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- W1531987504 abstract "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.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.Overall, regular and variant HSMRs were highly correlated (ρ>0.8), but differences of up to 10 points were common. Two hospitals were particularly affected when palliative care was excluded from the risk models. Excluding unplanned stays ending in same-day live discharge had the least impact despite their high frequency. The largest impacts were seen when capturing postdischarge deaths and using just five high-mortality diagnosis groups.HSMRs in most hospitals changed by only small amounts from the various adjustment methods tried here, though small-to-medium changes were not uncommon. However, the position relative to funnel plot control limits could move in a significant minority even with modest changes in the HSMR." @default.
- W1531987504 created "2016-06-24" @default.
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- W1531987504 date "2011-07-25" @default.
- W1531987504 modified "2023-09-22" @default.
- W1531987504 title "Hospital Standardized Mortality Ratios: Sensitivity Analyses on the Impact of Coding" @default.
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- W1531987504 doi "https://doi.org/10.1111/j.1475-6773.2011.01295.x" @default.
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