biostudies-literatureUnknown46(6pt1)Bottle A<h4>Introduction</h4>Hospital standardized mortality ratios (HSMRs) are derived from administrative databases and cover 80 percent of in-hospital deaths with adjustment for available case mix variables. They have been criticized for being sensitive to issues such as clinical coding but on the basis of limited quantitative evidence.<h4>Methods</h4>In a set of sensitivity analyses, we compared regular HSMRs with HSMRs resulting from a variety of changes, such as a patient-based measure, not adjusting for comorbidity, not adjusting for palliative care, excluding unplanned zero-day stays ending in live discharge, and using more or fewer diagnoses.<h4>Results</h4>Overall, regular and variant HSMRs were highly correlated (ρ>0.8), but differences of up to 10 points were common. Two hospitals were particularly affected when palliative care was excluded from the risk models. Excluding unplanned stays ending in same-day live discharge had the least impact despite their high frequency. The largest impacts were seen when capturing postdischarge deaths and using just five high-mortality diagnosis groups.<h4>Conclusions</h4>HSMRs in most hospitals changed by only small amounts from the various adjustment methods tried here, though small-to-medium changes were not uncommon. However, the position relative to funnel plot control limits could move in a significant minority even with modest changes in the HSMR.Health services research1741-61https://www.ebi.ac.uk/biostudies/studies/S-EPMC3393030biostudies-literatureHospital standardized mortality ratios: sensitivity analyses on the impact of coding.PMC3393030Jarman BAylin PBottle AfalseHospital standardized mortality ratios: sensitivity analyses on the impact of coding.<h4>Introduction</h4>Hospital standardized mortality ratios (HSMRs) are derived from administrative databases and cover 80 percent of in-hospital deaths with adjustment for available case mix variables. They have been criticized for being sensitive to issues such as clinical coding but on the basis of limited quantitative evidence.<h4>Methods</h4>In a set of sensitivity analyses, we compared regular HSMRs with HSMRs resulting from a variety of changes, such as a patient-based measure, not adjusting for comorbidity, not adjusting for palliative care, excluding unplanned zero-day stays ending in live discharge, and using more or fewer diagnoses.<h4>Results</h4>Overall, regular and variant HSMRs were highly correlated (ρ>0.8), but differences of up to 10 points were common. Two hospitals were particularly affected when palliative care was excluded from the risk models. Excluding unplanned stays ending in same-day live discharge had the least impact despite their high frequency. The largest impacts were seen when capturing postdischarge deaths and using just five high-mortality diagnosis groups.<h4>Conclusions</h4>HSMRs in most hospitals changed by only small amounts from the various adjustment methods tried here, though small-to-medium changes were not uncommon. However, the position relative to funnel plot control limits could move in a significant minority even with modest changes in the HSMR.2011-01-01T00:00:00Z2011 Dec2024-12-04T12:56:12.736Z2019-03-27T00:55:24ZS-EPMC33930302179058710.1111/j.1475-6773.2011.01295.x