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Mortality league tables: do they inform or mislead?
1Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London.
Quality in Health Care : QHC
|February 7, 1995
Summary
Mortality league tables can be misleading due to small sample sizes and difficulties in adjusting for patient severity. Further research is needed, but publishing these tables may be driven by politics rather than science.
Area of Science:
- Health Services Research
- Medical Statistics
Background:
- Hospital mortality league tables are frequently published.
- Methodological issues, including severity adjustment and sample size, affect their reliability.
Purpose of the Study:
- To examine methodological challenges in publishing hospital mortality league tables.
- To assess the impact of severity adjustment and sample size on hospital rankings.
Main Methods:
- Retrospective analysis of inpatient hospital records from 22 hospitals.
- Analysis focused on specific diagnoses including aortic aneurysm, colon cancer, and head injury.
- In-hospital mortality rates were adjusted for disease severity and calculated using admissions and episodes.
Main Results:
- Small numbers of deaths for specific conditions led to wide confidence intervals.
- Hospital rankings based on mortality rates were sensitive to severity adjustments.
- Unexplained variations in death rates were observed.
Conclusions:
- Crude mortality rate comparisons can be misleading.
- Current methods for severity adjustment in league tables are inadequate.
- Publication of mortality league tables may be politically motivated rather than scientifically sound.