Mortality rankings improve when DNR patients are factored out

A study published in The Journal of the American Medical Association found that do-not-resuscitate (DNR) are not factored out of quality rankings for hospitals. Furthermore, it found that quality rankings improve noticeably for several hospitals when DNR cases were taken into account.
Researchers reviewed 90,644 pneumonia cases in 303 California hospitals, with DNR rates ranging between 9%-22%, with a 16% median. Since DNR patients weren’t factored out of mortality rankings, hospitals with higher DNR patient populations were more likely to receive a lower ranking.  The study showed that only 14 out of the 27 hospitals labeled “low-performing outliers” remained outliers after DNR rates were accounted for.
Researchers suggest that hospitals who want more accurate quality and mortality ratings should develop a standardize method of reporting DNR status in hospital discharge forms.
"None of Medicare's publicly reported mortality measures includes do-not-resuscitate (DNR) status in risk adjustment, largely because such data are not routinely reported by hospitals,” study author Leora I. Horwitz, MD, said, “but also in part because of an underlying assumption that the increased mortality risk of such patients can be accounted for by comorbidity adjustment."
The study came out just days after Medicare penalized 758 hospitals for low quality scores.