What hospital mortality league tables tell you

Aylin, Paul; Jarman, Sir Brian; Kelsey, Tim

doi:10.1136/bmj.326.7403.1397-b

Cited by 3 publications

(2 citation statements)

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“…This is not surprising since the use of administratively generated data for research purposes, as in the first objective above, is widely regarded as problematic. Also for PM of individuals or institutions, their suitability needs critical consideration (Spiegelhalter et al ., 2002; Dyer, 2003; Carter, 2003; Jacobsen et al ., 2003; Aylin et al ., 2003; Bridgewater et al ., 2003).…”

Section: Introductionmentioning

confidence: 99%

Performance Indicators: Good, Bad, and Ugly

Bird

David²,

Farewell

et al. 2004

Journal of the Royal Statistical Society Series A: Statistics in Society

271

174

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Section: Introductionmentioning

confidence: 99%

Performance Indicators: Good, Bad, and Ugly

Bird

David²,

Farewell

et al. 2004

Journal of the Royal Statistical Society Series A: Statistics in Society

271

174

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“…Despite these having a high impact in the press and being of great interest to the public, their use remains controversial. [2][3][4][5][6][7][8][9][10] The Dr Foster organisation was established in 2000 as an independent group providing 'authoritative and independent guides to UK health services in the public and private sectors'. In particular, Dr Foster publishes standardised mortality rates for a range of diagnoses and procedures for NHS acute trusts in England, with the aim of allowing consumers and doctors to 'make the best possible choices'.…”

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confidence: 99%

AAA Benchmarking by Dr Foster: A Cause for Concern?

Pandey

Kerle

Jenkins

et al. 2007

annals

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INTRODUCTIONThe publication of interpretable performance data for hospitals is an important service. In November 2002, the medical benchmarking company Dr Foster published a league table based on the results of abdominal aortic aneurysm (AAA) repair. The purpose of our study was to establish the validity of the data used in benchmarking.PATIENTS AND METHODS Data on elective infra-renal AAA (IRAAA) repair was obtained from three sources. Data used by Dr Foster was based on the hospital PAS system. The databases for both Dr Foster and PAS were analysed and cross-referenced to the vascular unit database maintained by a separately employed audit co-ordinator. RESULTS Of 395 total aortic aneurysm repairs, 223 (56%) were identified as elective IRAAA repairs on the unit database. Of these, 125 were identified on the PAS database and 115 on the Dr Foster database. The number of deaths was the same in both the unit and Dr Foster databases ( n = 11) but the Dr Foster database included deaths in patients who had undergone juxtarenal ( n = 1), Type III TAAA ( n = 2) and Type IV TAAA ( n = 4) repairs and omitted 7 deaths following IRAAA. The sensitivity and specificity for the PAS dataset was 0.51 and 0.93, respectively. For Dr Foster, the results were worse with a sensitivity and specificity of 0.41 and 0.86, respectively. The accuracy of the data was 0.6 and 0.69 for Dr Foster and PAS, respectively. Standardised mortality ratios (SMRs) were used to rank hospitals. Dr Foster's published SMR for elective AAA repair for our unit was 160. The actual SMR was 67.CONCLUSIONS Robust and accurate published league tables should be supported and commended but currently available data appear to be misleading and may cause unnecessary concern to patients.

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Objective Assessment of the Quality of Hospital Care: Dream or Reality?

Bíró¹,

Takács²

2007

Hungarian Medical Journal

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What hospital mortality league tables tell you

Cited by 3 publications

References 2 publications

Performance Indicators: Good, Bad, and Ugly

Performance Indicators: Good, Bad, and Ugly

AAA Benchmarking by Dr Foster: A Cause for Concern?

Objective Assessment of the Quality of Hospital Care: Dream or Reality?

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