so infrequently, some hospitals might choose, instead, to evaluate the relationship between a death and a specific type of anesthetic for a special study.
There are three major types of anesthesia:
General, regional, and local.
When general anesthesia is administered:
The patient is unconscious and has no sensations. General anesthesia is given intravenously or inhaled.
When regional anesthesia is given, the patient:
May be awake or may be sedated. Regional anesthetics remove the ability to feel any pain or sensations in a specific region of the body. A peripheral nerve block is a type of regional anesthetic that blocks pain and sensations around a specific nerve or group of nerves. These are often used on the hands, arms, feet, legs, or face.
Types of regional anesthesia:
Spinal and epidural anesthesia; used near the spinal cord and the spinal nerves and block pain and sensation in an entire region of the body, such as the abdomen, hips, or legs.
Local anesthesia:
Numbs a small area of the body. This involves an injection of an anesthetic, in this case, a numbing agent, placed directly into the area to block pain. During the procedure the patient may also receive medication to help him or her relax (WebMD 2014)
The formula for calculating the anesthesia death rate is:
Total deaths caused by anesthetic agents x 100 / Total number of anesthetics administered
Example for calculating the anesthesia death rate: If anesthetics were given 2,000 times to surgical patients and one patient death was attributed to anesthesia during the past year, the anesthesia death rate would be computed as follows:
(1×100)/2,000 = 100/2,000 = 0.05%
The fact that anesthesia deaths occur infrequently is reason to:
Always check the placement of the decimal point in calculations of anesthesia death rates
Cancer mortality rate
A mortality rate measures the risk of death for the cause under study in a defined population during a given time period.
The cancer mortality rate is the:
Proportion of patients who die from cancer.
The National Center for Health Statistics:
Collects data on all cancer deaths occurring in the United States and classifies them by sex, age, race, and cancer site so that mortality for a given time period can be determined for the entire country or selected areas (Shambaugh et al. 1994).
The formula for calculating the cancer mortality rate for a population is:
Number of cancer deaths during a period x 100,000 / Total number in population at risk
Example for calculating the cancer mortality rate for a population is: In 2013, 584,881 people died from cancer in the United States. The estimated 2013 census for the US population was 316,094,000 (US Census Bureau 2013). The formula for calculating the cancer mortality rate per 100,000 people in 2013 would be:
Number of cancer deaths in 2013/population at risk. 584,881 x 100,000 / 314,094,000 = 58,488,100,000/314,094,000 = 185.0 deaths from cancer per 100,000 population (this is a crude death rate)
Cancer registrar
Knowledge of healthcare statistics is an essential tool for cancer registrars. A cancer registrar is an individual who is responsible for maintaining a complete summary of the history, diagnosis, treatment, and disease status for every cancer patient seen in the healthcare facility.
Accurate cancer data is vital to:
The fight against cancer, and cancer registrars are critical to capturing that data. Hospital and other cancer registry data are reported to population-based (central or regional) registries.
Hospital cancer registries were developed as:
Organized programs in hospitals to collect information about cancer patients.
The primary goal of hospital cancer registries is to:
Help improve treatment of cancer through various methods, including comparing different types of therapies used to treat cancer.
The American College of Surgeons Commission on Cancer offers:
The opportunity for hospitals and treatment centers to become accredited.
When you are calculating the cancer death rate in your own facility, use the formula for a rate—that is:
The number of deaths from a specific diagnosis of cancer divided by the number of discharges of that same diagnosis of cancer.
Calculating the cancer death rate in your own facility, use the formula for a rate-for example:
Community Hospital had five cases of prostate cancer patients who died last year. There were a total of 189 prostate cancer patients discharged in the same time period.

