number of deaths with a Hospital Standardised Mortality Ratio (HSMR) diagnosis to the expected number of deaths, multiplied by 100. Denominator superspells with method of discharge as death (DISMETH=4,5) Denominator: Superspells containing a spell with a primary dominant diagnosis of any of the 56 CCS groups that comprise the HSMR basket (contributing to 80% of deaths) Age on admission (in five year bands up to 90+) Interactions between age on admission (in five year bands up to 90+) and Charlson score Admission method or elective) deprivation quintile of the area of residence of the patient (based on the Carstairs Index) Diagnosis/procedure subgroup Co-morbidities (based on Charlson score) Number of previous emergency admissions Year of discharge (financial year) Whether or not palliative care Month of admission Source of admission Reported as HSMR - The ratio of the observed number of in-hospital deaths during admissions with a Hospital Standardised Mortality Ratio (HSMR) diagnosis to the expected number of deaths, multiplied by 100 Interpretation: of 100 represents the national average. A trust with An HSMR of 100 means the number of patients who died is exactly as it would be expected taking into account the standardisation factors. An HSMR above 100 means more patients died than would be expected; one below means fewer patients died than would be expected. Publicly reported: Dr Foster Quality Accounts () and in the My Hospital Guide Hospital reporting: For member organisations via online system. No detail available. 2. In-hospital mortality indicators for acute myocardial infarction In-hospital mortality indicators for acute myocardial infarction hospital morbidity
A revascularization procedure is coded: Percutaneous coronary intervention (CCI: 1.IJ.50^^, 1.IJ.57.GQ^^ or 1.IJ.54.GQ.AZ*) or Coronary artery bypass (CCI: 1.IJ.76^^) Exclusion Criteria: AMI admissions (ICD-10-CA: I21.^ or I22.^ as a diagnosis type M, 1, 2, W, X or Y in the 12 months preceding the admission date on the index AMI record Age (in years) associated with index AMI record ≤19 Refer to Section 5: Identifying Acute Care and Day Hospital standardised mortality ratio - AMI. The ratio of the observed number of deaths to the expected number of deaths, multiplied by 100. Numerator All spells with method of discharge as death, defined by a specific diagnosis code for the primary diagnosis of the spell (AMI), excluding day cases. Denominator The expected number of in-hospitals deaths derived from logistic regression. Exclusion criteria: Daycases (where classpat = 2 in the first episode) Not specified Risk adjustments are made for: Sex Age on admission (in five year up to 90+) Admission method (non-elective or elective) Socio-economic deprivation quintile of the area of residence of the patient (based on the Carstairs Index) Primary diagnosis (based on the Clinical Classification System - CCS group) Co-morbidities (no further information available) How reported: Standardised ratio for Trusts (147) Observed / expected x100 Interpretation: It is expressed as a relative risk, where a risk rating of 100 represents the national average. If the trust has an HSMR of 100, that means that the number of patients who died is exactly as it would be expected taking into account the standardisation factors. Publicly reporting: Dr Foster Quality Accounts () Hospital reporting: hospital
Number of previous emergency admissions Year of discharge (financial year) Palliative care (whether the patient is being treated in specialty of palliative care). Participating hospitals access details online via a secure website. Acute myocardial infarction: 30-day case-fatality rate / in-hospital mortality rate. Year: 2006 Number of deaths in the hospital that occurred within 30 days of hospital admission with primary diagnosis of AMI. Numerator Number of deaths in the hospital that occurred within 30 days of hospital admission with primary diagnosis of AMI. Denominator Number of people hospitalised with primary diagnosis of AMI. Exclusion criteria: that occur out of hospital AMI patient who were admitted with other conditions and died in the hospital Not specified. Varies for countries. Standardised for differences in age (45+ years) and sex. Comparability issues include: variation in the data collection period, age groups, coding practice, collection methods. How reported: Rates per 100 patients, age-sex standardised rates per 100 patients with 95% confidence intervals. Better quality is associated with a lower score. Public reporting: is an annual publication reporting indictor performance for participating countries. The data is also reported online via the . . Comparative analysis is performed from data collected from 17 different countries Hospital reporting: No 3. In-hospital mortality indicators for stroke In-hospital mortality indicators for stroke
