Hospital mortality: when failure is not a good measure of success

The Hospital Standardized Mortality Ratio Fallacy

“…Some have demonstrated that use of HSMRs may reduce in-hospital mortality by supporting improvement initiatives for reducing hospital mortality with reduced HSMRs as a result. [39][40][41][42][43] Nevertheless, as discussed in this report, many others have previously demonstrated that the HSMR is not a reliable measurement of quality of care, 2,8,11,20,[30][31][32][33]35,[44][45][46][47][48] with the most important shortcomings summarized in Table 2. Besides, hospitals might try to lower the HSMR, although it is not even proven yet that a lower HSMR is an indicator of good quality.…”

Public Reporting of Hospital Hand Hygiene Compliance—Helpful or Harmful?

“…6 The reporting of hospital-standardized mortality ratio in Canada led to reductions in this outcome to an extent that was inconsistent with the use of evidence-based improvement strategies. 7 When public reporting is mandated without guidance on how improvement should be achieved or without additional resources to support improvement, it is not surprising that indicator-based improvement strategies are used.…”

A New Method for Evaluating Trauma Centre Outcome Performance

“…39,48,49 Criticism often stems from bad methodology and the inappropriate interpretation and dissemination of results. Indeed, inappropriate risk adjustment methods and one-level regression modeling have often been used to generate profiling estimates, and SMRs are still wrongly used to rank institutions.…”