Improve Mortality Ratios with Increased Utilization of Palliative and Hospice Care: Focus on the Numerator and the Denominator

Mortality ratios are an important metric in measuring hospital quality and has become increasingly more important in recent years due to public reporting of quality metrics and hospital renumeration from value-based purchasing programs. The purpose of this study is to demonstrate evidence-based interventions that will result in an improved Observed/Expected Mortality Ratio. Methods utilized include reviewing the literature, assembling multidisciplinary teams, targeting interventions to improve morality ratios, and measuring the outcome of the interventions. The first phase of the study focuses on improving documentation and resultant coding to more accurately depict disease severity influencing expected mortality ratios. The second phase focuses on increasing utilization of appropriate palliative care and hospice services which can contribute to improving mortality ratios by providing the appropriate level of care at the correct location. The second phase also focuses on education about palliative care and hospice, creating a mortality review committee, increasing utilization of palliative care services, and removing barriers to hospice care to improve mortality ratios. Both phases of the study resulted in improving mortality ratios at two of the three hospitals involved over the study period. The number of palliative care consults increased during the second phase of the study. Review of documentation of mortality records during the first phase of the study resulted in one higher score each month in SOI (Severity of Illness) and/or ROM (Risk of Mortality). The Mortality Review Committee created in the second phase of the study resulted in higher Relative Expected Mortality in all cases reviewed. The interventions utilized in this study can be applied universally to hospitals around the world to attempt to improve mortality ratios