Professor Brian Jarman, was head of the Division of Primary Care and Populations Health Sciences in the Faculty of Medicine at Imperial College, London. He now heads Dr Foster Unit at Imperial College, which calculates a wide range of international indices of health care including the Hospital Standardised Mortality Ratio (HSMR) for hospitals in several countries (including US, UK, Sweden, Netherlands, Australia, Singapore and Canada). He also is an advisor to the Dr Foster companies.
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The methodological challenges of public reporting of hospital data: the role of HSMR
It is well known that hospital quality varies widely, yet it remains difficult to measure. To improve hospital quality, hospital outcomes need to be measured and made comparable. Directly comparing mortality between hospitals would not show hospital quality as the number of hospital inpatient deaths is likely to be influenced by the characteristics of admitted patients. These characteristics will not be distributed evenly across hospitals. Consequently hospitals that treat more severe patients will have higher expected inpatient mortality irrespective of their quality. A profound analysis of hospital mortality requires case-mix adjustment for e.g. differences in diagnosis, age and sex. A popular comparable measure is the Hospital Standardized Mortality Ratio (HSMR), which is an indicator that corrects hospital inpatient mortality for case-mix differences. The main purpose of the HSMR is to give an indication of the quality of care in hospitals. The HSMR measure is now used in the US, Canada, Sweden and Australia to assess care, identify areas for possible improvement and monitor performance over time. HSMR data might be used as indicators of quality differences in Dutch hospital care.
The lecture sheets are available at the bottom of this page.
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