The rate of prostate cancer deaths was 2.65%. (5×100)/189 – 500/189 = 2.645 or 2.65%

Cancer registry
May be maintained by a separate department or may be a function of the health information department. States may also have a state cancer registry that is responsible for collecting data about cancer. A cancer registry collects data about the diagnosis, treatment, and follow-up of cancer patients. These statistics are important in tracking cancer survival rates.
An evaluation by an independent team to determine whether the facility’s cancer registry meets their standards, which guide treatment and ensure patient-centered care:
Facilities may choose to undergo accreditation through the American College of Surgeons Commission on Cancer (2014). Statistics must show the facility is providing high-quality care and follow-up to its cancer patients. Physicians and researchers conduct research studies to learn about the biology of cancer and investigate new treatments and tests and learn how to prevent cancers from occurring.
Case fatality rate
The total number of deaths due to a specific illness during a given time period divided by the total number of cases during the same period.
Case fatality rate example: Using the example of patients with acute myocardial infarction, every patient discharged with the diagnosis of acute myocardial infarction has the potential to die. Thus, the formula is:
Number of patients with acute myocardial infarction who died x 100 / Number of patients discharged with a diagnosis of acute myocardial infarcation
If a hospital had 40 acute myocardial infarction discharges last year and eight deaths, the death rate would be:
(8 × 100) / 40 = 20.00%
If 50 kidney transplant patients were discharged in the past year and two died, the calculation would be:
(2 × 100) / 50 = 4.00%
Case fatality rate formula:
Number of people who die of a disease in a specified period x 100 / Number of people who have the disease
The case fatality rate can be used to examine the death rates by physician. If Dr. Howard discharged 600 patients in the past year and 27 died, the formula would be:
(27 × 100) / 600 = 4.50%
Centers for Medicare and Medicaid Services
The division of the Dept of Health and Human Services that is responsible for developing healthcare policy in the US and for administering the Medicare program and the federal portion of the Medicaid program.
CMS also publishes Hospital Compare at Medicare.gov that:
Gives healthcare providers information about hospitals in their area, including death rates, which can be indicators of the quality of care given to patients. HIM practitioners must understand basic death rates and be ready to calculate or verify other data pertaining to mortality.
Death rate data also are important in helping public health agencies plan for health services. For example, the CMS:
Publishes information on death rates among Medicare patients, specific ethnic groups, and patients in particular diagnosis categories, to name a few.
Complication
A medical condition that arises during an inpatient hospitalization. According to the Centers for Medicare and Medicaid Services, a complication is a condition that occurs during the patient’s hospital stay that extends the length of stay by at least one day in 75 percent of cases.
Complications may be related to:
The quality of care received by patients. The purpose of collecting a complication rate is to determine if changes in the treatment or practice in the facility can prevent them from occurring again.
Crude death rate
It encompasses deaths in a given population for a given period of time frame divided by the estimated population for the same period of time. In other words, it is based on the entire US population. One can calculate specific rates for the risk of a particular cancer occurring in a population or its subgroups, such as a particular age group or sex.
Dead on arrival (DOA)
Patients who are dead on arrival are not included in the gross death rate bc DOAs are not admitted to the hospital
Death rate
Have always been important information for health agencies and hospitals in evaluating the quality of medical care. It may also be useful to examine death rates based on certain characteristics, such as socioeconomic status, geography or location, age, and cause of death.
Organizations such as the American Heart Association, the American Cancer Association, and other groups are:
Interested in looking at death rates to help bring attention to their causes and to raise money for research. Researchers use death rates to show causes of death in certain populations. All this information can help improve the quality of medical care given to patients.
Disposition
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.
Early fetal death
Less than 20 weeks gestation; weight of 500 grams or less
Fetal death
ºIs the death of a product of human conception before its complete expulsion or extraction from the mother, regardless of the duration of the pregnancy; also called stillborn.
ºA 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.
ºThe death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life (for example, beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles).
Fetal deaths are not included in :
The hospital death rate but are often calculated separately. 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 1 percent.
Fetal death rate
Both intermediate and late fetal deaths constitute what is commonly termed a stillbirth. The formula for calculating the fetal death rate is: Total number of intermediate and / or late fetal deaths a period x 100 (divided by) Total number of live births + Intermediate and late fetal deaths for the period
Fetal death rate example: During November, a hospital had 207 live births, one early fetal death, two intermediate fetal deaths, and three late fetal deaths. To determine the fetal death rate for the hospital,
The total number of intermediate and late fetal deaths (5) is multiplied by 100 and divided by the total number of live births and the intermediate and late fetal deaths (207 + 5). The calculation is as follows:

