title: Amenable mortality revisited: the AMIEHS study.
abstract: OBJECTIVE
  There is a renewed interest in health system indicators. In 1976 a measure of quality of healthcare, amenable mortality, was introduced by Rutstein. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective healthcare. In the project "Amenable mortality in the European Union: toward better indicators for the effectiveness of health systems" (AMIEHS), we introduce a new approach to the selection of indicators of amenable mortality.
  
  
  METHODS
  Based on predefined selection criteria and a broad review of the literature on the effectiveness of medical interventions, a first set of potential indicators of amenable mortality (causes of death) was selected. The timing of the introduction of medical innovations was established through reviews and questionnaires sent to national experts from seven participating European countries. The preselected indicators were then validated by a trend analysis that identified associations between the timing of innovations and cause-specific mortality trends and by a Delphi-procedure.
  
  
  RESULTS
  After a short review of previous lists of amenable mortality indicators and a detailed description of the innovative procedure in the AMIEHS project we present a list of 14 causes of death that passed our selection criteria. We illustrate our empirical validation of these indicators using the examples of peptic ulcer and renal failure.
  
  
  CONCLUSIONS
  The innovation developed in the AMIEHS study is a rigorous new approach to the concept of amenable mortality that includes empirical validation. Only validated indicators can be successfully used to assess the quality of healthcare systems in international comparisons.
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. r.hoffmann@erasmusmc.nl
authors.forename: Rasmus
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Iris
authors.initials: I
authors.lastname: Plug
authors.forename: Bernadette
authors.initials: B
authors.lastname: Khoshaba
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D001271:Atlases as Topic; D002423:Cause of Death; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000592:standards; D003697:Delphi Technique; D036262:Empirical Research; D005060:Europe / Q000453:epidemiology; D005062:European Union; D006305:Health Status Indicators; D006801:Humans; D038801:International Classification of Diseases; D009026:Mortality / Q000639:trends; D011314:Preventive Health Services; D011643:Publishing; D016896:Treatment Outcome