Hospital Standardized Mortality Ratio (HSMR)
From April 2012 to March 2013, the overall HSMR for Hamilton Health Sciences was 91.
What is "Hospital Standardized Mortality Ratio"?
- HSMR is an overall quality indicator and measurement tool that compares a hospital's mortality rate with the average national experience, given the types of patients cared for. It has been used by many hospitals worldwide to assess and analyze mortality rates and to identify areas for improvement.
- HSMR is the ratio of the actual number of deaths to the expected number of deaths, multiplied by 100.
- It is based on diagnosis groups that account for 80% of all deaths in acute care hospitals, and is adjusted for factors such as: diagnosis group, age, sex, length of stay, admission category, co-morbidities, and transfers.
- A ratio that is equal to 100 suggests that there is no difference between the hospital's mortality rate and the average national experience, given the types of patients cared for.
- A ratio greater than 100 suggests that the hospital's mortality rate is higher than the average national experience, given the types of patients cared for.
- A ratio less than 100 suggests that hospital's mortality rate is lower than the average national experience, given the types of patients cared for.
- HSMR results have been publicly reported for a number of years.
- The previous baseline year for HSMR calculations was 2004-2005. However, morbidity and mortality patterns are changing. In addition, Hospitals, like ours, have implemented a range of initiatives to reduce mortality and improve patient care.
- As a result, HSMR results across the country have been progressively improving. This is a good thing, but we never want to lose sight of the importance of what tracking and monitoring patient safety indicators is all about, and that is ongoing quality improvement.
- So, this year, the methodology used to calculate HSMR results was updated.
- The baseline year for the data has changed (from 2004-05 to 2009-10) and updated methodology was used to re-calculate HSMR results for 2007-08, 2008-09, 2009-10, 2010-11, and 2011-12.
- There have also been some other changes incorporated into this year’s HSMR results. For example, Quebec is now included, more diagnoses are added and a new approach to logistic regression modeling is used.
- Because of the new baseline, HSMR values may look like they have increased for the majority of hospitals when compared to the results released last year. Generally, HSMR results across the country have increased by about 10 points in light of the re-baselined data. However, the trend remains similar for most organizations.
- Rather than focusing on the differences between the results calculated using the new and old methodologies, it is recommended that the focus be on the change over time using the new methodology publicly available this year.
- Five years of results using the new methodology are provided and allow for appropriate trending to be considered.
How are hospitals using HSMR data to help reduce mortality rates and make improvements?
- HSMR has been used by hospitals in several countries to assess in-hospital mortality rates and to help organizations identify areas for improvement. HSMR should be used as a tool to help follow progress over time, and make quality improvements based on the results. That said, we recognize there is always more to do to make the care we provide better, timelier and safer. Patients should know that their hospital is safe, that the care they receive there is top-notch, and that every effort is to ensure they receive the highest-quality care possible.
- Ontario hospitals are using the HSMR for internal benchmarking purposes. Annually reported data helps to show hospitals how their HSMR has changed, where they have made progress, and where they can continue to improve.
- Trending HSMR results for several years has proven very useful: stable reporting year after year helps show how our HSMR has changed in relation to our quality improvement efforts – where we’ve made progress and where we can continue to improve.
- Each year, we carefully review the results, identify and work to implement improvements wherever possible. This year will be no exception.
Interpreting the Hospital Standardized Mortality Ratio Reports
- HSMR can be a very effective quality improvement tool. It should be seen as a system-level measure, and not focused on individuals. A higher than average HSMR result does not necessarily mean that a hospital is "unsafe" just as a lower than average HSMR does not necessarily mean a hospital is "safe." It is vital that HSMR results be viewed in the context of other performance indicators.
- The HSMR tool is not intended to serve as a measure for hospitals to compare themselves against other organizations, or for the public to use as a measure of choosing where to seek care.
- We strongly support the public reporting of quality indicators such as HSMR because we believe it will inspire improved performance, enhance patient safety, and strengthen the public’s confidence in Ontario’s hospitals.
- It is important to note that hospitals – even within a region – often serve different segments of the population with different health needs. That’s perhaps one reason why our hospital scored differently than another in our LHIN.
HSMR: Our Current Year's Results for Hamilton Health Sciences (HHS)
- From April 2012 to March 2013, the overall HSMR for Hamilton Health Sciences was 91.
What are we doing to continue to improve our HSMR rate at Hamilton Health Sciences?
Under the Excellent Care for All Act, hospitals are required to develop a Quality Improvement Plan (QIP) that outlines clear objectives for improving patient care. We submitted our QIP to Health Quality Ontario in April 2011 and one of the targets we set for ourselves was an HSMR rate less than 100 by the end of fiscal year 2011/12 which was achieved. This year’s QIP (2012/13) is also publicly posted, so it’s one more way we are staying accountable to our community, patients and staff and being openly committed to improving the care we provide. Furthermore, a random sample of deaths that occur at HHS are reviewed in order to identify opportunities to improve our care processes. HHS also has many other projects and initiatives underway that will result in safer care. Some of these projects include:
- Application of best practice to decrease ventilator associated pneumonia, central line infections, surgical site infections, and falls
- Electronic Documentation
- Patient Safety Leadership Walk-arounds
- Hand Hygiene Improvement initiatives
- Improving access to care and services
- Safe Surgery Checklist
- Automated medication dispensing machines