Sterftecijfers Hospitals

HSMR

Inderdaad zijn het wel heel ruwe data waar we in Nederland mee te maken krijgen schrijft ook het gezaghebbende Medisch Contact over de gepubliceerde ziekenhuissterftecijfers. Aan de overzijde van de Noordzee is men verder. Zie het  fraaie rapport uit 2009 uit Engeland met de HSMR (hospital standardized mortality rate). Maar lees ook over de voordelen van veiligheid.Jaren geleden was ik al onder de indruk van de data die in Schotland worden geproduceerd door de ISD (Information Services Division) als afdeling van de NHS National Services Scotland.

 
The aim of the Scottish Patient Safety Programme is to reduce hospital mortality by 15% by the end of the programme in December 2011. 
Development of the case-mix adjustment methodology for Scotland began in early 2008 and although the method used in England by Dr Foster informed the Scottish process, the models are different and reflect differences in the source data.

Toelichting Schotse HSMRs


The HSMR is calculated for all acute inpatient and day case patients admitted to all specialties (medical and surgical). The calculation takes account of patients who died within 30 days from admission; it includes deaths that occurred in the community (out of hospital deaths) as well as those occurring in-hospital.
The HSMR is calculated as:

Hospital Standardised Mortality Ratio (HSMR) = Observed Deaths / Expected Deaths

To calculate the expected deaths, a predicted probability of death within 30 days from admission was calculated for each patient based on the patient’s primary diagnosis; specialty (medical or surgical); age; sex; where they were admitted from; the number and severity of prior morbidities in the previous (i) 12 months (ii) 5-years; the number of emergency admissions in the previous 12 months; whether admitted as an inpatient or day case and type of admission (elective / non-elective). In order to count the number of patients and deaths within each quarter the patient’s last stay within each quarter was selected. The outcome (whether the patient is alive or dead within 30 days) and the variables used for case-mix adjustment were taken from the first episode of the stay. Patients with admissions in different quarters will be counted in each quarter but the death is only counted once. If a patient was admitted in one quarter but died in the subsequent quarter, any admissions in this latter quarter were excluded.  This ensured that the analysis was patient-based, within quarter, and that deaths were counted only once. Dit type grafiek vind ik eigenlijk veel interessanter.De overleving na opname wegens een heupfractuur. Het rolschermpje kan de deelnemende ziekenhuizen stuk voor stuk naar voren halen.

Overleving heupfracturen per ziekenhuis


U zult zien dat er verschillen zijn!