Principal variable is not what it seems in league tables

doi:10.1136/bmj.322.7295.1181/a

BMJ 2001;322:1181 ( 12 May )

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Principal variable is not what it seems in league tables

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EDITOR $---$ Sir Brian Jarman's analysis of hospital death rates with "Dr Foster's guide to better health" (Sunday Times) may serveto improve the quality of hospital care $---$ indirectly.¹ The principaldependent variable is, however, not what it seems, even afteradjustment for age, sex, diagnosis, emergency admission, and lengthof stay, so that like is not compared with like. Rates derivedfrom hospital episode statistics, deaths per 1000 finished consultantepisodes, almost defy interpretation, because the denominatorsare episodes, not patients. Although this analysis selects a subsetof episodes that end in discharge or death, the denominators representadmissions, not people. Fairer measures of hospital performanceare based on 30 day deaths per 100 000 population. ² ³

The first conclusion of the study should read that the number of hospital episodes (or admissions) has increased by approximately2.6% annually. The numbers of deaths have remained nearly constant.It is only a . . . [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
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