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ScotPHO Training Day Hospital Standardised Mortality Ratios

Explore in-depth insights on Hospital Standardised Mortality Ratios (HSMR) and how it drives better healthcare decisions. Understand the methodology, diagnostic groupings, and patient record sets to improve patient outcomes. Utilize HSMR funnels and control limits to identify high-risk areas and improve mortality rates. Get access to timely data releases and support for quality improvement initiatives. Enhance patient care with actionable information.

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ScotPHO Training Day Hospital Standardised Mortality Ratios

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  1. ScotPHO Training DayHospital Standardised Mortality Ratios Richard Dobbie Gavin MacColl (ISD Quality Improvement Programme) better information --> better decisions --> better health

  2. Routine Linked Data Quality Strategy – Patient Centred Clinical Engagement Quality Improvement Programme • Hospital Standardised Mortality Ratios (HSMR’s) • Surgical / Medical Profiles • Scottish Arthroplasty Project • Complaints • Incident Reporting Pilot • ‘Better Together’ Inpatient Survey • National Audits • SICSAG / Stroke / STAG-Sepsis / Renal Registry

  3. Observed Deaths HSMR = Predicted Deaths S Observed Deaths = Deaths S Predicted Deaths = Predicted Probabilities What is an HSMR? better information --> better decisions --> better health

  4. Data source - SMR01/GRO linked data Outcome - 30 day mortality Patient indexing – Quarterly (CIS) Explanatory variables • Age, sex, deprivation • Type of admission (elective / non-elective) • Inpatient / day case • Place admitted from • Number of previous emergency admissions • Primary diagnosis • Prior morbidity – 1 and 5 years • Surgical / non-surgical specialty HSMR Methodology better information --> better decisions --> better health

  5. Profiles HSMR’s SAP Patient Record Sets better information --> better decisions --> better health

  6. Primary Diagnostic Groupings better information --> better decisions --> better health

  7. Prior Morbidity better information --> better decisions --> better health

  8. Scottish Case-Mix Model(selected pathways in model) better information --> better decisions --> better health

  9. Timeline of HSMR Development better information --> better decisions --> better health

  10. Timeline of HSMR Development better information --> better decisions --> better health

  11. Quarterly Release better information --> better decisions --> better health

  12. Quarterly Release better information --> better decisions --> better health

  13. Quarterly Release Baseline better information --> better decisions --> better health

  14. Jan – Mar 09 Apr – Jun 09 Jul – Sep 09 Oct – Dec 09 9 Months Jul – Sep 10 Oct – Dec 10 Jan – Mar 11 Apr – Jun 11 4 Months 3 Months Addressing Timeliness better information --> better decisions --> better health

  15. Timetable better information --> better decisions --> better health

  16. better information --> better decisions --> better health

  17. What is a High HSMR? • A high HSMR where variation greater than +3SDs above Scotland HSMR • Also where HSMR >Scot HSMR but within control limits; Where HSMR is increasing or is steady over time • Distribution of variation shown on a funnel plot • In addition to published data, HSMR used as part of an internal process to highlight hospitals with exceptional variation (variation outwith norm) • Data variability on a funnel plot is not published – risk ofleague tables • Escalation protocol for potential quality/safety concerns flagged up by data – instigated by QIS (HIS) and ISD better information --> better decisions --> better health

  18. HSMR Funnel Plot Control Limits Upper & Lower Scot HSMR CL+3SD Hospitals HSMR Unusual HSMR above CL(+3SD) CL+2SD CL-2SD CL-3SD better information --> better decisions --> better health

  19. Information Support to Boards 1 • Provide data to support further investigation into high HSMR • HSMR trend over time and control limits better information --> better decisions --> better health

  20. Information Support to Boards 2HSMR within control limits over time HSMR within Control limits Scot HSMR better information --> better decisions --> better health

  21. Information Support to Boards 2 HSMR reaching control limits Unusual HSMR above CL(+3SD) Scot HSMR better information --> better decisions --> better health

  22. Information Support to Boards 2 • Provide data to support further investigation into high HSMR • HSMR trend over time and control limits • HSMR stratified : Elective / non elective admissions, age group, specialty, diagnostic grouping better information --> better decisions --> better health

  23. Information Support to Boards 2 • Elective / non elective, age group, specialty, diagnostic grouping • Example HSMR elective / non elective, age group, specialty, diagnostic grouping better information --> better decisions --> better health

  24. Information Support to Boards 2 • Elective / non elective, age group, specialty, diagnostic grouping • Indicator of where to start to look • Indicate where Scot HSMR < lower 95% CI HSMR HSMR Scot HSMR better information --> better decisions --> better health

  25. Deaths 30-Day Survivors Information Support to Boards 3 Case Listing better information --> better decisions --> better health

  26. Unlikeliest Death According to Model Unlikeliest Survivor According to Model Information Support to Boards 3 Case Listing better information --> better decisions --> better health

  27. Information Support to Boards 3 Value of Case Listing • Review of the patient journey • Review of clinical records • ICD 10 coding vs SMR01 linked file • HSMR catalyst for improvement(s) in SMR01 coding accuracy better information --> better decisions --> better health

  28. Three funnel plots Effect of Coding better information --> better decisions --> better health

  29. Regression – Scotland, Crosshouse The 15% ‘Target’ better information --> better decisions --> better health

  30. Issues • Importance of Robust Clinical Coding • Individual probabilities of death based on ICD-10 coding • Supporting Users • Developing data pack (case listings, aggregations etc) • Working (proactively with stakeholders locally to avoid surprises • Main contacts (Patient Safety Leads, Clinical Governance) • Refer to existing resources (Navigator, Surgical / Medical Profile, ACaDMe) • Data Timeliness • SMR01 and GRO data submissions • 30-day Follow-up • Reduced lag better information --> better decisions --> better health

  31. Thank you very much for listening If you would like to contact us: Richard Dobbie Richard.Dobbie@nhs.net Gavin MacColl Gavin.Maccoll@nhs.net Website address: www.isdscotland.org

  32. Any Questions? better information --> better decisions --> better health

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