Versions Compared

Key

  • This line was added.
  • This line was removed.
  • Formatting was changed.
HTML
<div id="summaryView" role="tabpanel" aria-labelledby="tabSummaryView">
HTML Table
classconfluenceTable
Table Row (tr)
Table Cell (td)
Name
Table Cell (td)
Hospital Deaths (HSMR)
Table Row (tr)
Table Cell (td)
Short/Other Names
Table Cell (td)

Hospital Standardized Mortality Ratio (HSMR)

Table Row (tr)
Table Cell (td)
Description
Table Cell (td)

The ratio of the actual number of in-hospital deaths in a region or hospital to the number that would have been expected, based on the types of patients a region or hospital treats.

For further details, please see the General Methodology Notes.

Table Row (tr)
Table Cell (td)
Interpretation
Table Cell (td)
Lower is better. The HSMR is most useful to follow a hospital's performance over time.
Table Row (tr)
Table Cell (td)
HSP Framework Dimension
Table Cell (td)

Health System Outputs: Appropriate and effective

Table Row (tr)
Table Cell (td)
Areas of Need
Table Cell (td)

Getting Better

Table Row (tr)
Table Cell (td)
Geographic Coverage
Table Cell (td)

All provinces

Table Row (tr)
Table Cell (td)
Reporting Level/Disaggregation
Table Cell (td)

National, Province/Territory, Region, Facility

Table Row (tr)
Table Cell (td)
Indicator Results
Table Cell (td)

Accessing Indicator Results on Your Health System: In Depth

HTML
</div>
HTML
<div id="fullView" role="tabpanel" aria-labelledby="tabFullView">
HTML

<div role="button" class="expandableTitle" aria-controls="identifyingInfoRegion">Identifying Information</div>
HTML Table
ididentifyingInfoRegion
Table Row (tr)
Table Cell (td)
Name
Table Cell (td)
Hospital Deaths (HSMR)
Table Row (tr)
Table Cell (td)
Short/Other Names
Table Cell (td)

Hospital Standardized Mortality Ratio (HSMR)

HTML

<div role="button" class="expandableTitle" aria-controls="descAndCalRegion">Indicator Description and Calculation</div>
HTML Table
iddescAndCalRegion
Table Row (tr)
Table Cell (td)
Description
Table Cell (td)

The ratio of the actual number of in-hospital deaths in a region or hospital to the number that would have been expected, based on the types of patients a region or hospital treats.

For further details, please see the General Methodology Notes.

Table Row (tr)
Table Cell (td)
Calculation: Description
Table Cell (td)

The ratio of the actual number of in-hospital deaths to the expected number of in-hospital deaths, for conditions accounting for about 80% of inpatient mortality

Unit of Analysis: Hospitalization

Table Row (tr)
Table Cell (td)
Calculation: Geographic Assignment
Table Cell (td)

Place of service

Table Row (tr)
Table Cell (td)
Calculation: Type of Measurement
Table Cell (td)

Ratio

Table Row (tr)
Table Cell (td)
Calculation: Adjustment Applied
Table Cell (td)

The following covariates are used in risk adjustment:
For each HSMR diagnosis group, the HSMR logistic regression models are fitted with age, sex, length-of-stay (LOS) group, admission category (urgent and elective), comorbidity (Charlson Index Score) group and transfers as independent variables.

Table Row (tr)
Table Cell (td)
Calculation: Method of Adjustment
Table Cell (td)

Logistic regression

Table Row (tr)
Table Cell (td)
Denominator
Table Cell (td)

Description:
Expected deaths, or number of deaths that would have occurred in a hospital or region had the mortality of these patients been the same as the mortality of similar patients across the country, based on the reference year (2012–2013)
Inclusions:
1. Discharge between April 1 of a given year and March 31 of the following year

2. Admission to an acute care institution (Facility Type Code = 1)

3. Discharge with diagnosis group of interest (i.e., one of the diagnosis groups that account for about 80% of in-hospital deaths, after excluding patients receiving palliative care)

4. Age at admission between 29 days and 120 years

5. Sex recorded as male or female

6. Length of stay of up to 365 consecutive days

7. Admission category recorded as urgent/emergent or elective (Admission Category Code = U or L)
Exclusions:
1. Cadavers or stillborns (Discharge Disposition Code = 08 or 09)

2. Self sign-outs or did not return from a pass (Discharge Disposition Code = 06, 12, 61,* 62,* 65,* 66,* 67*)

3. Records with brain death as most responsible diagnosis code (ICD-10-CA: G93.81)

4. Records with most responsible diagnosis (MRDx) of palliative care (ICD-10-CA: Z51.5). For Quebec data: records where Z51.5 coded as MRDx, or cancer (C00–C97) coded as MRDx and Z51.5 coded in any secondary diagnosis field

5. Medical assistance in dying (MAID):
• 2016–2017 to 2017–2018 data only:
Discharge Disposition Code = 07 (in-hospital death) AND either 1 of the following 2:
– Prefix = J in any field; OR
– 3 CCI codes: 1.ZZ.35.HA-P7, 1.ZZ.35.HA-P1, 1.ZZ.35.HA-N3 (all present on the same abstract)
• 2018–2019 data onward: Discharge Disposition Code = 73

Note
*2018–2019 data onward

Table Row (tr)
Table Cell (td)
Numerator
Table Cell (td)

Description:
Observed deaths, or actual number of in-hospital deaths that occurred in a hospital or region
Inclusions:
Death (Discharge Disposition Code = 07, 72,* 74*)

Note
*2018–2019 data onward

Exclusions:
Same as for the denominator

HTML

<div role="button" class="expandableTitle" aria-controls="backgroundRegion">Background, Interpretation and Benchmarks</div>
HTML Table
idbackgroundRegion
Table Row (tr)
Table Cell (td)
Rationale
Table Cell (td)

The HSMR is a performance indicator that allows hospitals to measure and monitor their progress in quality of care.

