Mortality indicators

Question 1

What is the crude mortality rate?

Answer 1

simply the number of deaths that occurred divided by number of administrations to a healthcare provider in a specific time interval

Often X 100 = %

Question 2

What is crude mortality an indicator of?

Answer 2

reasonable indicator of mortality when used to track longitudinal changes in mortality within a healthcare provider as long as there is no reason to believe that the case mix is changing over time

Question 3

What is HSMR?

Answer 3

Based on a subset of diagnoses which give rise to 80% of in-hospital deaths

Question 4

What does HSMR stand for?

Answer 4

Hospital standardised mortality ratios

Question 5

What are HSMRs based on?

Answer 5

routinely collected administrative data often known as hospital episode statistics (HES), secondary uses service data (SUS) or commissioning datasets (CDS)

Question 6

How do hospitals produce these statistics in regards to HSMR?

Answer 6

Routine coding of episodes of care for each patient admitted a routine set of statistics is recorded

Question 7

What is taken into account to adjust for the case mix in HSMR?

Answer 7

• Age
• Sex
• Deprivation (as estimated from post code)
• Ethnicity
• Diagnosis
• Method of admission
• Previous admissions
• Month of admission
• Provision of palliative care
• Comorbidities (using Charlson Index)

Question 8

The HSMR ratio?

Answer 8

The ratio is the expected number of deaths (in hospital within 30 days of admission) divided by the actual number of deaths multiplied by 100. For HSMR the national average is 100.

Question 9

How does the HSMR lie within 3 groups?

Answer 9

published with a statistical confidence interval so that each HSMR can be shown to lie within one of the 3 groups

Question 10

What are the 3 grousp -HSMR?

Answer 10

• Significantly better than national average
• Not significantly different to national average
• Significantly worse than national average

Question 11

What are steps to take if there is a raised HSMR?

Answer 11

Check coding
Case mix- has something extraordinary occurred to distort the mix
Structure-does healthcare organisation and partners work in a different way in other trusts
Process- are systems in place as good as they should be?
Individuals or teams- is it due to them?

Question 12

What is SHMI?

Answer 12

new indicator introduced in October 2011

Question 13

How is SHMI different from HSMR?

Answer 13

It is derived from all admissions to a secondary care organisation not a subset like HSMR
Based on a 3 year national data AND includes all deaths at 30 days not just those in hospital

Question 14

What 5 factors are used to standardise SHMI?

Answer 14

• Primary diagnosis
• Admission type
• Co-morbidities (Charlson Index)
• Age
• Sex

Question 15

What does the SHMI predict?

Answer 15

number of expected deaths and the SHMI is expressed as the ratio of expected to actual deaths
SHMI national average =1
Outliers are determined at 99.8 CI

Question 16

What can SHMI indicate due to looking at deaths from outside hospital as well?

Answer 16

Care within a health community and excluded bias due to better access to community care for the dying