Published 29 April 2009, doi:10.1136/bmj.b1749
Cite this as: BMJ 2009;338:b1749

Letters

Standardised mortality ratios

Institutional performance

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

In light of the report by Mohammed and colleagues,1 we comment on the use of risk adjustment measures by the Paediatric Intensive Care Audit Network (PICANet). PICANet collects data on admissions to paediatric intensive care units in the UK and Ireland. We assess performance in terms of mortality, adjusting for case mix severity using the paediatric indices of mortality.2 3 These predict risk adjusted probability of mortality using clinical and physiological data.

PICANet does not produce league tables but presents risk adjusted and unadjusted standardised mortality ratios and crude mortality in its national reports. We have a clear policy on dealing with anomalous data, including examination of data issues.

PICANet does not see increased standardised mortality ratios (whether risk adjusted or not) as proof of poor quality of care.

We agree that accurate recording of information is essential to reliable use of risk adjustment. PICANet has a comprehensive data definitions manual . . . [Full text of this article]

Phil McShane, statistician1, Elizabeth Draper, principal investigator, PICANet2, Patricia McKinney, principal investigator, PICANet1, Roger Parslow, principal investigator, PICANet1

1 Paediatric Epidemiology Group, Division of Epidemiology, University of Leeds, Leeds, 2 Perinatal and Paediatric Epidemiology, University of Leicester, Leicester

p.mcshane@leeds.ac.uk


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Relevant Article

Evidence of methodological bias in hospital standardised mortality ratios: retrospective database study of English hospitals
Mohammed A Mohammed, Jonathan J Deeks, Alan Girling, Gavin Rudge, Martin Carmalt, Andrew J Stevens, and Richard J Lilford
BMJ 2009 338: b780. [Abstract] [Full Text] [PDF]

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