Ever since the HSMR measure was first developed and disseminated by CIHI, many hospitals and health providers across Canada have been using it as part of their ongoing efforts to improve care.

The HSMR can be used to track the overall change in mortality resulting from a broad range of factors, including changes in the quality and safety of care delivered.

Table Row (tr)
Table Cell (td)
Interpretation
Table Cell (td)

Lower is better. The HSMR is most useful to follow a hospital's performance over time.

Table Row (tr)
Table Cell (td)
HSP Framework Dimension
Table Cell (td)

Health System Outputs: Appropriate and effective

Table Row (tr)
Table Cell (td)
Areas of Need
Table Cell (td)

Getting Better

Table Row (tr)
Table Cell (td)
Targets/Benchmarks
Table Cell (td)

Not applicable

Table Row (tr)
Table Cell (td)
References
Table Cell (td)

Alexandrescu R, Jen MH, Bottle A, Jarman B, Aylin P. Logistic versus hierarchical modeling: an analysis of a statewide inpatient sample. J Am Coll Surg 2011;213(3):392-401.

Bottle A, Jarman B, Aylin P. Hospital standardized mortality ratios: sensitivity analyses on the impact of coding. Health Serv Res 2011;46(6pt1):1741-1761.

Bottle A, Jarman B, Aylin P. Strengths and weaknesses of hospital standardised mortality ratios. BMJ 2011;342:c7116.

Breslow NE, Day NE. Statistical Methods in Cancer Research: Volume II: The Design and Analysis of Cohort Studies. Lyon: International Agency for Research on Cancer; 1987.

Jarman B, Gault S, Alves B et al. Explaining differences in English hospital death rates using routinely collected data. BMJ 1999;318(7197):1515-1520.

Jarman B, Bottle A, Aylin P, Browne M. Monitoring changes in hospital standardised mortality ratios. BMJ 2005;330(7487):329.

Quan H, Li B, Couris CM et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011;173(6):676-682.

HTML

<div role="button" class="expandableTitle" aria-controls="availabilityRegion">Availability of Data Sources and Results</div>
HTML Table
idavailabilityRegion
Table Row (tr)
Table Cell (td)
Data Sources
Table Cell (td)

DAD, HMDB

Table Row (tr)
Table Cell (td)
Available Data Years
Table Cell (td)

Type of Year:
Fiscal
First Available Year:
2013
Last Available Year:
2017

Table Row (tr)
Table Cell (td)
Geographic Coverage
Table Cell (td)

All provinces

Table Row (tr)
Table Cell (td)
Reporting Level/Disaggregation
Table Cell (td)

National, Province/Territory, Region, Facility

HTML

<div role="button" class="expandableTitle" aria-controls="resultRegion">Result Updates</div>
HTML Table
idresultRegion
Table Row (tr)
Table Cell (td)
Update Frequency
Table Cell (td)

Twice a year

Table Row (tr)
Table Cell (td)
Indicator Results
Table Cell (td)

Web Tool:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

Table Row (tr)
Table Cell (td)
Updates
Table Cell (td)

Changes to the HSMR methodology, implemented in February 2015, include the following:

1. HSMR results are calculated with an updated baseline using 2012–2013 data. The previous baseline was calculated using 2009–2010 data.

2. The statistical test of significance is based on comparing results with the national average (as opposed to 100).

HTML

<div role="button" class="expandableTitle" aria-controls="qualityRegion">Quality Statement</div>
HTML Table
idqualityRegion
Table Row (tr)
Table Cell (td)
Caveats and Limitations
Table Cell (td)

Medical assistance in dying (MAID) was decriminalized in Canada with the enactment of Bill C-14 in June 2016. MAID cases are excluded from HSMR calculations for all DAD-submitting provinces and territories. It is not possible to exclude MAID cases from Quebec results due to differences in data collection. The impact of the differences of MAID exclusion is not fully known but is estimated to have a small effect on interprovincial comparability.

Table Row (tr)
Table Cell (td)
Trending Issues
Table Cell (td)

Not applicable

Table Row (tr)
Table Cell (td)
Comments
Table Cell (td)

The average experience of Canadian hospitals is set at 100 and is based on data collected in 2012–2013. HSMR results are compared against the current national average. An HSMR above the national average indicates that the hospital's mortality rate is higher than the average HSMR. An HSMR below the national average indicates that the hospital's mortality rate is lower than the average HSMR.

Further information is available in the Technical Notes and other HSMR resources: https://www.cihi.ca/en/health-system-performance/quality-of-care-and-outcomes/hsmr

Indicator results are also available in

HTML
</div>