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Predicting acute myocardial infarction (AMI) 30-days mortality: Using standardised mortality ratio (SMR) as the
Mohd Kamarulariffin Kamarudin1, Calyn Tan Jen Ai2, Nur Lisa Zaharan3
1Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
Background:
A standardised mortality ratio (SMR) is the hospital observed mortality divided by its predicted mortality and has been used as an indicator to monitor hospital performance.
Objectives:
This study developed a model that predicted 30-day mortality for acute myocardial infarction (AMI) and compared the SMR among 41 Malaysian public hospitals using statistical process control charts.
Methods & Results:
Data from referral centres and specialist hospitals with cardiology services were analysed. Both referral centres and specialist hospitals had comparable mortality, except for Hospitals A and B, which the study considered outliers. Two-thirds of the remaining hospitals had an SMR of above one (SMR 1.05-1.51), but the indices were still within the expected variations.
Conclusion:
The SMR coupled with a funnel plot and variable life adjusted display (VLAD) can identify hospitals with potentially higher than expected mortality rates.
Insights
This study assessed hospital performance in Malaysia using the standardized mortality ratio (SMR) for acute myocardial infarction (AMI). Most hospitals showed SMRs within expected ranges, indicating generally stable performance.
Area of Science:
- Healthcare Management
- Public Health
- Cardiology
Background:
- The standardized mortality ratio (SMR) is a key metric for monitoring hospital performance.
- It compares observed mortality to predicted mortality within a healthcare setting.
Purpose of the Study:
- To develop a predictive model for 30-day mortality in acute myocardial infarction (AMI).
- To compare SMRs across 41 Malaysian public hospitals using statistical process control.
Main Methods:
- Analysis of data from referral and specialist hospitals with cardiology services.
- Application of statistical process control charts for SMR comparison.
- Identification of outliers (Hospitals A and B) with distinct mortality profiles.
Main Results:
- Overall comparable mortality rates were observed between hospital types.
- Two-thirds of hospitals had SMRs above 1 (ranging from 1.05 to 1.51).
- Despite being above one, these SMRs remained within expected variations for most institutions.
Conclusions:
- The SMR, when used with funnel plots and VLAD, effectively identifies hospitals with potentially elevated mortality rates.
- This approach aids in targeted performance improvement initiatives within the Malaysian public healthcare system.
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