Stroke in-hospital mortality. Year: 2012 Recommended change: (Review 2012) Patients who died in hospital and had a length of stay less than or equal to 30 days. Denominator Current: Patients with a principal diagnosis of Intracerebral haemorrhage; other non-traumatic intracranial haemorrhage; cerebral infarction; or stroke; not specified as haemorrhage or infarction length of stay 3 or more days unless the patient died in hospital Recommended from 2012 review – not yet incorporated into specifications: Inclusion of all in hospital mortalities Expand age of patients to include those aged 18‐29 years Linkage of episodes across hospitals to be the same as linkage within hospitals, i.e. – link to subsequent acute stroke episodes or other non‐acute episodes Transfers out from the initial hospital providing acute treatment are included, as are transfers in and out of subsequent hospitals in a single ‘continuum of care’. A transferred case is defined as either: an admission to a subsequent hospital within 12 hours of separation from the previous hospital OR an admission to a subsequent hospital within 36 hours with indication of either a ‘transfer out’ or a ‘transfer in’ Exclusion criteria: Current transfers in transfers out changes of episode type, and change: to include 18-29 years Age group, septicaemia, malignancy, heart failure, acute lower respiratory tract infection and influenza, and renal failure. Recommended: To remove septicaemia and acute respiratory tract infection and include risk adjustment for stroke type: Age group Heart failure Malignancy Renal Failure Stroke type (as defined by ICD code block: I61, I62, I63, or I64) to pg 8 for rationale of risk adjustment recommendations. A rate reflects higher quality Publicly reporting: The Hospital Performance Reports are no longer available publicly on the website. At the time of the last literature review in 2009, the 2004 data was available publicly. Hospital reporting Via secure online platform provided in partnership with . Features of the website include charting to show performance against control limits for a selected indicator and facility. Includes systems for actioning performance results found to be outside the control limits. The Opus 5 website also includes functionality for analysing causes and determining workflow to address quality issues. VLAD is updated on a monthly. A flag is initiated where the VLAD line meets the lower or upper control limits.
of the patient (based on the Carstairs Index) Primary diagnosis (based on the Clinical Classification System - CCS group) Co-morbidities (no further information available) Number of previous emergency admissions Year of discharge (financial year) Palliative care (whether the patient is being treated in specialty of palliative care). Public reporting: Dr Foster Quality Accounts () Hospital reporting: Participating hospitals access details online via a secure website. Stroke 30 day case-fatality rate/in-hospital mortality rate. Year: 2006 Number of deaths in the hospital that occurred within 30 days of hospital admission with primary diagnosis of hemorrhagic and ischemic stroke. Numerator Number of deaths in the hospital that occurred within 30 days of hospital admission with primary diagnosis of hemorrhagic stroke, and ischemic stroke (ICD-9 or Denominator Number of people hospitalised with primary diagnosis of stroke. Not specified Not specified. Varies for participating countries. Standardised rates for differences in age (45+ years) and sex. Comparability issues include: variation in the data collection period, age groups, coding practice, collection methods. How reported: Rates per 100 patients, age-sex standardised rates per 100 patients with 95% confidence intervals. Interpretation: Better quality is associated with a lower score. Public reporting: is an annual publication reporting indictor performance for participating countries. The data is also reported online via the . Comparative analysis is performed from data collected from 17 different countries Hospital reporting: No
