Differences in death rates in English hospitals

BMJ 1999;319:854 ( 25 September )

Letters

Differences in death rates in English hospitals

Effects of admission rates may have been understated

Data are inadequate basis for drawing conclusion of paper

Effects of admission rates may have been understated

The first 150 words of the full text of this article appear below.

EDITOR $---$ Unlike Jarman et al, I do not yet think that we can state with confidence that "more doctors means fewer deaths."¹As the authors make clear, there has been a lively discussionon comparative hospital death rates in the United States. Fromthis debate two points emerge clearly: for any given populationthe standardised admissions rate is positively correlated withthe standardised death rate but is inversely correlated with thestandardised hospital death rate (defined as any death within30 days of a hospital admission). ² ³ Where a population isadmitted to hospital fairly frequently a higher proportion ofadmissions will not be associated with subsequent death; hencethere will be a lower apparent hospital mortality. A study inOhio found African-Americans to have consistently higher admissionsand lower severity-adjusted hospital mortality than white patientstreated at the same hospitals.⁴

It was therefore informative that the authors included with their . . . [Full text of this article]

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Explaining differences in English hospital death rates using routinely collected data: Brian Jarman, Simon Gault, Bernadette Alves, Amy Hider, Susan Dolan, Adrian Cook, Brian Hurwitz, and Lisa I Iezzoni
BMJ 1999 318: 1515-1520. [Abstract] [Full Text] [PDF]