BMJ  2003;326:1397-1398 (21 June), doi:10.1136/bmj.326.7403.1397-b

Letter

What hospital mortality league tables tell you

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

EDITOR—Jacobson et al take issue with Dr Foster's publication of mortality league tables and pose four main questions.¹

Firstly, they ask what the data mean, citing changes in the type of care provided in hospitals. Hospital standardised mortality ratios were designed to be a robust measure of in-hospital mortality, taking into account differences in patient mix with explicit adjustment for 80 different diagnoses, admission method, age, sex, and length of stay. We found that after adjustment, death rates show no bias against hospitals with more patients staying more than 28 days, or against hospitals with more geriatric beds.² We agree that hospital mortality is only one outcome measure and is included as such in the "wealth of information" in the hospital guide.

Secondly, they ask whether the results are a valid measure of what they purport to be, acknowledging Dr Foster's ongoing enhancements to the quality of the . . . [Full text of this article]

Dr Foster Unit at Imperial p.aylin@imperial.ac.uk Department of Epidemiology and Public Health, Imperial College London, St Mary's Campus, London W2 1PG

Dr Foster Unit at Imperial b.jarman@imperial.ac.uk Department of Epidemiology and Public Health, Imperial College London, St Mary's Campus, London W2 1PG

Dr Foster Limited, Sir John Lyon House, London EC4V 3NX

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