(5 × 100) / (207 + 5) = 500 / 212 2.356 = 2.36%

Keep in mind that the denominator in the fetal death rate formula does not include discharges:
If you remember the formula for rates discussed in Chapter 2, that is, the number of times something actually happened in relation to the number of times it could have happened, it becomes clear that every birth could be a fetal death. And, be sure to include the intermediate and late fetal deaths in the denominator. This is an exception to the general rule of using discharges in the denominator for death statistics.
Typically, hospitals are required to report fetal deaths to a state agency. However, the reporting method varies according to :
ºIndividual state laws, statutes, and regulations.
ºBecause fetal deaths are not considered patient deaths, they are not included in any other calculation of deaths but, instead, are calculated separately.
ºDetermination 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.
Gross (hospital) death rate
Defined as the number of inpatient deaths for a given period of time divided by the total number of live discharges and deaths for the same time period

Numerator: Total number of inpatient deaths, including NBs, for a given period × 100

Denominator: Total number of discharges, including A&C and NB deaths, for the same period

When computing hospital death rates:
The concept of number of occurrences versus number of times something could have occurred still applies. That is, every patient discharged from the hospital could possibly have died. Of course, this does not happen, but it is still a statistical possibility.
The formula for calculating the hospital death rate (gross death rate) is:
The number of patient deaths divided by the number of patient discharged alive and deaths, as shown: Number of inpatient deaths (including NB) in a period / Number of discharges (including A&C and NB deaths) in the same period
Gross death rate example:
If a hospital had 7 deaths and 520 discharges for a month, the gross death rate would be:

(7×100) / 520 = 1.35%

A synonymous term for gross death rate:
Hospital death rate
Hospital death rate
Also known as gross death rate

When computing hospital death rates, the concept of number of occurrences versus number of times something could have occurred still applies. That is, every patient discharged from the hospital could possibly have died. Of course, this does not happen, but it is still a statistical possibility. Therefore, the formula for calculating the hospital death rate (gross death rate) is the number of patient deaths divided by the number of patient discharged alive and deaths, as shown:

Number of inpatient deaths (including NB) in a period x 100 / Number of discharges (including A & C and NB deaths) in the same period

Hospital live birth
In an inpatient facility, the complete expulsion or extraction of a product of human conception from the mother, regardless of the duration of pregnancy, which, after such expulsion or extraction, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles
Infant death
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)
Institutional death rate
ºVarious reporting or accrediting agencies sometimes request the net death rate, also referred to as the institutional death rate.
ºUsually, adult, child, and newborn statistics are kept separately.
ºHowever, when calculating the net death rate, newborn deaths are included in the inpatient deaths with the adult/children deaths. ºHistorically, hospital inpatient deaths were classified as either those that occurred less than 48 hours after admission and those deaths that occurred 48 hours or more after admission.
Net death rate (Institutional death rate) calculation:
Total number of inpatient deaths, including NBs, minus deaths < 48 hours for a given period × 100 / Total number of discharges, including A&C and NB deaths, minus deaths < 48 hours for the same period
Intermediate fetal death
20 weeks complete gestation; but less than 28 weeks. Weight 501 to 1,000 grams
Late fetal death
28 weeks complete gestation; weight of over 1,000 grams
Maternal death
Defined as 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 would be a motor vehicle accident or a fall down a flight of stairs. An example of an incidental death would be a suicide or homicide.
Many healthcare facilities also differentiate between direct obstetrical deaths and indirect obstetrical deaths.
A direct obstetrical death is a death directly related to the pregnancy, for example, a patient who died after a C-section because of a nick to the uterine artery that resulted in hemorrhage. An indirect obstetrical death is not directly due to obstetrical causes, even though the physiologic effects of the pregnancy are partially responsible for the death.
An example of an indirect obstetrical death is diabetes.
A pregnant woman can have complications of the diabetes that are aggravated by the pregnancy, but the cause of death is the diabetes and not the pregnancy.
Maternal death rate
ºWhen computing the maternal death rate, hospitals usually classify only direct obstetrical deaths as maternal deaths and include only those deaths that occur during hospitalization. Nonmaternal deaths (deaths resulting from accidental or incidental causes not related to pregnancy or its management) are not included.

ºA woman who dies after an abortion is considered a maternal death, as is an obstetrical patient who dies in the prepartum period (that is, the time period occurring before childbirth—some facilities refer to these as antepartum deaths) of a cause due to pregnancy.

