Here’s a head-scratcher: hospitals that report higher scores on safe practices measures don’t have a significantly lower rate of patient deaths compared to hospitals that reported lower scores on these measures, finds a new study. From the lowest to highest quartile of a Safe Practices Survey completed voluntarily by hospitals, inpatient death rates adjusted for patient and hospital characteristics were 1.97 percent, 2.04 percent, 1.96 percent, and 2.00 percent.

“It is possible that inviting hospitals to self-report on their patient safety practices and then assigning them to quartiles of score is not an effective way to assess hospital quality and safety,” says the researchers at the University of California, San Francisco. “Our findings should not be interpreted, however, as indicating that the safe practices are not important or that they cannot be measured in an informative and valid way. Rather, future work should seek to establish valid methods for assessing adherence to the safe practices.”

The study, which appears in the Journal of the American Medical Association, looks at the relationship between scores reported by urban hospitals on the 2006 Safe Practices Survey and risk of in-hospital death. The analysis determined the relationship between quartiles of scores and risk-adjusted inpatient mortality, after adjusting for hospital discharge volume and teaching status. The mortality data were obtained from the Nationwide Inpatient Sample, a database that includes information on inpatient discharge.

The researchers say they found that quartiles of Safe Practices Survey were not a significant predictor of mortality. “In this first study of the relationship between survey scores and hospital outcomes, we studied a national sample of hospitals and found no relationship between quartiles of score and in-hospital mortality, regardless of whether we adjusted for expected mortality risk and certain hospital characteristics,” they write.

They say further research is needed to determine how performance on the Safe Practices Survey or other instruments designed to measure safe practices performance may correlate with other outcomes of interest to patients and policy makers.