Details

Autor(en) / Beteiligte

• Santhakumaran, Shalini

Titel

How to adjust for case-mix when comparing outcomes across healthcare providers

Ist Teil von

• Archives of disease in childhood. Education and practice edition, 2014-04, Vol.99 (2), p.70-71

Ort / Verlag

London: BMJ Publishing Group

Erscheinungsjahr

2014

Link zum Volltext

Quelle

BMJ Journals Archiv - DFG Nationallizenzen

Beschreibungen/Notizen

• Comparisons of healthcare measures across regions of England are already freely available through the National Health Service (NHS) Atlas of Variation in Healthcare, 1 and individual cardiac surgeons working in the NHS have had survival rates following surgery published for several years. 2 Variation in outcomes can be due to many factors, so the 'signal' (variation due to the factors we are interested in) needs to be identified separately from the 'noise' (other variation). Deaths Rate (%) <28 weeks 300 66 22 200 44 22 3000 750 25 28-32 weeks 200 6 3 300 9 3 7000 350 5 Total 500 72 14.4 500 53 10.6 10 000 1100 11 --- Unit A Unit B Standardised mortality ratio (SMR) = 100xobserved deaths/expected deaths in Unit A population using case-mix specific rates from all neonatal units in the region = 100x72/(300x25% +200x5%) = 84.7 Directly standardised rate = expected rate in population of all neonatal units in the region using case-mix specific rates from Unit A = (3000x22%+7000x3%)/10 000 = 8.7% SMR=100x53/(200x25%+300 x 5%)=81.5 Directly standardised rate==(3000x22%+7000x3%)/10 000=8.7% Indirect standardisation Indirect standardisation is the method used to calculate the standardised mortality ratio (SMR) which is a commonly reported if somewhat controversial measure. 3 The SMR is often misused to compare hospitals with one another, for example in league tables.