Hospital Standardised Mortality Ratio (HSMR)
Identifying Attributes
Care Settings
Country
Publishing Organisation
Type of Quality Indicator
IOM Quality Dimension
Domain
Defining Attributes
Definition
The ratio of the observed number of hospital separations that end in the patient's death, to the number of separations expected to end in death based on the patient's characteristics, for principal diagnoses accounting for 80% of in-hospital mortality.
Numerator
Observed number of in-hospital deaths x 100
Denominator
Expected number of in-hospital deaths (the sum of the estimated probabilities of death for all separations meeting the denominator criteria, calculated using national risk adjustment coefficients).
Exclusions
Missing: admission mode, sex.
Use of Risk Adjustment
Risk Adjustments
Age at admission (years) • Sex • Principal diagnosis code (mapped to national in-hospital mortality risk deciles) • Admission urgency status: emergency, elective • Length of stay (including leave days) categorised as 1 day, 2 days, 3-9 days, 10-15 days, 16-21 days and 22-365 days • Additional (comorbid) diagnoses (Charlson index) categorised into 0 – Charlson Index score of 0; 1 – Charlson index score of 1; 2 Charlson index score ≥2 • Admission mode (inward transfer status) = admitted patient transferred from another hospital.
Stratifications
By hospital peer group.
Collection and Reporting Attributes
Type of Data Collection
Data Collection Methods
Core Hospital-Based Outcome Indicators
Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Internal state/territory reports