title: [Robustness of Hospital Benchmarking with the Hospital Standardized Mortality Ratio (HSMR): An Analysis of Secondary Data from 37 German Hospitals].
abstract: Introduction:Internationally, the hospital standardized mortality ratio is increasingly used as a risk-adjusted simple measure for quality control. Goodness of fit of different risk models in Germany and robustness of hospital comparisons were evaluated with a secondary data analysis.Methods:Anonymized routine data from the year 2012 of 37 hospitals of the association Quality Indicators for Ecclesiastical Hospitals were used. 2 independent risk models and the observed mortality were compared, the risk models considered both the original and the adapted forms.Results:The risk models showed an area under curve between 0.906 [95% CI 0.904-0.908] and 0.920 [0.918-0.922]. There was a significant correlation between the risk models and the observed mortality with a correlation coefficient between 0.388 (p<0.05) and 0.936 (p<0.01). 26 hospitals had an identical assessment in all risk models comparing their HSMR with the group. 2 hospitals achieved a positive and a negative assessment taking into account the observed mortality.Conclusion:The quality of the risk models is high and the hospital comparison with the HSMR remained stable. However, it is unclear whether the differences are caused by quality-related issues or by different structures and case-mix. Therefore, the HSMR is primarily intended for quality management purposes within German hospitals.
authors.affiliation: Essen.
authors.forename: J
authors.initials: J
authors.lastname: Stausberg
authors.affiliation: Arbeitsgemeinschaft katholischer Krankenhäuser Saarland, Caritasverband für die Diözese Trier e. V.
authors.forename: T
authors.initials: T
authors.lastname: Jungen
authors.affiliation: Klinik für Herzchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck.
authors.forename: C
authors.initials: C
authors.lastname: Bartels
authors.affiliation: Geschäftsführung, Klinikum St. Elisabeth Straubing, Straubing.
authors.forename: C
authors.initials: C
authors.lastname: Scheu
mesh_terms: D001509:Bed Occupancy; D019985:Benchmarking / Q000379:methods / Q000592:standards*; D005858:Germany; D019538:Health Care Surveys; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012680:Sensitivity and Specificity