Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.

<h4>Background</h4>The 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 standardiz...

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Autores principales:	Maurice E Pouw, Linda M Peelen, Hester F Lingsma, Daniel Pieter, Ewout Steyerberg, Cor J Kalkman, Karel G M Moons
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5fb6b06fafc045299eaf37e68a757652
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spelling	oai:doaj.org-article:5fb6b06fafc045299eaf37e68a7576522021-11-18T07:49:56ZHospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.1932-620310.1371/journal.pone.0059160https://doaj.org/article/5fb6b06fafc045299eaf37e68a7576522013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23593133/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>The 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.<h4>Methods</h4>Retrospective 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.<h4>Results</h4>A 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.<h4>Conclusion</h4>Direct 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.Maurice E PouwLinda M PeelenHester F LingsmaDaniel PieterEwout SteyerbergCor J KalkmanKarel G M MoonsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 4, p e59160 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Maurice E Pouw Linda M Peelen Hester F Lingsma Daniel Pieter Ewout Steyerberg Cor J Kalkman Karel G M Moons Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.
description	<h4>Background</h4>The 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.<h4>Methods</h4>Retrospective 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.<h4>Results</h4>A 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.<h4>Conclusion</h4>Direct 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.
format	article
author	Maurice E Pouw Linda M Peelen Hester F Lingsma Daniel Pieter Ewout Steyerberg Cor J Kalkman Karel G M Moons
author_facet	Maurice E Pouw Linda M Peelen Hester F Lingsma Daniel Pieter Ewout Steyerberg Cor J Kalkman Karel G M Moons
author_sort	Maurice E Pouw
title	Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.
title_short	Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.
title_full	Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.
title_fullStr	Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.
title_full_unstemmed	Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.
title_sort	hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/5fb6b06fafc045299eaf37e68a757652
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Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.

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