Do hospital mortality scores contain hidden flaws?

What is it about?

Standardized hospital mortality scores (HSMR/SHMI) are needed to detect gross examples of poor hospital care. However, they are unduly reliant on diagnosis as a proxy for patient acuity. Indeed after adjusting for diagnosis, age, etc could it be possible that hospital mortality scores are merely measuring differences in patient acuity between hospitals? This paper demonstrates how these scores are unduly influenced by changes in service configuration and how the spatiotemporal passage of an infectious-like event across England causes undulations in all-cause mortality and hospital deaths.

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Why is it important?

HSMR/SHMI are supposed to be gold standard methods which can be relied upon to initiate a clinical audit. If it is true that they are merely measuring differences in acuity then they become a dangerous tool which can misdirect physician resources.

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