Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
권호 표지
DOI QR코드

DOI QR Code

How Can We Use Hospital-Standardized Mortality Ratio as a Quality Indicator of Hospital Care in Korea?

일반 질 지표로서의 병원 표준화 사망비에 대한 고찰

  • Kim, Seon-Ha (Department of Nursing, Dankook University College of Nursing) ;
  • Choi, Eun Young (Department of Preventive Medicine, University of Ulsan College of Medicine) ;
  • Lee, Hyeon-Jeong (Department of Preventive Medicine, University of Ulsan College of Medicine) ;
  • Ock, Minsu (Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jo, Min-Woo (Department of Preventive Medicine, University of Ulsan College of Medicine) ;
  • Lee, Sang-il (Department of Preventive Medicine, University of Ulsan College of Medicine)
  • 김선하 (단국대학교 간호학과) ;
  • 최은영 (울산대학교 의과대학 예방의학교실) ;
  • 이현정 (울산대학교 의과대학 예방의학교실) ;
  • 옥민수 (울산대학교 의과대학 울산대학교병원 예방의학과) ;
  • 조민우 (울산대학교 의과대학 예방의학교실) ;
  • 이상일 (울산대학교 의과대학 예방의학교실)
  • Received : 2017.01.02
  • Accepted : 2017.03.14
  • Published : 2017.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

The hospital standardized mortality ratio (HSMR) is a widely used generic measure for assessing quality of hospital care in many countries. However, the validity of HSMR as a quality indicator is still controversial. We critically reviewed characteristics of HSMR and suggested how to use HSMR as a quality indicator in the Korean setting. The association between HSMR and other quality measures of hospital care is inconclusive. In addition current HSMR model has shortcomings in risk adjustment because of the lack of clinical data, accuracy of disease coding, coding variation among hospitals, end-of-life care issues, and so on. Therefore, HSMR should be used as an indicator for improvement, not for judgement such as public reporting and pay-for-performance. More efforts will be needed to tackle practical and methodological weaknesses of HSMR in the Korean setting.

