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First, I was teaching a university course on policy research methods, and in, of all places, a two-part Sunday Times supplement, there appeared some near-perfect raw material for a student assignment: the first ever listing of standardised 'death rates' (HSMRs) for England's or any other nation's hospitals.
HSMRs' other key feature is that they measure hospitals not against some objective clinical standard, but against each other.
HSMRs, however, were here to stay, although they have continued to trail controversy in their wake.
The Department of Health in England is undertaking a review of HSMRs on behalf of the National Quality Board (the joint statement is available at http://www.dh.gnv.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_113024) and is considering these problems in its attempt to recommend a hospital mortality measure for the NHS.
In England, HSMRs are derived from the national administrative dataset covering all NHS (public) hospitals, hospital episode statistics (HES).
To assess the magnitude of the effect of some of the key criticisms of HSMRs around clinical coding and denominator inflation, we fitted nine new series of logistic regression models using the same 4 years as above with some key differences from the regular model.
The George Eliot Hospital NHS Trust denied that a high HSMR indicated poor patient care.
It also recorded that the general death rate, referred to in the report as the Hospital Standardised Mortality Ratio (HSMR), was nine per cent above average.
The survey also claims that four other regional trusts - The Royal Wolverhampton Hospitals NHS Trust, George Eliot Hospital NHS Trust, The Dudley Group of Hospitals NHS Foundation Trust and Shrewsbury and Telford Hospital NHS Trust - recorded a higher than expected HSMR rate.
But I believed at the time the processes we were engaged in were a robust and appropriate response to the potential for concerns the HSMRs flagged up.
HSMRS is a project of the library's Food and Nutrition Information Center, an Internet-oriented service group of registered dietitians and nutrition-information specialists geared to rapidly responding to the nutrition concerns of the nation's consumers and healthcare providers.
HSMRS provides nutrition information, foodservice training, and other support services.
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