Mortality in discharges with principal diagnosis code of pneumonia. All discharges, age 18 years and older, with a principal diagnosis code of pneumonia, excluding: missing discharge disposition transferring to another hospital Major Diagnostic Category (MDC): pregnancy, childbirth, and puerperium 5. In-hospital mortality indicators for hip fracture In-hospital mortality indicators for hip fracture Source Definition Numerator / Denominator Inclusion / Exclusion Criteria for Denominator Age group Risk adjustment Reporting Year: 2012 In-hospital deaths of patients admitted for fractured neck of femur operative intervention Numerator: Observed number of deaths for NOF patients × national in-hospital mortality rate for NOF patients Where Observed number of deaths for NOF patients = the number of Inclusion criteria: Principal diagnosis29 of NOF (S72.0, S72.10, S72.11) AND Procedure code30 in (47519-00 [1479] , 47522-00 [1489], 47528-01 [1486], 47531-00 [1486], 49315-00 [1489]) AND External cause31 code of (W00.x – W19.x,) OR secondary diagnosis code32 of Tendency Age at date of admission is between 50 and 120, inclusive Risk adjustments made for: Age in years at date of admission Sex Additional (comorbid) diagnoses: Ischaemic heart disease Dysrhythmia How reported: Reported as the risk adjusted rate – the ratio of observed (actual) number of in-hospital deaths to expected number of in-hospital deaths for fractured neck of femur (NOF) patients, multiplied by the national mortality rate for NOF patients. Interpretation: hospital hospital
separations (meeting the denominator criteria) where separation mode = died. National mortality rate = national observed number of in-hospital deaths for NOF ÷ national observed number of separations for NOF Denominator: Expected number of deaths for NOF patients = the sum of the estimated probabilities of death for all separations (meeting the denominator criteria), calculated using national risk-adjustment coefficients. to fall not elsewhere classified (R29.6). Age at date of admission is between 50 and 120, inclusive Length of stay (LOS, including days) is between 1 and 30 days, inclusive (1 ≤ LOS ≤ 30). Acute lower respiratory tract infection (LRTI) and influenza Kidney (renal) failure Heart failure A higher than the national rate corresponds to a higher than expected mortality rate, while a value of lower than the national rate corresponds to a lower than expected mortality rate. High or rising rates signal that a problem might exist and that further investigation is required. Public reporting: TBA Hospital reporting: TBA Fractured neck of femur in hospital mortality. Year: 2008/09 Fractured Neck of patients who died in‐hospital and had a length of stay less than or equal to 30 days. Numerator: Patients died in-hospital. Denominator Current: Patients with a principal diagnosis of fracture of femur with at least one of the following procedures: Internal fixation of fracture of trochanteric or subcapital femur; Hemiarthroplasty of femur; Open reduction of fracture of femur with internal fixation; Closed reduction of fracture of Inclusion criteria: Current 50 years or older patients have spent at least one night in Recommended (revised) 50 or older All lengths of stays All transfers in and transfers out All episode types All external cause codes Exclusion criteria: Current excluding transfers in and transfers out 50 and older Risk adjustments are made for: Currently age group sex ischaemic heart disease dysrhythmias failure acute lower respiratory tract infection and influenza failure Recommended (revised): How reported: Reported as rate per 100 separations. Interpretation: Better quality is associated with a lower score. Publicly reporting: The Hospital Performance Reports are no longer available publicly on the website. At the time of the last literature review in 2009, the 2004 data was available publicly. Hospital reporting hospital
Hip fracture mortality rate. Year: 2013 New definition (2013): In-hospital deaths per 1,000 hospital discharges with hip fracture as a principal diagnosis for patients ages 65 years and older. Excludes periprosthetic fracture discharges, obstetric discharges, and transfers to another hospital. Previous definition (2009): Number of deaths per 100 discharges with principal diagnosis code of hip fracture. Numerator: Number of deaths among cases meeting the inclusion and exclusion rules for the denominator. Denominator: Discharges, for patients ages 65 years and older, with a principal ICD-9-CM diagnosis code for hip fracture. New exclusion criteria (2013): with any-listed ICD-9-CM diagnosis codes for periprosthetic fracture (99644 PERIPROSTHETIC FX-PROS JT) transferring to another short-term hospital (DISP=2) MDC 14 (pregnancy, childbirth, and puerperium) with missing discharge disposition (DISP=missing), gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing) or principal diagnosis (DX1=missing) Previous exclusion criteria (2009): cases with any diagnosis of periprosthetic fracture missing discharge disposition transferring to another short-term Major Diagnostic Category (MDC): pregnancy, childbirth, and puerperium 65 and older Risk adjustment not provided. Observed rates may be stratified by: Hospitals Age groups Race/ethnicity categories Sex Payer categories How reported: Reported as rate per 1000 discharges. Interpretation: Better quality is associated with a lower score. Public reporting None of the s include in-hospital mortality for fractured neck of femur. Hospital reporting: Via website. Hospitals may also use the software to create their own reports
