title: The standardised mortality ratio: the proper quality indicator in acute leukaemia?
abstract: BACKGROUND
  The standardised mortality ratio (SMR) is a quality indicator used to measure quality of care in the Netherlands. It is subject to much criticism, which was the reason to study the value of the SMR as a quality indicator for the treatment of acute leukaemia.
  
  
  METHODS
  A retrospective analysis was performed in patients with acute leukaemia admitted to a Santeon hospital during the period 2005-2009. SMR values were calculated and compared with the overall survival (OS).
  
  
  RESULTS
  During the study period, 455 unique patients were admitted with acute leukaemia. SMR calculation was based on 992 admissions. SMR analysis yielded a high mortality ratio in hospital 1, 2, 3 and 4 in comparison with the national average (100), significant for hospital 1 and 4 (180 [CI 95% 126-257] and 187 [CI 95% 134-261], respectively) OS analysis also showed a significantly different outcome between hospitals. However, using OS as outcome parameter, hospital 2 and 6 showed the lowest performance as compared with hospital 1 and 4 using SMR as parameter. After multivariate analysis, age (HR 1.04; CI 95% 1.03-1.05; p < 0.001) and hospital (hospital 5 compared with 6: HR 0.54; CI 95% 0.30- .98; p = 0.043; hospital 2 compared with 1: HR 1.51; CI 95% 1.02-2.23; p = 0.039) were the only significant variables that influenced OS.
  
  
  CONCLUSIONS
  Outcome according to SMR is not equivalent to outcome according to OS. This study shows that the use of the SMR as a quality indicator for the treatment of acute leukaemia does not appear to be justified.
authors: Haven Hospital÷Erasmus MC, Rotterdam, the Netherlands.
authors: L
authors: L
authors: Saes
authors: W G
authors: WG
authors: Peters
authors: R
authors: R
authors: Schaafsma
authors: D J
authors: DJ
authors: van Spronsen
authors: A W G
authors: AW
authors: van der Velden
authors: W F
authors: WF
authors: van den Bosch
authors: E
authors: E
authors: Meijer
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007938:Leukemia / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult