Fears over hospital death figures

21 August 2008 12:27am

Linking hospital death rates to quality of care is "at best ambiguous and at worst potentially misleading", according to a new report.

Hospital standardised mortality ratios (HSMR) are compiled by comparing the numbers of deaths at a Trust with the number of deaths expected taking into account the sort of patients they treat.

The publication of the figures, by health information provider Doctor Foster Intelligence, has lead to fears that hospitals could be ranked according to how likely a patient is to survive in their care.

But in a report commissioned by NHS West Midlands and published in the Health Service Journal (HSJ), academics at the University of Birmingham found "little or no evidence that a high standardised mortality ratio systematically reflects poor quality of care or a failing hospital."

The HSJ reports that the strategic health authority asked the university to examine the the statistics after five of its trusts were listed as "poor performing" on mortality rates in Dr Foster Intelligence's Hospital Guide 2007, published in April last year.

The research also found that differences in the way hospitals record and code deaths could explain around 30% of the variations between hospital's standardised mortality ratios. In addition hospitals with more provision in their area for hospices, nursing homes and community hospitals tended to have lower HSMRs, claimed the report.

A spokeswoman for The Department for Health said: "We welcome all contributions to the development indicators that will help improve our knowledge of clinical quality. It is important that indicators are accurate, technically robust, meaningful and adjusted for risk. The more scientific debate there is about how to achieve this the better.

"The Birmingham University study looked at only one particular measure, the overall hospital standardised mortality ratio. This is not the same as the procedure-specific survival rates that have been well validated in several specialties now."

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