If the healthcare facility’s service classification system includes a breakdown of obstetrical discharges into delivered, aborted, not delivered, and postpartum (the time after childbirth), all these should be:
Included in the total obstetrical discharges in the denominator of the formula (and in the numerator if the mother dies).
The formula for calculating the maternal death rate is:
Number of direct maternal deaths for a period x 100 / Number of obstetrical discharges (including deaths for the period
Maternal death rate example: At University Hospital, a mother died immediately after delivery. The hospital’s annual obstetrics/gynecology discharges are classified as: delivered, 4,782; aborted, 97; not delivered (prepartum), 186; and postpartum, 46.
The calculation of the hospital maternal mortality rate is:

(1 x 100) / 4,782 + 97 + 186 + 46 = 100 / 5,111 = 0.0195 = 0.02%

Maternal death rate notes from University hospital example:
ºSome patients are divided into prepartum (not delivered) and postpartum cases.

ºA patient who comes into the hospital in labor but does not deliver and is discharged home is considered a prepartum patient;

ºA patient who comes into the hospital after delivery with an infection of the C-section incision site is considered a postpartum patient.

ºA postpartum patient may be admitted to the hospital following her delivery for a variety of reasons such as hemorrhage or infection.

ºWhen reporting this in obstetrical statistics, many hospitals will classify this as an “undelivered patient, postpartum” to distinguish these obstetrical patients from delivered patients.

Mortality
A term referring to the incidence of death in a specific population; also, the loss of subjects during the course of a clinical research study, or attrition
Mortality rate
Measures the risk of death for the cause under study in a defined population during a given time period. The cancer mortality rate is the proportion of patients who die from cancer.
Neonatal death
The death of a liveborn infant within the first 27 days, 23 hours, and 59 minutes following the moment of birth
Neonatal period
The period of an infant’s life from the hour of birth through the first 27 days, 23 hours, and 59 minutes of life
Net death rate
Various reporting or accrediting agencies sometimes request the net death rate, also referred to as the institutional death rate.

Usually, adult, child, and newborn statistics are kept separately. However, when calculating the net death rate, newborn deaths are included in the inpatient deaths with the adult/children deaths.

Historically, hospital inpatient deaths were classified as:
Either those that occurred less than 48 hours after admission and those deaths that occurred 48 hours or more after admission.
The net death rate came into use because:
It was felt that healthcare providers should not be held accountable for a death that occurred less than 48 hours after admission because they would not have had enough time to directly affect the patient’s condition; only emergency treatment could be provided during this period of time.

With the technology available today, many authorities believe this concept is no longer valid. Regardless of this consideration, the net death rate excludes deaths under 48 hours and is less than the gross death rate.

The formula for calculating the net death rate is:
Total number of inpatient deaths (including NB) – minus deaths < 48 hours for a given period x 100 / Total number of discharges (including NB deaths) - minus deaths < 48 hours from the same period
Example: Last month, Community Hospital had 255 discharges, including nine deaths. Three of the deaths were patients who were in the hospital less than 48 hours. The net death rate would be calculated as follows:
[(9-3) x 100] / (255 -3) = 600/252 = 2.38%
Net death rate formula:
Numerator: Total number of inpatient deaths, including NBs, minus deaths < 48 hours for a given period × 100 Denominator: Total number of discharges, including A&C and NB deaths, minus deaths < 48 hours for the same period
Newborn
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 death rate separately.
Newborn death
Death of a liveborn infant born in the hospital who later dies during the same admission
Newborn death rate
The formula for calculating the newborn death rate (also called the newborn mortality rate) is:

Total number of newborn deaths for a period x 100 / Total number of newborn discharges (including deaths) for the period

When computing newborn mortality rates, the answer should be carried out to at least three decimal places and rounded to two places. This is important because newborn death rates are usually very small. When healthcare facilities report discharges, they typically include deaths in the discharge figures because a death is a type of a discharge.

