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Dutch Health Care Inspectorate and public reporting of the HSMR

Dutch Health Care Inspectorate and public reporting of the HSMR. The Dutch Safety Campaign promise 50 % reduction avoidable deaths. Dutch Patient safety Campaign. Dutch hospitals, the medical, nursing and consumers associations presented the campaign and develop the necessary interventions

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Dutch Health Care Inspectorate and public reporting of the HSMR

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  1. Dutch Health Care Inspectorateand public reporting of the HSMR

  2. The Dutch Safety Campaign promise 50 % reduction avoidable deaths

  3. Dutch Patient safety Campaign • Dutch hospitals, the medical, nursing and consumers associations presented the campaign and develop the necessary interventions • Minister of Health finances the campaign • Health Care Inspectorate supervises the implementation of interventions and the effect of the campaign

  4. How to measure decrease of avoidable death HSMR seems promising • Correction for patient factors like age, urgency and diagnosis • Diagnosis (50 groups, contributing to 80% of hospital deaths) • Uses standard registration of medical data • No increase of administrative burden

  5. How to measure decrease of avoidable death • HSMR seems promising • But the contribution of avoidable occurrences in hospital deaths is very small* *Martine de Bruyne

  6. HSMR questions • Is the inclusion of 50 diagnose groups sufficient • Full correction for patient characteristics is impossible, but is HSMR correction sufficient? • Is the registration of data complete and reliable?

  7. Comparability of hospitals University hospitals < 80% deaths in included diagnose groups e.g. perinatal deaths rare diseases Teaching hospitals (STZ) >80% deaths in included diagnose groups Small rural hospitals < 50 diagnose groups

  8. Correction for diagnose group does not take into account that severity of disease in one diagnose group may vary widely Geelkerken et al. Medisch Contact 2008:9;370-374. Van den Bosch et al. Ned Tijdschr Geneeskd. 2008;152:…. Comparability within diagnose groups

  9. Incomplete data • LMR is no longer mandatory • Some sections are incomplete e.g. • Urgency (no ER, so no urgent admittance?) • Some data are incomprehensible e.g. • other / miscellaneous

  10. Conclusions(H)SMR • Can be used to monitor hospital mortality at a national level • Can not be used to monitor preventable deaths • Can not (yet) be used to compare hospital mortality in public • Can be used by hospitals to monitor their own hospital mortality in time, between departments and in different diagnose groups in order to improve patient safety

  11. It is the result that counts

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