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Standard hospital quality measures are inaccurate on avoidable deaths


14 July 2015

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Alternative measures should be used to assess hospitals’ quality of care as the current system does not accurately show how many deaths could have been avoided, a study revealed.

Alternative measures should be used to assess hospitals’ quality of care as the current system does not accurately show how many deaths could have been avoided, a study revealed.

The standardised mortality ratios (SMRs), such as HSMR (Hospital standardised mortality ratio) and SHMI (Summary hospital level mortality indicator), have been widely used for more than 20 years, often to identify ‘problem’ hospitals. However, they do not represent quality of care and should not be used, the authors at London School of Hygiene & Tropical Medicine said.

Dr Helen Hogan, lead author, said: “Our findings suggest that the commonly used hospital-wide SMRs are not a useful reflection of the proportion of avoidable deaths in a trust.

“Dreadful though each avoidable hospital death is, they are too infrequent to be the basis of a robust indicator to detect significant differences between trusts. There are credible alternatives for assessing the quality of hospitals which give a fairer and more accurate picture,” she said.

The researchers found that the proportion of avoidable hospital deaths was 3.6%. There was no significant association between hospital-wide SMRs and the proportion of avoidable deaths in a trust.

The study was commissioned by Professor Sir Bruce Keogh, Medical Director of NHS England, following his review of 14 Trusts in 2013, which questioned whether SMRs for hospitals provide an accurate indication of the number of avoidable deaths occurring.

The National Institute of Health Research and the Department of Health funded it.

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