Newborn death rate Example: If University Hospital had 2,567 newborn discharges and two newborn deaths in one year, its newborn mortality rate would be calculated as:
(2 × 100) / 2,567 = 200 / 2,567 = 0.077 = 0.08%
Researchers frequently use birth certificate data for public health and policy studies. Similar vital statistics formulas are used in the United States. Following are two examples of vital statistics formulas.
Neonatal mortality rate formula:

Number of neonatal deaths during a period x 1,000 / Number of live births during the period
Infant mortality rate formula:
Number of infant deaths (neonatal and postneonatal) during a period x 1,000 / Number of live births during the period
Infant mortality rate Example: If a hospital had 4,270 births, three newborn deaths, and 4,269 newborn discharges, the vital statistics neonatal mortality rate would be calculated as follows:
(3 × 1,000) / 4,270 = 3,000 / 4,270 = 0.70 per 1,000
Newborn mortality rate
Also called newborn death rate

Formula:
Total number of newborn deaths for a period x 100 / Total number of newborn discharges (including deaths) for the period

Perinatal death
An all-inclusive term referring to both stillborn infants and neonatal deaths
Postneonatal death
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)
Postoperative death rate
Also called the surgical death rate, refers to the number of deaths occurring after an operation has been performed. Standard instructions for computing the postoperative death rate involve the ratio of deaths within 10 days after surgery to the total number of patients operated on during that period.
The formula for calculating the postoperative death rate is:
Total number of deaths (within 10 days after surgery) x 100 / Total number of patients who were operated on for the period
Some healthcare practitioners question the usefulness of the postoperative death rate calculation in evaluating the effectiveness of a healthcare facility’s medical care. Thus:
Rather than compute a total postoperative death rate, some hospitals evaluate the relationship of deaths following specific operations (for example, abdominal aortic aneurysm repair or coronary artery bypass grafts).
Postpartum
The time after childbirth
Prepartum
The period of time occurring before childbirth
Stillbirth
ºA woman who delivers a stillbirth is counted as one delivery and one intermediate or late fetal death.
ºThis is also considered to be one delivery and one birth since a stillbirth is considered to be a birth but not a live birth.
ºBoth intermediate and late fetal deaths constitute what is commonly termed a stillbirth.
Surgical death rate
The postoperative death rate, also called the surgical death rate, refers to the number of deaths occurring after an operation has been performed. Standard instructions for computing the postoperative death rate involve the ratio of deaths within 10 days after surgery to the total number of patients operated on during that period.
Surgical operation
Defined as one or more surgical procedures performed at one time for one patient via a common approach or for a common purpose.
Surgical procedure
Is 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.
World Health Organization (WHO)
ºAn international organization founded by the United Nations (UN), is the directing and coordinating authority on international health within the UN’s system.

ºThe WHO provides leadership on critical health matters and works to support countries to ensure all their citizens have accessible and safe healthcare and helps prevent the spread of communicable diseases, especially vaccine-preventable diseases.

TheWorld Health Organization (WHO) supports good health through:
The continuum of life and are working toward reducing quality of life disparities among countries.
The WHO supports healthcare research in:
Maternal, child, and adolescent health; malaria; tuberculosis; HIV; Ebola and other global healthcare issues (WHO 2016). For example, in 1988, the WHO helped launch the Global Polio Eradication Initiative to help protect all children from polio. As a result of this immunization initiative, the number of polio cases has dropped by 99%. Today, only two counties remain polio-endemic, meaning that the disease is regularly found in the population. The WHO continues to work with these two countries to ensure that polio will be stopped.
Death rates are important information for health agencies and hospitals in evaluating:
The quality of medical care
It may also be useful to examine death rates based on certain characteristics such as:
Socioeconomic status, geography or location, age, and cause of death
Death rate info is used by a variety of industries. For example:
The auto industry uses death rate info to determine the likelihood of drivers and passengers dying in some car models compared with others
An article in the Journal of the American Medical Association calling for more emphasis on a new medical specialty—intensive care specialists, or intensivists—showed that:
Having such intensive care experts could reduce death rates. The study showed that having high numbers of intensivists was associated with lower hospital mortality and lower intensive care unit (ICU) mortality (Pronovost et al. 2002).
The patients cared for by intensivists had:
Reduced ICU and hospital death rates and lengths of stay. Health information management (HIM) practitioners—and anyone else who relies on statistical information—must remember that numbers count, not only in reports and records, but also in the human equation.

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