Key result
Hospital standardized mortality ratios correlate weakly with other measures of quality of care and have significant limitations when derived solely from administrative data.
Hospital standardized mortality ratios (HSMR) are flawed as standalone performance measures due to weak correlation with quality of care, lack of precision, and susceptibility to bias from administrative data coding.
HSMRs warrant caution as sole hospital quality metrics; leaves open validation of superior measures from richer clinical data.
Mortality for specific conditions and procedures has figured prominently among outcomes-based performance measures.[1][1]–[3][2] However, in recent years there has been renewed interest in overall hospital mortality, specifically the hospital standardized mortality ratio (HSMR) ([Box 1][3]).[4][4
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Shojania et al. (2008) conducted a review in Hospital mortality and performance measurement. Hospital standardized mortality ratio (HSMR) was evaluated. Hospital standardized mortality ratios correlate weakly with other measures of quality of care and have significant limitations when derived solely from administrative data.
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