1. Mortality measures 18 March 2008 Mike Davidge

2. Mortality measures What measure are we using? To track the progress of the campaign we are using Brian Jarman’s measure: Hospital standardised mortality ratio

3. Mortality measures Why use this? Why can’t we just track the number of deaths?

4. Mortality measures What is HSMR? The HSMR is calculated as a ratio of the actual number of deaths to the expected number of deaths among patients in acute hospitals. An HSMR equal to 100 suggests that there is no difference between the hospital’s mortality rate and the overall average rate; greater than 100 suggests that the local mortality rate is higher than the overall average; and less than 100 suggests that the local mortality rate is lower than the overall average.

5. Mortality measures Which patients in the original study? looked at four years of data, from1991-2 to 1994-5. excluded community and specialty institutions, small hospitals and hospitals without accident and emergency units. excluded any hospital that had poor quality data included discharge records only Included discharges if the primary diagnosis was one of 85 primary diagnoses which accounted for 80% of deaths. Excluded all transfers between hospitals (2% of admissions and 3% of discharges).

6. Mortality measures Expected deaths Stratify national admissions according to:  Diagnosis  Age group  Gender  Type of admission (acute/ non acute) National mortality proportion (NMP) = deaths per admission in each group Expected deaths (Trust A) = NMP x Trust A admissions

7. Mortality measures Who calculates We have an agreement that Dr Foster Intelligence will calculate the monthly HSMRs for us