Hospital standardized mortality ratios: a tale of two sites

In 2008, Caritas Health Group (CHG), composed of the Edmonton area Catholic acute hospital sites, became part of Covenant Health, Alberta's largest faith-based healthcare provider. In 2005, Capital Health (CH)/CHG began its work with the Canadian Institute of Health Information (CIHI). It is one of eight pioneer health regions in Canada to test the methodology of the hospital standardized mortality ratio (HSMR) developed in the United Kingdom, through Sir Brian Jarman, director of the Dr. Foster Unit (DRF), at the Imperial College in London. This article focuses on understanding the UK's HSMR process and describing its use in two hospitals in the Edmonton area. The hospitals used raw mortality data and chart review processes following the introduction of the HSMR in Canada in order to better understand the intricacy of this measure. The article focuses on the in-house process that became a foundation for an in-depth exploratory use of the CIHI HSMR e-portal for hospital sites within the province of Alberta.