Inpatient Mortality Indicators

The Inpatient Mortality Indicators (IMIs) are part of the Inpatient Quality Indicators that were developed by the federal Agency for Healthcare Research and Quality (AHRQ). These measures provide a perspective on hospital quality of care with a focus on inpatient mortality for certain procedures and medical conditions where evidence suggests that high mortality rates may be associated with deficiencies in the quality of hospital care provided.  

Which IMIs are Included in this Analysis?#

The 2021 IMIs consist of six medical conditions and five surgical procedures.

Medical Conditions:

• Acute Myocardial Infarction
• Acute Stroke (Total, Hemorrhagic, Ischemic, and Subarachnoid)
• Gastrointestinal Hemorrhage
• Heart Failure
• Hip Fracture
• Pneumonia

Surgical Procedures:

• Abdominal Aortic Aneurysm Repair – Open and Unruptured
• Abdominal Aortic Aneurysm Repair – Endovascular and Unruptured
• Carotid Endarterectomy
• Pancreatic Resection
• Percutaneous Coronary Intervention

Why are the IMIs Important?#

The IMIs were calculated for the patients who died in the hospital before discharge. The rates vary substantially across hospitals, suggesting differential quality of care provided by hospitals. The IMI findings provide performance benchmarks that hospitals can utilize to improve quality and patients can use to make informed healthcare decisions.

Which Hospitals have Better than Expected and Worse than Expected Mortality Rates?#

Hospitals were rated “Better”, “Worse”, or “As Expected” by comparing their risk-adjusted mortality rates with the overall state rates for each IMI.  Risk adjustment is a statistical methodology that takes into account a patient’s age, sex, and underlying health conditions. Hospitals with a higher mortality rate are distinguished from those with a lower mortality rate, indicating opportunities for care quality improvement.

• When compared to the state average rates, 56 hospitals (17.6%) were rated “Better”, and 85 hospitals (26.6%) were rated “Worse” on at least one risk-adjusted mortality indicator.
• Of the 56 better-rated hospitals, 34 were rated “Better” on a single indicator, 15 on two indicators, three on three indicators, two on four indicators, and two on five indicators.
• Of the 85 worse-rated hospitals, 58 were rated “Worse” on a single indicator, 17 on two indicators, six on three indicators, three on four indicators, and one on five indicators.
• There were 184 (57.7%) hospitals rated as “Average”, or not significantly different from the state average, for all 11 mortality indicators.
• In general, hospitals showed fairly consistent performance across all 11 indicators. Six hospitals (1.9%), however, had “mixed” results – they were rated “Better” on at least one indicator and “Worse” on at least one indicator.

The visualization below shows hospitals’ IMI ratings from 2017 to 2021, which can be used to assess hospital performance and quality of care over time. The Number of Better/Worse Ratings filter allows the user to select a performance category (“Better”, “Worse”, or “As Expected”) to view the hospitals in that category. Changes have been made to the AHRQ software and IMI specifications over the past five years; therefore, exact comparisons over time should be interpreted with caution. 

California Hospital Inpatient Mortality Procedures and Conditions, 2017-2021#

Note: *Mixed Rating indicates hospitals that were rated “Better” on at least one indicator and “Worse” on at least one indicator.

Where are Hospitals with Better than Expected and Worse than Expected Mortality Indicators Located?#

The visualization below shows a map displaying geographic locations of hospitals with “Better”, “Worse” and “As Expected” performance ratings on each of the 11 IMIs.

California Hospital Inpatient Mortality Procedures and Conditions, 2021#

Note: Based on the AHRQ methodology, hospitals were not reported for a specific medical condition or procedure if fewer than three patients were treated.

Additional Information#

Topic: Healthcare Quality
Source Link: AHRQ Quality Indicators
Citation: HCAI – California Hospital Inpatient Mortality Rates and Quality Ratings, 2017-2021
Temporal Coverage: 2017-2021
Spatial/Geographic Coverage: Statewide, County
Frequency: Annual