Mortality Rate, this is how it is calculated, interpreted and adjusted. Statement below is taken from Press release by NCUHT dated 21 October 2014 ‘Two years ago, North Cumbria University Hospitals NHS Trust was recorded as having one of the highest Hospital Standardized Mortality Ratios (HSMR) in England and was visited in the summer of 2013 by a specialist review team as part of the national Keogh Review process. Since then, and thanks to difficult but vital changes which have been implemented by clinicians, the Trusts overall HSMR has seen a sustained reduction and continues to decline’ Two years ago we were highlighted as having one of the highest mortality rates in England but the facts now speak very clearly for themselves. The difficult and important decisions we have taken to transfer certain patients from West Cumbria to Carlisle to make sure they get access to the best possible, safest care, is now firmly evidenced in our improved mortality data.’ .What is HSMR (Hospital Standardized Mortality Rate) and RAMI (Risk adjusted Mortality Index)? Mortality rate is calculated from RAMI (Risk Adjusted Mortality Index). Which means in, simple term, Death already happened divided by Expected Death. Expected deaths are worked out from ‘Severity index’ Severity index is worked out from hospital diagnosis codes.( Every condition patient suffers from has code, and this how Private health care provider like BUPA charges the patient for their treatment and NHS hospital does the same thing to get money from CCG, Clinical Commissioning Group) for example, patient with hip fracture has a broken bone+ past heart attack + some kidney Problem in past, if all the history in recorded in death certificate than, that patient if dies, than it is expected death, and not counted as high mortality. Same patient has only broken hip bone is recorded in death certificate, and no other past problems recorded, and patient dies than it is unexpected death, and included as high mortality. So the problem is not that that patient is not treated well at, just that all past illness was not recorded in the death certificate. So in simple term these recording of all illness, are called coding. So improving coding than effectively improves mortality index, without even transferring patients from one hospital to another hospital, but if you do transfer that patient than it is easy to claim that mortality has improved by transferring the patient. The more codes, in general, the higher the expected mortality, the lower the HSMR (Hospital Standardized Mortality Ratios) or RAMI (Risk Adjusted Mortality Index) and the better the hospital appears. The fundamental issue is that it is these coding variations, and not the quality of Care that determines the result. So by improving coding of the patient illness, it is also possible to show improvement in mortality index and result of the treatment, without doing any major changes. All foundation NHS Trust has very organized and efficient coding department, to charge CCG for the treating their patient and Northumbria is no exception. So it may be that WCH has, or had, poor coding department, but it certainly did not provide poor care to the population of west Cumbria. Hospital management can, and do,take the advantage of poor coding practices of one hospital, to transfer the services to another hospital, and thus be able to claim that mortality has improved because of their policy of transfer of patients. And because of management style,experienced staffs leaves, and recruitment becomes difficult, compounding the problems.
Posted on: Fri, 24 Oct 2014 10:34:08 +0000
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