Keywords

References

  1. Health Insurance Review and Assessment Service. Comprehensive quality report of National Health Insurance 2015. Wonju: Health Insurance Review and Assessment Service; 2016.
  2. Institute of Health Policy and Management, Seoul National University Medical Research Center. A study on development and utilization of generic quality indicator. Wonju: Health Insurance Review and Assessment Service; 2012.
  3. Kim M, Kim H, Hwang SH. Developing a hospital-wide all-cause risk-standardized readmission measure using administrative claims data in Korea: methodological explorations and implications. Health Policy Manag 2015;25(3):197-206. DOI: https://doi.org/10.4332/kjhpa.2015.25.3.197.
  4. Choi EY, Ock M, Lee S. Is the risk-standardized readmission rate appropriate for a generic quality indicator of hospital care? Health Policy Manag 2016:26(2):148-152. DOI: https://doi.org/10.4332/kjhpa.2016.26.2.148.
  5. Health Insurance Review and Assessment Service. The first generic quality assessment information session for hospitals. Wonju: Health Insurance Review and Assessment Service; 2014.
  6. Jarman B, Gault S, Alves B, Hider A, Dolan S, Cook A, et al. Explaining differences in English hospital death rates using routinely collected data. BMJ 1999;318(7197):1515-1520. DOI: https://doi.org/10.1136/bmj.318. 7197.1515.
  7. Dr Foster Intelligence. Understanding HSMRs: a toolkit on hospital standardised mortality ratios [Internet]. London: Dr Foster Intelligence; 2014 [cited 2016 Dec 28]. Available from: http://www.drfoster.com/wp-content/uploads/2014/09/HSMR_Toolkit_Version_9_July_2014.pdf.
  8. Van Gestel YR, Lemmens VE, Lingsma HF, de Hingh IH, Rutten HJ, Coebergh JW. The hospital standardized mortality ratio fallacy: a narrative review. Med Care 2012;50(8):662-667. DOI: https://doi.org/10.1097/MLR.0b013e31824ebd9f.
  9. NHS Choices. Mortality ratio: deaths in hospital within 30 days of discharge [Internet]. London: National Health Service [cited 2016 Dec 28]. Available from: http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=96&OrgType=Hospital.
  10. Dr Foster. Dr Foster hospital guide 2013 [Internet]. London: Dr Foster; 2013 [cited 2016 Dec 28]. Available from: http://www.drfoster.com/updates/recent-publications/the-hospital-guide-2013/.
  11. Canadian Institute for Health Information. HSMR: a new approach for measuring hospital mortality trends in Canada [Internet]. Ottawa (ON): Canadian Institute for Health Information; 2007 [cited 2016 Dec 28]. Available from: https://secure.cihi.ca/free_products/HSMR_hospital_mortality_trends_in_canada.pdf.
  12. Institute for Healthcare Improvement. Move your dot: measuring, evaluating, and reducing hospital mortality rates [Internet]. Cambridge (MA): Institute for Healthcare Improvement; 2003 [cited 2016 Dec 28]. Available from: http://www.ihi.org/resources/Pages/IHIWhitePapers/MoveYourDotMeasuringEvaluatingandReducingHospitalMortalityRates.aspx.
  13. National Health Performance Authority. Towards public reporting of standardised hospital mortality in Australia [Internet]. Sydney (NSW): National Health Performance Authority; 2016 [cited 2016 Dec 28]. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129555679.
  14. Lee EJ, Hwang SH, Lee JA, Kim Y. Variations in the hospital standardized mortality ratios in Korea. J Prev Med Public Health 2014;47(4):206-215. DOI: https://doi.org/10.3961/jpmph.2014.47.4.206.
  15. Pouw ME, Peelen LM, Lingsma HF, Pieter D, Steyerberg E, Kalkman CJ, et al. Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization. PLoS One 2013; 8(4):e59160. DOI: https://doi.org/10.1371/journal.pone.0059160.
  16. Jarman B, Pieter D, van der Veen AA, Kool RB, Aylin P, Bottle A, et al. The hospital standardised mortality ratio: a powerful tool for Dutch hospitals to assess their quality of care? Qual Saf Health Care 2010;19(1):9-13. DOI: https://doi.org/10.1136/qshc.2009.032953.
  17. Chung TK, Kang SH. The comparison of risk adjusted mortality rate between Korea and United states. J Digit Policy Manag 2013;11(5):371-384.
  18. Hwang SH. The relationship between inpatient costs and risk-adjusted mortality in hospitals [dissertation]. Seoul: Seoul National University; 2012.
  19. Iezzoni LI. Assessing quality using administrative data. Ann Intern Med 1997;127(8 Pt 2):666-674. DOI: https://doi.org/10.7326/0003-4819-127-8_part_2-199710151-00048.
  20. Shin E, Park YM, Park YG, Kim BS, Park KD, Meng KH. Estimation of disease code accuracy of national medical insurance data and the related factors. Korean J Prev Med 1998;31(3):471-480.
  21. Park BJ, Suh SW, Sung JH, Paerk GD, Kim SH. Improvement plan for validity of health insurance disease code and establishment of data application plan, 2002. Wonju: Health Insurance Review and Assessment Service; 2003.
  22. Bae SO, Kang GW. A comparative study of the disease codes between Korean national health insurance claims and Korean national hospital discharge in-depth injury survey. Health Policy Manag 2014;24(4):322-329. DOI: https://doi.org/10.4332/kjhpa.2014.24.4.322.
