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ÖSTERGÖTLANDS LÄN Linköping

Calculation of adjusted death rates, HSMR E xperience in Sweden Hans Rutberg, Senior medical adviser Swedish National Board of Health and Welfare. Sweden Inhabitants ~ 9 million County Councils: 21 Hospitals ~ 70. ÖSTERGÖTLANDS LÄN Linköping.

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ÖSTERGÖTLANDS LÄN Linköping

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  1. Calculation of adjusted death rates, HSMR Experience in SwedenHans Rutberg, Senior medical adviserSwedish National Board of Health and Welfare

  2. Sweden Inhabitants ~ 9 million County Councils: 21 Hospitals ~ 70 ÖSTERGÖTLANDS LÄNLinköping

  3. Age, sex, admission method, los, diagnosis, HSMRs - hospital standardised mortality ratios 1995-2001 (99% CIs) Source: Sir Brian Jarman

  4. Walsall change of HSMR Observed – expected deaths (for top 80% all deaths) by 19 March 2005= a reduction of 303 deaths (379 death if scaled to 100% deaths, 0.147/bed/year reduction) First publication of HSMRs Jan 2001 Start of improvement interventions Source: Sir Brian Jarman

  5. Walsall Hospital Standardised Mortality Ratio, HSMR, England 2000-01distribution and Walsall 19/3/2005 Walsall 2000/1 Walsall 19 March 2005, but with wide CIs Source: Sir Brian Jarman

  6. Evaluation of HSMR in Sweden • A project initiated by the National Board of Health and Welfare, the Federation of County Councils and the Southeast health care region. • A national interest to use HSMR to compare hospitals and county councils • A possible indicator for comparison of the Nordic countries?

  7. Swedish Hospital Discharge Register started in the 1960:s. Since 1987 it covers all public, in-patient care in Sweden • Data on patient: Personal id-number, sex, age, place of residence • Data on hospital: County council, hospital, department • Administrative data Date of admission/discharge, LoS, acute/planned admissions, admitted from, discharged to • Medical data Main and secondary diagnoses, surgical procedures, external cause of injury and poisoning

  8. HSMR in Sweden Variables: • Sex • Age • Length of stay • Way of admission, transfer from other hospital • Acute/planned admission • Main diagnosis

  9. HSMR in Sweden Main diagnosis • The main diagnoses accounting for80 % of hospital mortality • 58 diagnoses • 370 000 admissions yearly, ~ 25 % of all admissions • 27 000 deaths annually

  10. HSMR in Sweden Discharged as dead • Good quality • 27 000 registrations per year • 30 days mortality ??

  11. Swedish deaths 2001 by CCS* group(*Clinical Classification System. Elixhauser A, Andrews RM, Fox, S. Clinical classifications for health policy research: Discharge statistics by principal diagnosis and procedure. Provider Studies Research Note 17. Rockville, MD:Agency for Health Care Policy and Research; 1993. AHCPR Pub. No. 93-0043. www.ahrq.org) Source: Sir Brian Jarman

  12. HSMR in SwedenLength of stay,1998-2004 OR 95 % CI 0-7 days 0.52 0.51 0.53 8-14 days 0.48 0.47 0.49 15-28 days 0.71 0.70 0.72 29-365 days 1.00 --

  13. HSMR in Sweden1998-2004 OR 95 % Ci • Transfer from other hospital 1,26 1,24-1,28 • Not planned 2,53 2,50-2,56

  14. HSMR in SwedenAdmission data

  15. Swedish preliminary HSMRs 1998-2004 (some exclusions will be necessary)

  16. Swedish preliminary county HSMRs 1998-2004 (some exclusions will be necessary)

  17. HSMR, County Council, The Swedish Hospital Discharge Register,1998-2004.

  18. HSMR, County Council, compensated for transfer within hospital

  19. HSMR in Sweden Data quality problem: • Transfer within hospital (1,2 - 10,1%) • Transfer between hospitals (2,2 - 43,5%) • Underreporting planned/not planned • Large vs. small hospitals?

  20. HSMR in Sweden Future steps: • Present the method and publish preliminary results on county council level in the Swedish Medical Journal • Discuss data quality with those responible on county council level • Consider to use HSMR as a national indicator • Pilot project in the South-east healthcare region on structured patient record review on hospital deaths with IHIs Trigger Tool

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