ArticlePloS one2013
Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
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- Using days alive and out of hospital to measure surgical outcomes in New Zealand: a cross-sectional study.BMJ open · 2023Article
- Can we trust the standardized mortality ratio? A formal analysis and evaluation based on axiomatic requirements.PloS one · 2021Article
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- Observed to expected or logistic regression to identify hospitals with high or low 30-day mortality?PloS one · 2018Article
- Initial disease severity and quality of care of emergency department sepsis patients who are older or younger than 70 years of age.PloS one · 2017Observational
- The development and acceptability of symptom management quality improvement reports based on patient-reported data: an overview of methods used in PROSSES.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2016Article
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- Variations in the hospital standardized mortality ratios in Korea.Journal of preventive medicine and public health = Yebang Uihakhoe chi · 2014Article
- Identifying unusual performance in Australian and New Zealand intensive care units from 2000 to 2010.BMC medical research methodology · 2014Article
- Article
- Direct risk standardisation: a new method for comparing casemix adjusted event rates using complex models.BMC medical research methodology · 2013Article
- Including post-discharge mortality in calculation of hospital standardised mortality ratios: retrospective analysis of hospital episode statistics.BMJ (Clinical research ed.) · 2013Article
- Variation in surgical-readmission rates and quality of hospital care.The New England journal of medicine · 2013Article
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Authors and funding
7 authors.
Funding
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Abstract
backgroundThe hospital standardized mortality ratio (HSMR) is developed to evaluate and improve hospital quality. Different methods can be used to standardize the hospital mortality ratio. Our aim was to assess the validity and applicability of directly and indirectly standardized hospital mortality ratios.
methodsRetrospective scenario analysis using routinely collected hospital data to compare deaths predicted by the indirectly standardized case-mix adjustment method with observed deaths. Discharges from Dutch hospitals in the period 2003-2009 were used to estimate the underlying prediction models. We analysed variation in indirectly standardized hospital mortality ratios (HSMRs) when changing the case-mix distributions using different scenarios. Sixty-one Dutch hospitals were included in our scenario analysis.
resultsA numerical example showed that when interaction between hospital and case-mix is present and case-mix differs between hospitals, indirectly standardized HSMRs vary between hospitals providing the same quality of care. In empirical data analysis, the differences between directly and indirectly standardized HSMRs for individual hospitals were limited.
conclusionDirect standardization is not affected by the presence of interaction between hospital and case-mix and is therefore theoretically preferable over indirect standardization. Since direct standardization is practically impossible when multiple predictors are included in the case-mix adjustment model, indirect standardization is the only available method to compute the HSMR. Before interpreting such indirectly standardized HSMRs the case-mix distributions of individual hospitals and the presence of interactions between hospital and case-mix should be assessed.
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