Mortality rankings improve at UK HealthCare

lblackford@herald-leader.comJune 10, 2013 

University of Kentucky HealthCare improved its patient mortality rankings during the past 10 months, moving up to 11th-best out of 100 peer institutions, according to new numbers from the University HealthSystem Consortium.

During the previous fiscal year, UK HealthCare ranked 26th out of 101 university-based hospitals. The ranking is based on the mortality index of 26 medical units at UK, including cardiology, neurology and gastroenterology.

UK's overall mortality index was 0.73 in the first quarter of 2013, which means that for every 100 people expected to die, only 73 actually did.

The only medical unit at UK that has dropped significantly since July 2012 is adult cardiothoracic surgery, which ranked 68th out of 91 other institutions. The unit ranked 32nd out of 97 institutions in the prior year.

Bernard Boulanger, UK's chief medical officer, could not explain why the mortality rate had gone up for adult cardiothoracic patients.

"We're committed to improving all these categories," he said. "We monitor our care environment, and if we pick up signals that something is wrong, we investigate that."

Cardiothoracic surgery, which involves surgery on organs inside the chest, produced negative publicity earlier this year when UK HealthCare abruptly halted its pediatric cardiothoracic surgery program without explanation. Its chief surgeon, Mark Plunkett, was suspended from doing surgery.

An investigation of the program is under way, UK general counsel William Thro said Monday. Plunkett remains employed at UK, he said.

Meanwhile, pediatric cardiothoracic patients have been referred to hospitals in other states.

The University HealthSystem Consortium did not produce a mortality index for UK's pediatric cardiothoracic program because the number of patients was too small, Boulanger said.

UK has acknowledged that it calculated mortality rates for its pediatric cardiothoracic program as part of its investigation, but UK has refused to release them.

In May, the attorney general's office issued an opinion that said UK must release the pediatric mortality rates and other data to WUKY, the university-owned radio station.

WUKY and the Lexington Herald-Leader have requested the data under the Kentucky Open Records Act, but UK has appealed the attorney general's ruling in Fayette Circuit Court.

Thro said Monday that releasing the mortality rates might somehow allow individual patients to be identified, which would break federal medical confidentiality rules.

Boulanger said UK was committed to improving transparency, noting that this was the first time UK had posted its overall mortality index ranking on a website aimed at providing more information to the public about patient care at UK (Ukhealthcare.uky.edu/quality). Those numbers have been released previously during Board of Trustees committee meetings.

"It's a challenge to use transparency to drive improvements, and at the same time respect patient information and allow us to do in-depth internal reviews to improve quality," Boulanger said.

The rankings by University HealthSystem Consortium are based on a mortality index, rather than a mortality rate. Because academic medical centers take in the sickest patients, the index takes into account how many people are expected to die versus how many actually die. If the index is 1, the number of patient deaths equaled the number of expected deaths. If it's less than 1, fewer patients died than were expected.

UK's mortality index has hovered between 0.68 and 0.78 since January 2012.

"Most UHC members are improving, but we're improving faster," Boulanger said.

Linda Blackford: (859) 231-1359Twitter: @lbblackford.

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