Dots, Data, and Decisions Ontario Executive Patient Safety Series – Winter 2007 The Challenge • No needless deaths • No needless pain or suffering • No unwanted waiting • No helplessness • No waste Source: http://www.ihi.org/ihi/Files/IMPACT/Spring2004LearningSession/2004-06-29/Berwick_Plenary.pdf Much has Been Done … Trend in Age-Adjusted 30-Day In-Hospital Death Rate Excludes NL, QC, BC
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Dots, Data, and Decisions - Canadian Patient Safety Institute€¦ · Cardiac Pain Syndromes Orthopaedic Conditions Average Gain in Functional Status/Day Source: Natio nal Rehab il
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• HSMR is a measure designed to track changes in hospital mortality rates
• Based on diagnosis groups that account for 80% of deaths
• Adjusted for factors affecting mortality (e.g. mix of diagnoses, age, sex, length of stay)
Observed deaths
Expected deaths
HSMR= X 100
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HSMR is easy to interpretEqual to 100� No difference between facility’s mortality rate
and average rate
• More than 100� Facility’s mortality rate is higher than the
average rate
• Less than 100� Facility’s mortality rate is lower than the
average rate
What Does Average Mean? (Results from Baker/Norton)
Extra hospital days associated with adverse events
Deaths among patients with preventable adverse events
Saving More Lives: Using HSMR
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Progress to date
• Methodology developed and tested with Pioneer Group & experts
• ~ 350 sites from 125 organizations participating� First HSMR data sent in December 2005 � “Trend tracker” real-time quarterly HSMR updates
• Spreading the word, learning from early adopters
• Work in progress� Monthly (or more frequent) updates for larger facilities� Electronic HSMR� “Saved lives” calculation� Analysis of factors affecting results
How Are Hospitals Using HSMR?• Data validation
• Identifying opportunities� Clinical/improvement teams doing mortality reviews &