Dataset Information

Trends in Canadian hospital standardised mortality ratios and palliative care coding 2004-2010: a retrospective database analysis.

ABSTRACT:

Background

The hospital standardised mortality ratio (HSMR), anchored at an average score of 100, is a controversial macromeasure of hospital quality. The measure may be dependent on differences in patient coding, particularly since cases labelled as palliative are typically excluded.

Objective

To determine whether palliative coding in Canada has changed since the 2007 national introduction of publicly released HSMRs, and how such changes may have affected results.

Design

Retrospective database analysis.

Setting

Inpatients in Canadian hospitals from April 2004 to March 2010.

Patients

12 593 329 hospital discharges recorded in the Canadian Institute for Health Information (CIHI) Discharge Abstract Database from April 2004 to March 2010.

Measurements

Crude mortality and palliative care coding rates. HSMRs calculated with the same methodology as CIHI. A derived hospital standardised palliative ratio (HSPR) adjusted to a baseline average of 100 in 2004-2005. Recalculated HSMRs that included palliative cases under varying scenarios.

Results

Crude mortality and palliative care coding rates have been increasing over time (p<0.001), in keeping with the nation's advancing overall morbidity. HSMRs in 2008-2010 were significantly lower than in 2004-2006 by 8.55 points (p<0.001). The corresponding HSPR rises dramatically between these two time periods by 48.83 points (p<0.001). Under various HSMR scenarios that included palliative cases, the HSMR would have at most decreased by 6.35 points, and may have even increased slightly.

Limitations

Inability to calculate a definitively comparable HSMR that include palliative cases and to account for closely timed changes in national palliative care coding guidelines.

Conclusions

Palliative coding rates in Canadian hospitals have increased dramatically since the public release of HSMR results. This change may have partially contributed to the observed national decline in HSMR.

SUBMITTER: Chong CA

PROVIDER: S-EPMC3533024 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Trends in Canadian hospital standardised mortality ratios and palliative care coding 2004-2010: a retrospective database analysis.

Chong Christopher Aky CA Nguyen Geoffrey C GC Wilcox M Elizabeth ME

BMJ open 20121105 6

<h4>Background</h4>The hospital standardised mortality ratio (HSMR), anchored at an average score of 100, is a controversial macromeasure of hospital quality. The measure may be dependent on differences in patient coding, particularly since cases labelled as palliative are typically excluded.<h4>Objective</h4>To determine whether palliative coding in Canada has changed since the 2007 national introduction of publicly released HSMRs, and how such changes may have affected results.<h4>Design</h4>R ...[more]

PMID: 23131397

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Dataset Information

Trends in Canadian hospital standardised mortality ratios and palliative care coding 2004-2010: a retrospective database analysis.

Background

Objective

Design

Setting

Patients

Measurements

Results

Limitations

Conclusions

Publications

Trends in Canadian hospital standardised mortality ratios and palliative care coding 2004-2010: a retrospective database analysis.

Similar Datasets

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