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Validation of Jarman's method of calculation of hospital standardised mortality ratios

Sunil Kumar Bhat1, Sangeeta Malla

  • 1School of Medicine and Pharmacology, Royal Perth Hospital Unit, Perth, WA, Australia.

Australian Health Review : a Publication of the Australian Hospital Association
|February 2, 2013
PubMed

Insights

The Linkage-derived cumulative mortality ratio (CMR) more accurately ascertains deaths than the Jarman-derived hospital standardised mortality ratio (HSMR). Using linked data overcomes issues with incorrect deaths and unfair apportionment in hospital performance metrics.

Area of Science:

  • Health Services Research
  • Public Health
  • Health Informatics

Background:

  • Hospital Standardised Mortality Ratios (HSMR) are used to assess hospital performance.
  • Existing methods like the Jarman-derived HSMR have limitations in accurately reflecting mortality data.
  • Inter-hospital comparisons based on mortality ratios are published but can show variability.

Purpose of the Study:

  • To compare Jarman-derived hospital standardised mortality ratios (HSMR) with Linkage-derived cumulative mortality ratios (CMR).
  • To evaluate the accuracy of different methods for ascertaining hospital mortality data.
  • To identify discrepancies and reasons for differences between HSMR and CMR.

Main Methods:

  • Derived HSMR and CMR values from single-year cohorts of linked patient admissions and deaths for four hospital groups.
  • Compared HSMR and CMR values across different hospital types.
  • Explored differences and suggested reasons for non-matching and discordant mortality data.

Main Results:

  • Metropolitan teaching hospitals showed a significantly lower Jarman-derived HSMR (0.95) compared to the Linkage-derived CMR (0.99).
  • Metropolitan non-teaching public hospitals exhibited a significantly lower Linkage-derived CMR (0.81) than the Jarman-derived HSMR (1.03).
  • The Jarman method showed unfair apportionment of excess deaths to teaching hospitals.

Conclusions:

  • The Linkage-derived CMR, using state death registry data, more accurately ascertains the number of deaths than the Jarman-derived HSMR.
  • The Linked method overcomes issues of incorrect deaths and unfair apportionment seen in the Jarman method.
  • Dual death derivations can identify unmatched or discordant deaths, aiding in the understanding of hospital discharge practices.
Abstract

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