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Scottish death rates published with health warning

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6969.1599a (Published 17 December 1994) Cite this as: BMJ 1994;309:1599
  1. Luisa Dillner
  1. BMJ

    Death rates for NHS patients in Scotland were published for the first time by the Scottish Office this week with the warning that only limited comparisons could be made between hospitals. The data published in the Clinical Outcome Indicators Report 1994 looks at 17 measures. Although not all are related to death, the ones most likely to cause a public outcry are mortality within 30 days of admission for acute myocardial infarction, stroke, or fractured neck of femur.

    Although the report states that the data do not constitute league tables, the indicators are listed to allow comparisons between the average outcomes of over 20 NHS trusts between 1990 and 1993. For myocardial infarctions, for example, there is a twofold difference between Fife Healthcare NHS Trust, with a mortality rate of nearly 30%, and Western General Hospitals NHS Trust, with a rate of just over 15%. But Dr Robert Kendell, chief medical officer for Scotland, says in his introduction to the report, “It would be wrong to conclude from any one of these clinical outcome indicators that one hospital provides better treatment than another.” Each table carries a footnote:

    “Warning: This information should be interpreted strictly in accordance with the general and the specific guidance given in this report.”

    FIG

    Deaths occurring within 30 days of admission as percentage of all admissions with acute myocarardial infarction, October 1990 to September 1993

    Dr Kendell emphasises that variations in outcomes are as likely to be due to differences in patients themselves rather than in the quality of care between hospitals. No quality of care measures were …

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