We need to balance the technical challenges of hospital standardised mortality ratios with the need to improve care processes
That “sunshine is the best disinfectant” is attributed to the distinguished American jurist Louis Brandeis, who spent much of his career supporting individual rights in the context of corporate and monopoly power.1 State and federal governments, in conjunction with bodies such as the Australian Commission on Safety and Quality in Health Care and the Australian Institute of Health and Welfare, are developing indicators for the safety and quality of Australian hospital care, presumably with the intention of using them to illuminate some of the inner workings of our hospital system for the benefit of both health care providers and the community at large. The challenges posed by such a program are illustrated in this issue of the Journal by Scott and colleagues2 and Gallagher and Krumholz.3
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- 1. Brandeis L. The regulation of competition versus the regulation of monopoly. An address to the Economic Club of New York on November 1, 1912. http://www.law.louisville.edu/library/collections/brandeis/node/260 (accessed Nov 2010).
- 2. Scott IA, Brand C, Phelps G, et al. Using hospital standardised mortality ratios to assess quality of care — proceed with extreme caution. Med J Aust 2011; 194: 645-648.
- 3. Gallagher M, Krumholz HM. Public reporting of hospital outcomes: a challenging road ahead. Med J Aust 2011; 194: 658-660.
- 4. Steering group for the national review of the hospital standardised mortality ratio. National review of HSMR — consensus statement. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_121327.pdf (accessed Nov 2010).
- 5. Ben-Tovim DI, Pointer SC, Woodman R, et al. Routine use of administrative data for safety and quality purposes — hospital mortality. Med J Aust 2010; 193 (8 Suppl): S100-S103. <MJA full text>
- 6. Australian Commission on Safety and Quality of Health Care. National indicators of safety and quality. http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/PriorityProgram-08_HospLvl-Indicators (accessed Nov 2010).
- 7. Moran JL, Solomon PJ; Adult Database Management Committee of the Australian and New Zealand Intensive Care Society (ANZICS). Global quantitative indices reflecting provider process-of-care: database derivation. BMC Med Res Methodol 2010; 10: 32.
- 8. Ghaferi A, Birkmeyer J, Dimick J. Variation in hospital mortality associated with inpatient surgery. N Engl J Med 2009; 361: 1368-1375.
- 9. Board N, Watson DE. Using what we gather — harnessing information for improved care. Med J Aust 2010; 193 (8 Suppl): S93-S94. <MJA full text>
The Clinical Epidemiology Unit, Flinders Medical Centre has received grant support from the Australian Commission on Safety and Quality in Health Care for analysis of hospital mortality data.