mortality indicators Flashcards
what are the three commonly used measures of mortality in NHS?
crude mortality rate, hospital standardised mortality ratio, summary hospital mortality indicator
what is the purpose of a mortality indicator?
to see if the mortality level is expected, compare to other providers of care and see the changes over time
what is crude mortality rate?
it is the number of deaths per number of hospital admissions over a set period of time
why is there variation between organisations?
may be due to quality of care or could be due to case mix - differing levels of comorbidity or deprivation
what is case mix useful for?
tracking changes over time as long as the case mix is not believed to have changed
what is HSMR?
it is the number of deaths in a trust using diagnoses that make up 80% of hospital deaths - that is taken from routinely collected data
what does HSMR look at?
the predicted number of deaths compared to actual using standardised mortality ratio
what is included in the standardised mortality ratio?>
age, sex, gender, ethnicity, deprivation, method of admission, previous admissions, comorbidites, month of admission and provision of palliative care and diagnosis
what can HSMR predict?
the number of deaths per case mix per year
how do you calculate the ratio?
expected number of deaths / actual x100 - national average is 100
why is there variation in HSMR between trusts?
variation in care, variation in coding and variation in community provision
why might HSMR be lower than expected?
poor care, poor coding, different patient pathways - lower opportunity to die outside of hospital - fewer hospices etc
what are the categories of HSMR results?
significantly better than national average, significantly worse or not significantly different to NA
what do you need to check for HSMR?
check coding, case mix, structure, process and individuals or teams (least likely)
how is SHMI different to HSMR?
it is derived from all admissions to secondary care and not just a subset
