The BBC reports today (25 February 2014) that a leading academic is calling into question the value of measuring hospital death rates and suggesting that these statistics should be ignored.
Two measures of death rates are currently calculated. The Hospital Standardised Mortality Ratio (HSMR), which compares the expected death rate in a hospital with the actual rate, and the Summary Hospital-Level Mortality Index (SHMI), which includes details of patients who die within the first 30 days of their discharge from hospital after treatment.
The NHS has commissioned a review of these data to assess their respective merits in assessing standards of care. The review is being led by Professor Nick Black and is due to report in December 2014.
Speaking to the BBC's File on 4, broadcast on Radio 4 on 25 February, Professor Black is reported to have said that the HSMR measure should be ignored. He is quoted as saying that he does not think the data have any value and are a distraction because they present a misleading picture of the quality of care that a hospital provides and can be influenced by factors outside an individual hospital's control. For example, patients with terminal illnesses who need end-of-life care are less likely to die in hospital if there is a local hospice, whereas, there is often no real alternative to dying in hospital in an area without a hospice.
Mortality data are used to monitor hospitals' performance and inform decision-making. The Care Quality Commission (CQC), the body tasked with auditing standards in hospitals, uses the mortality data to inform and prioritise its programme of inspections.
Within the last month, six NHS hospital trusts have been identified as having high mortality rates and all are now in special measures. Sir Bruce Keogh, who led the investigation that followed in the wake of the appalling care exposed at Mid-Staffs NHS Trust, found that there were failings in care at 14 hospitals with the highest death rates.
Commenting on the remarks, Andrew Clayton, associate in the Penningtons Manches’ clinical negligence team, said: "Mortality data do have shortcomings. They cannot be taken in isolation and need to be analysed alongside other statistics and qualitative information such as local demographics and factors that may not be easy to measure mathematically. While mortality data are somewhat crude, they have a part to play in forming an overall picture of the standard of care being provided. Recent experiences, including the Mid-Staffs enquiry, suggest these data may indicate potential concerns that can, at least, inform where attention and resources might need to be focussed.
"Both patients and decision-makers depend on data such as mortality statistics to help them make informed choices about where to be treated or where to prioritise resources. If mortality data lack value, as today's report suggests, then more needs to be done to refine the information on patient outcomes available to those making these decisions."