• Print

released: 13 Mar 2009 author: Ben-Tovim D, Woodman R, Harrison J, Pointer S, Hakendorf P & Henley G

'Measuring and reporting mortality in hospital patients' aims to develop national indicators of in-hospital mortality and was one of several projects conducted as part of the National Indicators Project commissioned by the Australian Commission on Safety and Quality in Health Care. The project has two parts: a literature review focussing on methods for analysing and reporting in-hospital mortality, and a modelling project aimed at identifying national indicators of hospital mortality that can be implemented now and in the future.

ISBN 978 1 74024 904 1; Cat. no. HSE 69; 146pp.; Internet only

Full publication

Publication table of contents

  • Preliminary material (99KB PDF)
    • Title and verso pages
    • Contents
    • Acknowledgments
    • Abbreviations
    • Summary
  • Body section
    1. Introduction (35KB PDF)
      • 1.1 Context of the report
      • 1.2 Structure of the report
    2. Review of the literature (159KB PDF)
      • 2.1 General introduction: in-hospital mortality
      • 2.2 Introduction to the literature review
      • 2.3 Search method
      • 2.4 Considerations in the development of mortality as an indicator
      • 2.5 Model development
      • 2.6 Inter-hospital variation and risk-adjustment models
      • 2.7 Inter hospital variation and random variation
      • 2.8 The relationship between variations in hospital mortality and other measures
      • 2.9 Presentation of information about in-hospital mortality
      • 2.10 Conclusions
    3. Measuring in-hospital mortality in Australia (50KB PDF)
      • 3.1 Current in-hospital mortality reporting in Australia
      • 3.2 Mortality rates in Australian hospitals
      • 3.3 The analytic strategy
    4. Methods (62KB PDF)
      • 4.1 Data
      • 4.2 Single-year analysis: 2005-06
      • 4.3 Calculation of HSMRs
      • 4.4 Graphical methods of presentation
      • 4.5 Case selection
      • 4.6 Model checking
      • 4.7 Calculation of 95% confidence intervals
      • 4.8 Further development of the risk model
      • 4.9 Longitudinal analysis
      • 4.10 Statistical software
    5. Results (1MB PDF)1
      • 5.1 Inclusions and exclusions
      • 5.2 Model building and the effect of covariates on odds of in-hospital mortality
      • 5.3 Discriminatory and explanatory power
      • 5.4 Goodness of fit
      • 5.5 Individual HSMRs and their 95% confidence intervals
      • 5.6 Caterpillar plots
      • 5.7 Funnel plots
      • 5.8 Model development
      • 5.9 Inclusion of SEIFA
      • 5.10 Longitudinal analysis
    6. Discussion (96KB PDF)
      • 6.1 Can we produce in-hospital mortality indicators using Australian administrative data?
      • 6.2 How might in-hospital mortality indicators be used at different levels in Australia?
      • 6.3 Are the in-hospital mortality indicators valid and reliable?
      • 6.4 Presentation and use of indicators of in-hospital mortality
      • 6.5 What are the methodological obstacles to producing mortality indicators in Australia now?
      • 6.6 International benchmarking
      • 6.7 Conclusion
  • End matter (220KB PDF)
    • References
    • Appendixes
      1. Diagnoses accounting for 80% of in-hospital deaths
      2. Summary tables of HSMRs in 2005-06
      3. Funnel plots of HSMRs in 2005-06
      4. Caterpillar plots
      5. Data issues
        • National Hospital Morbidity Database
        • Errors, inconsistencies and uncertainties
        • Quality of ICD-10-AM coded data
    • List of tables
    • List of figures

Notes and corrections

The current version of the publication is presented above. Previous versions of files that have been updated or corrected are presented below.

  1. A correction has been made to figure 9.The previous figure did not reflect the data presented in table 16. (5 February 2010)

Recommended citation

Ben-Tovim D, Woodman R, Harrison J, Pointer S, Hakendorf P & Henley G 2009. Measuring and reporting mortality in hospital patients. Cat. no. HSE 69. Canberra: AIHW. Viewed 2 August 2014 <http://www.aihw.gov.au/publication-detail/?id=6442468221>.