Hastings MM, Andes S, Hsu A; Association for Health Services Research. Meeting.

Abstr Book Assoc Health Serv Res Meet. 1997; 14: 181.

Institute of Medicine of Chicago, IL 60604, USA.

RESEARCH OBJECTIVE(S): To examine trends in Chicago area hospital autopsy rates over 70 years (1920-1990); to examine hospital autopsy rates in recent years (1993, 1994, and 1995) and how they varied by type of hospital; and to assess the views of Chicago area hospital pathologists regarding reasons for the decline in autopsy rates and the use of autopsy in the future. STUDY DESIGN: (1) Analysis of Chicago area autopsy rates over a 70 year period, (2) survey and analysis of recent autopsy rates (1993-1995) to identify new trends and differences among hospitals; (3) analysis of hospital pathologists' attitudes towards the use of autopsy, its role in medical education, and the reasons for the ongoing low rate of autopsy. PRINCIPAL FINDINGS: The average Chicago area hospital autopsy rate rose from 11% in 1920 and peaked at 49% in 1955. The average autopsy rate declined steadily to 14% in 1985, and has continued to decline slowly since that year. The average hospital rates for 1993 and 1994 were 12%, and a slight decrease to 11% was found for 1995. Hospital pathologists identified the major reasons for the decline in autopsy to be: (1) the same information could be obtained from other technologies, (2) the lack of a specific autopsy percentage requirement by JCAHO, (3) fear of malpractice, and (4) lack of specific reimbursement for autopsies. Over 70% of the respondents believed that managed care would further decrease the autopsy rate. They also reported that direct reimbursement for autopsies and reinstatement of the JCAHO requirements for autopsy percentages would be necessary to increase the autopsy rate. They believed that neither was likely to occur. CONCLUSIONS: The autopsy has lost its place as the ultimate "medical audit" and as the "gold standard" of patient and hospital quality outcomes measurement. It has been replaced, at least in part, by other technologies, and its role in medical education has been significantly reduced. Even when autopsies are performed, their findings often are not used in the quality assurance activities of the hospital. RELEVANCE TO CLINICAL PRACTICE AND POLICY: Hospitals and physicians need to specify the conditions under which an autopsy should be ordered. There should be a systematic way to utilize autopsy results in quality assurance programs. The declining autopsy rate could hinder substantially our ability to identify new diseases and their progression. It also suggests that epidemiological data on diseases and causes of death may be inaccurate. Because autopsies appear to be concentrated in a relatively few teaching hospitals, access to this quality measure varies greatly.

Publication Types:

• Meeting Abstracts

Keywords:

• Attitude
• Autopsy
• Cause of Death
• Chicago
• Death Certificates
• Hospitals
• Hospitals, Teaching
• Humans
• Medical Audit
• Physicians
• hsrmtgs

Other ID:

• HTX/98608716

UI: 102233674

From Meeting Abstracts