News
Public Performance Reporting -
Hospital Standardized Mortality Ratio
December, 2008
Why is HSMR important?
Southlake’s HSMR
Frequently Asked Questions
On November 29, 2007, the Canadian Institute for Health Information (CIHI) released, for the first time, the Hospital Standardized Mortality Ratio (HSMR) results for large hospitals, Local Health Integration Networks (LHINs), and Regional Health Authorities across Canada. These data will be released on an annual basis going forward for all eligible hospitals. Effective December 2008, The Ontario Ministry of Health and Long Term Care requires that all eligible hospitals post their HSMR annual results on their public website.
What is the HSMR?
The HSMR is an analytical tool that allows hospitals to compare the actual number of deaths in their facility in a year to the number of deaths that might be expected based on the types of patients the hospital treats.
HSMR is calculated as the ratio of the number of actual deaths to the number of expected deaths in each acute care hospital across Canada.
Formula:
HSMR = Observed deaths x 100
Expected deaths
A patient’s age, sex, diagnosis, length of stay, type of admission, transfer status, and co-morbidities (or pre-admission conditions) are taken into consideration when the expected rate is calculated
The number of expected deaths is calculated specifically for Southlake, representing our volume and mix of patients.
The HSMR calculation is based on 65 diagnosis groups that account for about 80 per cent of in-hospital deaths in Canada, The diagnosis groups with the most deaths during the baseline year 2004-05 include acute myocardial infarctions (heart attacks), heart failure, pneumonia, chronic obstructive pulmonary disease, septicemia and stroke.
An HSMR equal to 100 means there is no difference between the hospital’s mortality rate and the average national rate. An HSMR greater than 100 would suggest a higher than average mortality rate and lower than 100 would suggest a lower than average rate.
Why is HSMR Important?
As a Regional Centre of Excellence, Southlake is committed to the continuous improvement of the quality of our care and services. While we constantly strive to provide safe and effective care, we also recognize that there is always more we can do to deliver on our vision of “Shockingly Excellent Service”
HSMR is an important indicator for Southlake because it allows us, for the first time, to measure and track our in-patient mortality rates in a way that adjusts for differences in the patients we serve. It is a well researched indicator developed specifically to help us identify opportunities for improvement and to measure our progress in reducing in-patient mortality over time
The Canadian Institute for Health Information has developed and tested the HSMR as just one measure of hospital performance. It is not intended to be used to make direct comparisons between hospitals, nor is it recommended that the public use it in choosing where to receive care.
Southlake’s HSMR
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Frequently Asked Questions
1. Why does Southlake have two HSMR results?
When calculating the HSMR, CIHI provided two HSMR results: one for all eligible cases and one excluding cases that hospitals have identified as palliative care.
Palliative care patients are those who are at the end stage of their life and are no longer receiving active treatment. As a result, the expected mortality rate for these patients is higher than for patients being admitted for active care and treatment.
Hospitals vary in the degree to which they separate end-of life care from active care in their health records. Different communities also have different levels of palliative care available outside of hospitals, which affects the number of patients who would receive palliative care in a specific hospital. Providing both ratios allows hospitals to examine these differences.
2. How will Southlake reduce its HSMR?
For the past two years, Southlake has had a renewed focus in strengthening our Patient Safety program. As outlined in our Strategic Plan, under Our Patients and Community Pillar, Southlake has made 5 Key Patient Safety commitments:
- Improve culture of safety
- Decrease medication errors
- Prevent nosocomial infections
- Reduce inpatient mortality
- Champion Safer Healthcare Now! Campaign.
As a Regional Centre of Excellence, Southlake is committed to lowering our HSMR significantly. We will do this by expanding and strengthening our patient safety practices , Hardwiring patient safety in all that we do.
We are currently in the process of doing this through our initiation of all 6 of the Safer Healthcare Now! Interventions, which are promoted by the Canadian Patient Safety Institute. Over time we will work to have all Interventions fully implemented throughout Southlake. These Interventions are:
Southlake, along with 9 other hospital sites, has also participated in The Hand Hygiene Improvement Program, a Ministry of Health and Long Term Care initiative that was trialed over 6 months. The program evaluated the hand hygiene behaviours of healthcare workers.
3. Another Hospital in the Region has a lower/higher HSMR than Southlake? What are they doing/not doing differently than Southlake?
The HSMR is designed primarily to allow hospitals to examine their own performance over time and as such, Southlake cannot comment on the HSMR results for other hospitals within our region or LHIN.
The HSMR indicator is not intended to serve as a measure for hospitals to compare themselves against other organizations. Hospital care is complicated and depends on many factors, not all of which are reflected or accounted for by HSMR. For this reason, many indicators in combination must be examined in order to understand how a particular hospital is performing. To judge performance on only one indicator would be misleading.
4. As a patient, should I be concerned over a higher/lower HSMR?
A higher than average HSMR does not necessarily mean that a hospital is “unsafe”, just the same as a lower than average HSMR does not mean a hospital is “safe”. At Southlake, we are committed to putting our patients first, always and without exception. We continually monitor our performance using a variety of standard measures, including the HSMR.
The HSMR indicator is only one in a series of indicators used by hospitals to evaluate the level of care they provide, and patients are encouraged to take this into consideration when making a decision on where to receive care.
5. Is the fact that a hospital treats more complicated patients taken into account with the HSMR methodology?
A number of factors contribute to in-hospital mortality. The HSMR methodology adjusts for several of them. Complicated patients tend to be those who are older, admitted under the urgent and emergency category, and those who stay longer in the hospital. The methodology has taken these factors into account, which is consistent with the HSMR methods used in other countries.
6. Are patients dying unnecessarily in Canadian hospitals?
Every year, it is estimated that between 9,000 and 24,000 Canadians die following an adverse event while in hospital care, possibly as a result of the event. More than one third of these events are considered to be preventable, according to a 2004 CIHI- and CIHR-funded study led by Dr. Ross Baker and Dr. Peter Norton. The two most common types of adverse events in hospitals are incidents related to medications and infections.
Hospitals, health regions, and health providers across Canada take patient safety seriously and many have joined efforts such as the Safer Healthcare Now! campaign to reduce deaths from adverse events.
7. How will HSMR make health care in Canada safer?
HSMR is a significant tool because of the real value it offers to each organization. It allows hospitals to monitor their individual performance by tracking changes over time, understand the factors that contribute to a higher or lower ratio, and identify strategies to reduce inpatient deaths.
The HSMR has proven to be an important motivator for change internationally. Hospitals in the U.K. and the U.S. have successfully reduced their mortality rates by implementing strategies that have improved the safety and quality of care for their patients.
How can I learn more about HSMR?
Additional information regarding the first-ever public release of the HSMR is available by visiting the Canadian Institute for Health Information’s website
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