The US hospital standardised mortality ratio: Retrospective database study of Massachusetts hospitals.

Objectives: To present a case-mix adjustment model that can be used to calculate Massachusetts hospital standardised mortality ratios and can be further adapted for other state-wide data-sets.

Design: We used binary logistic regression models to predict the probability of death and to calculate the hospital standardised mortality ratios. Independent variables were patient sociodemographic characteristics (such as age, gender) and healthcare details (such as admission source).

Classifying hospitals as mortality outliers: logistic versus hierarchical logistic models.

The use of hierarchical logistic regression for provider profiling has been recommended due to the clustering of patients within hospitals, but has some associated difficulties. We assess changes in hospital outlier status based on standard logistic versus hierarchical logistic modelling of mortality. The study population consisted of all patients admitted to acute, non-specialist hospitals in England between 2007 and 2011 with a primary diagnosis of acute myocardial infarction, acute cerebrovascular disease or fracture of neck of femur or a primary procedure of coronary artery bypass graft or repair of abdominal aortic aneurysm.

Current ICD10 codes are insufficient to clearly distinguish acute myocardial infarction type: a descriptive study.

Background: Acute myocardial infarction (AMI) type is an important distinction to be made in both clinical and health care research context, as it determines the treatment of the patient as well as affecting outcomes. The aim of the paper was to determine the feasibility of distinguishing AMI type, either ST elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI), using ICD10 codes.

Methods: We carried out a retrospective descriptive analysis of hospital administrative data on AMI emergency patients in England, for financial years 2000/1 to 2009/10.

Staff perceptions of quality of care: an observational study of the NHS Staff Survey in hospitals in England.

Background: There is some evidence to suggest that higher job satisfaction among healthcare staff in specific settings may be linked to improved patient outcomes. This study aimed to assess the potential of staff satisfaction to be used as an indicator of institutional performance across all acute National Health Service (NHS) hospitals in England.

Methods: Using staff responses from the NHS Staff Survey 2009, and correlating these with hospital standardised mortality ratios (HSMR), correlation analyses were conducted at institutional level with further analyses of staff subgroups.

Impact of transfer for angioplasty and distance on AMI in-hospital mortality.

Background: The aim of the study was to evaluate the impact of transfer status and distance on in-hospital mortality for acute myocardial infarction (AMI) patients undergoing angioplasty on the same or next day of hospital admission.

Methods: Retrospective analysis of English hospital administrative data using logistic regression modelling.

Results: After risk adjustment for the patient baseline characteristics, transferred patients had a higher in-hospital mortality rate than those admitted directly to hospital for angioplasty performed on the same or next day: OR=1.

Hospital standardized mortality ratios: sensitivity analyses on the impact of coding.

Introduction: Hospital standardized mortality ratios (HSMRs) are derived from administrative databases and cover 80 percent of in-hospital deaths with adjustment for available case mix variables. They have been criticized for being sensitive to issues such as clinical coding but on the basis of limited quantitative evidence.

Methods: In a set of sensitivity analyses, we compared regular HSMRs with HSMRs resulting from a variety of changes, such as a patient-based measure, not adjusting for comorbidity, not adjusting for palliative care, excluding unplanned zero-day stays ending in live discharge, and using more or fewer diagnoses.

Logistic versus hierarchical modeling: an analysis of a statewide inpatient sample.

Background: Although logistic regression is traditionally used to calculate hospital standardized mortality ratio (HSMR), it ignores the hierarchical structure of the data that can exist within a given database. Hierarchical models allow examination of the effect of data clustering on outcomes.

Study Design: Traditional logistic regression and random intercepts fixed slopes hierarchical models were fitted to a dataset of patients hospitalized between 2005 and 2007 in Massachusetts.

Using care bundles to reduce in-hospital mortality: quantitative survey.

Problem: To reduce hospital inpatient mortality and thus increase public confidence in the quality of patient care in an urban acute hospital trust after adverse media coverage.

Design: Eight care bundles of treatments known to be effective in reducing in-hospital mortality were used in the intervention year; adjusted mortality (from hospital episode statistics) was compared to the preceding year for the 13 diagnoses targeted by the intervention care bundles, 43 non-targeted diagnoses, and overall mortality for the 56 hospital standardised mortality ratio (HSMR) diagnoses covering 80% of hospital deaths.

Setting: Acute hospital trust in north west London.

In defence of the hospital standardized mortality ratio.

This commentary addresses many of the points made by Penfold and colleagues in the lead article of this issue of Healthcare Papers, including the relationships between hospital standardized mortality ratios (HSMRs) and adverse event reporting, hospital policy and discharge rates. It also discusses what the HSMR is intended to measure, the various analyses and cumulative sum statistic data that my colleagues and I provide to hospitals, interpretation of the results and the inclusion or exclusion of patients receiving comfort or palliative care. It should be noted that my colleagues and I still have the attitude that if anyone can make improvements in our methodologies, we are happy to adopt these improvements as long as they are statistically sound.

Measuring and explaining mortality in Dutch hospitals; the hospital standardized mortality rate between 2003 and 2005.

Background: Indicators of hospital quality, such as hospital standardized mortality ratios (HSMR), have been used increasingly to assess and improve hospital quality. Our aim has been to describe and explain variation in new HSMRs for the Netherlands.

Methods: HSMRs were estimated using data from the complete population of discharged patients during 2003 to 2005.

Learning from death: a hospital mortality reduction programme.

Problem: There are wide variations in hospital mortality. Much of this variation remains unexplained and may reflect quality of care.

Setting: A large acute hospital in an urban district in the North of England.

Scientific evaluation of community-based Parkinson's disease nurse specialists on patient outcomes and health care costs.

Objective: To determine the effects of community based nurses specialising in Parkinson's disease on health outcomes and healthcare costs.

Design: Two year randomised controlled trial in 438 general practices in nine randomly selected health authority areas of England.

Participants: 1859 patients with Parkinson's disease identified by the participating general practices.