Hospital standardised mortality ratio – fracture neck of femur. The ratio of the observed number of deaths to the expected number of deaths, multiplied by 100. Numerator: All spells with method of discharge as death (DISMETH=4), defined by a specific diagnosis code for the primary diagnosis of the spell. Denominator: Expected number of deaths derived from logistic regression. Exclusion criteria: Daycases classpat = 2 in the first episode) Not specified Risk adjustments are made for: Sex Age on admission (in five year bands up to 90+) Admission method (non-elective or elective) Socio-economic deprivation quintile of the area of residence of the patient (based on the Carstairs Index) Primary diagnosis (based on the Clinical Classification System - CCS group) Co-morbidities Number of previous emergency admissions Year of discharge (financial year) Palliative care (whether the patient is being treated in specialty of palliative care) How reported: Reported as standardised ratios for Trusts (147) (observed / expected). The is calculated by dividing the actual number of deaths by the expected number and multiplying the figure by 100. Interpretation: It is expressed as a relative risk, a risk rating of 100 represents the national average. If the trust has an HSMR of 100, that means that the number of patients who died is exactly as it would be expected taking into account the standardisation factors. An HSMR above 100 means more patients died than would be expected; one below 100 means that fewer than expected died. Control limits tell us the range of values which are consistent with random or chance variation. Data points falling within the control limits are consistent with random or chance variation and are said to display 'common-cause variation'; for data points falling outside the control limits, chance is an unlikely explanation and hence they are said to display 'special-cause variation' - that is, where the trust's rate diverges significantly from the national rate. hospital
Public reporting Dr Foster Quality Accounts () 6. In-hospital death in low mortality DRG Death in low mortality DRG Source and indicator name Definition Numerator / Denominator Inclusion / Exclusion Criteria for Denominator Age group Risk adjustment & statistical methods Reporting & interpretation Year: 2012 In-hospital deaths in Diagnosis Related Groups with a mortality rate less than 0.5% Numerator Number of in-hospital deaths for low mortality DRGs x 100 Number of in-hospital deaths = total number of separations (meeting denominator criteria) and separation mode11 = died. Denominator Number of separations in low-mortality DRGs. Low mortality DRGs are defined as DRGs with a national mortality rate of less than 0.5% over the previous 3 Inclusion criteria: Age at date of admission is between 18 and 120 years, inclusive DRGs codes: low mortality DRGs (see Appendix 2 for list of codes) Care type12 = acute care. Exclusion criteria: Any diagnosis (principal or additional) and/or any procedure of trauma, state, cancer. Age 18 – 120 years There is no risk adjustment for CHBOI 2 Death in low mortality DRGs however, stratification of results by peer group will improve the comparability and relevance of the unadjusted rates. How reported: Reported as the percentage of separations for low mortality diagnosis-related groups (DRGs) that end in death in hospital. Interpretation: High or rising rates signal that a problem might exist and that further investigation is required. Investigations should consider a range of possible explanations including: differences from the national patient population; structural or resource issues (e.g. staff shortages, ward closures, etc.); changes in treatment protocols; and professional practice (i.e. individual clinical staff actions) (Mohammed et al. 2004). For this indicator, the main risk lies in allocation of a low mortality DRG to a patient with multiple reasons for admission. Publicly reported: TBA
risk rating of 100 represents the national average. Control limits set at 99.8% No additional information provided about risk adjustment methods Data points falling above the upper 99.8% binomial control limit are said to be significantly ‘higher than expected’, data points falling below the lower 99.8% binomial control limit are said to be significantly ‘lower than expected’, otherwise ‘within expected range’. Publicly reporting: My Hospital Guide () and Dr Foster Quality Account () Hospital reporting: For member organisations via online system. No detail available.