The researchers conducted a retrospective cohort study of ICU patients admitted in 2008 using data from the Pennsylvania Health Care Cost Containment Council state hospital discharge dataset. They calculated the in-hospital and 30-day mortality rates and the discharge bias, defined as 30-day mortality minus in-hospital mortality.
The average hospital-specific discharge bias was 2.8+1.2 percent, meaning the hospital’s risk-adjusted mortality improved by 2.8 percent due to discharge bias. Discharge bias was higher in small and non-teaching hospitals, which increased their quality rank. Large hospitals and teaching hospitals had a smaller discharge bias, causing them to decrease in rank.
The authors concluded that current in-hospital mortality rates for ICU patients may reflect differences in discharge patterns more than quality of care.
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