Girling, AJ, Hofer, TP, Wu, J orcid.org/0000-0001-6093-599X et al. (4 more authors) (2012) Case-mix adjusted hospital mortality is a poor proxy for preventable mortality: a modelling study. BMJ Quality and Safety, 21 (12). pp. 1052-1056. ISSN 2044-5415
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode |
Keywords: | Preventable; Mortality; Case-mix |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Dentistry (Leeds) > Applied Health and Clinical Translation (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 12 Jul 2019 15:06 |
Last Modified: | 12 Jul 2019 15:06 |
Status: | Published |
Publisher: | BMJ Publishing Group |
Identification Number: | 10.1136/bmjqs-2012-001202 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:143967 |
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Licence: CC-BY-NC 3.0