  23. Dalton JE, Glance LG, Mascha EJ, Ehrlinger J, Chamoun N, Sessler DI. Impact of present-on-admission indicators on risk-adjusted hospital mortality measurement. Anesthesiology 2013;118(6):1298-1306. DOI: https://doi.org/10.1097/ALN.0b013e31828e12b3.
  24. Glance LG, Osler TM, Mukamel DB, Dick AW. Impact of the present-on-admission indicator on hospital quality measurement: experience with the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators. Med Care 2008;46(2):112-119. DOI: https://doi.org/10.1097/MLR.0b013e318158aed6.
  25. Brand C, Landgren F, Staley C, Tropea J, Liew D, Bohensky M, et al. Hospital mortality indicator (HMI) review. Sydney (NSW): Australian Commission on Safety and Quality in Health Care; 2013.
  26. Health Insurance Review and Assessment Service. Hospital guide for assessment using hospital standardized mortality ratio and risk standardized readmission rate. Wonju: Health Insurance Review and Assessment Service; 2016.
  27. Shahian DM, Wolf RE, Iezzoni LI, Kirle L, Normand SL. Variability in the measurement of hospital-wide mortality rates. N Engl J Med 2010; 363(26):2530-2539. DOI: https://doi.org/10.1056/NEJMsa1006396.
  28. Nicholl J. Case-mix adjustment in non-randomised observational evaluations: the constant risk fallacy. J Epidemiol Community Health 2007;61(11):1010-1013. DOI: https://doi.org/10.1136/jech.2007.061747.
  29. Mohammed MA, Deeks JJ, Girling A, Rudge G, Carmalt M, Stevens AJ, et al. Evidence of methodological bias in hospital standardised mortality ratios: retrospective database study of English hospitals. BMJ 2009; 338:b780. DOI: https://doi.org/10.1136/bmj.b780.
  30. Bottle A, Jarman B, Aylin P. Hospital standardized mortality ratios: sensitivity analyses on the impact of coding. Health Serv Res 2011;46(6pt1): 1741-1761. DOI: https://doi.org/10.1111/j.1475-6773.2011.01295.x.
  31. Chong CA, Nguyen GC, Wilcox ME. Trends in Canadian hospital standardised mortality ratios and palliative care coding 2004-2010: a retrospective database analysis. BMJ Open 2012;2(6):e001729. DOI: https://doi.org/10.1136/bmjopen-2012-001729.
  32. Higginson IJ, Sen-Gupta GJ. Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med 2001;3(3):287-300. DOI: https://doi.org/10.1089/jpm.2000.3.287.
  33. Ben-Tovim D, Woodman R, Harrison JE, Pointer S, Hakendorf P, Henley G. Measuring and reporting mortality in hospital patients [Internet]. Canberra (ACT): Australian Institute of Health and Welfare; 2009 [cited 2016 Dec 28]. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442457132.
  34. Robinson P. Data briefing: why end of life care should be recorded. Health Serv J 2008;118(6136):19.
  35. Korea Statistical Information Office. The cause of death statistics 2015 [Internet]. Daejeon: Statistics Korea; 2015 [cited 2016 Dec 28]. Available from: http://kosis.kr/ups/ups_01List.jsp.
  36. Seagroatt V, Goldacre MJ. Hospital mortality league tables: influence of place of death. BMJ 2004;328(7450):1235-1236. DOI: https://doi.org/10. 1136/bmj.38058.517118.47. https://doi.org/10.1136/bmj.38058.517118.47
  37. Pitches DW, Mohammed MA, Lilford RJ. What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care?: a systematic review of the literature. BMC Health Serv Res 2007;7:91. DOI: https://doi.org/10.1186/1472-6963-7-91.
  38. Hogan H, Healey F, Neale G, Thomson R, Vincent C, Black N. Relationship between preventable hospital deaths and other measures of safety: an exploratory study. Int J Qual Health Care 2014;26(3):298-307. DOI: https://doi.org/10.1093/intqhc/mzu049.
  39. Hogan H, Zipfel R, Neuburger J, Hutchings A, Darzi A, Black N. Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis. BMJ 2015; 351:h3239. DOI: https://doi.org/10.1136/bmj.h3239.
  40. Girling AJ, Hofer TP, Wu J, Chilton PJ, Nicholl JP, Mohammed MA, et al. Case-mix adjusted hospital mortality is a poor proxy for preventable mortality: a modelling study. BMJ Qual Saf 2012;21(12):1052-1056. DOI: https://doi.org/10.1136/bmjqs-2012-001202.
  41. Guru V, Tu JV, Etchells E, Anderson GM, Naylor CD, Novick RJ, et al. Relationship between preventability of death after coronary artery bypass graft surgery and all-cause risk-adjusted mortality rates. Circulation 2008;117(23):2969-2976. DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.722249.
  42. Lee HY, Park EC, Lee SG, Park SH, Kim TH. Development of classification criteria for hospital readmission and model for risk standardized readmission rate. Wonju: Health Insurance Review and Assessment Service; 2016.
  43. Jacobson B, Mindell J, McKee M. Hospital mortality league tables. BMJ 2003;326(7393):777-778. DOI: https://doi.org/10.1136/bmj.326.7393.777.
  44. Black N. Assessing the quality of hospitals. BMJ 2010;340:c2066. DOI: https://doi.org/10.1136/bmj.c2066.
  45. Mackenzie SJ, Goldmann DA, Perla RJ, Parry GJ. Measuring hospital-wide mortality-pitfalls and potential. J Healthc Qual 2016;38(3):187-194. DOI: https://doi.org/10.1111/jhq.12080.
  46. Raleigh VS, Foot C. Getting the measure of quality: opportunities and challenges [Internet]. London: The King's Fund; 2010 [cited 2016 Dec 28]. Available from: https://www.kingsfund.org.uk/sites/files/kf/Getting-the-measure-of-quality-Veena-Raleigh-Catherine-Foot-The-Kings-Fund-January-2010.pdf.