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Case-mix adjusted hospital mortality is a poor proxy for preventable mortality : a modelling study
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Girling, Alan J., Hofer, Timothy P., Wu, Jianhua, Chilton, Peter J., Nicholl, Jonathan P., Mohammed, Mohammed A. and Lilford, Richard (2012) Case-mix adjusted hospital mortality is a poor proxy for preventable mortality : a modelling study. BMJ Quality & Safety, Volume 21 (Number 12). pp. 1052-1056. doi:10.1136/bmjqs-2012-001202
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Official URL: http://dx.doi.org/10.1136/bmjqs-2012-001202
Abstract
Risk-adjustment schemes are used to monitor hospital performance, on the assumption that excess mortality not explained by case mix is largely attributable to suboptimal care. We have developed a model to
estimate the proportion of the variation in standardised mortality ratios (SMRs) that can be accounted for by variation in preventable mortality. The model was populated with values from the literature to estimate a
predictive value of the SMR in this context— specifically the proportion of those hospitals with SMRs among the highest 2.5% that fall among the worst 2.5% for preventable mortality. The extent to which SMRs reflect preventable mortality rates is highly sensitive to the proportion of deaths that are preventable. If 6% of hospital deaths are preventable (as suggested by the literature), the predictive value of
the SMR can be no greater than 9%. This value could rise to 30%, if 15% of deaths are preventable. The model offers a ‘reality check’ for case mix adjustment schemes designed to isolate the preventable
component of any outcome rate.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine | ||||
| Divisions: | Faculty of Social Sciences > Warwick Business School > Entrepreneurship, Innovation & Management Faculty of Social Sciences > Warwick Business School |
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| Library of Congress Subject Headings (LCSH): | Hospital patients--Mortality, Mortality, Medical care—Quality control | ||||
| Journal or Publication Title: | BMJ Quality & Safety | ||||
| Publisher: | BMJ Publishing Group Ltd. | ||||
| ISSN: | 2044-5415 | ||||
| Official Date: | 15 October 2012 | ||||
| Dates: |
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| Volume: | Volume 21 | ||||
| Number: | Number 12 | ||||
| Number of Pages: | 4 | ||||
| Page Range: | pp. 1052-1056 | ||||
| DOI: | 10.1136/bmjqs-2012-001202 | ||||
| Status: | Not Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Open Access | ||||
| Funder: | National Institute for Health Research (Great Britain) (NIHR), West Midlands Quality Institute, Engineering and Physical Sciences Research Council (EPSRC) | ||||
| Grant number: | GR/S29874/01) |
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