Background
Methods
Setting
The HSMR model used in this study
HSMR in brief
Agreement, or otherwise of the two models
Quality metrics of the two models
Sensitivity of the HSMR model to adjustment for readmission
Results
Agreement between the two models
CCS code | CCS-diagnostic group title | Number of admissions | Distance between model 1 and 2 (R2) | Number of hospitals with SMR significantly high? | c-statistic for | ||
---|---|---|---|---|---|---|---|
Model 1: no model 2: yes | Model 1: yes model 2: no | Model 1 | Model 2 | ||||
2 | Septicemia (except in labour) | 14647 | 0.83 | 2 | 1 | 0.760 | 0.783 |
12 | Cancer of oesophagus | 9703 | 0.74 | 1 | 3 | 0.730 | 0.763 |
13 | Cancer of stomach | 13945 | 0.75 | 0 | 2 | 0.733 | 0.779 |
14 | Cancer of colon | 45116 | 0.77 | 2 | 5 | 0.773 | 0.814 |
15 | Cancer of rectum and anus | 22246 | 0.72 | 1 | 3 | 0.771 | 0.817 |
17 | Cancer of pancreas | 9950 | 0.76 | 1 | 0 | 0.685 | 0.704 |
19 | Cancer of bronchus, lung | 76714 | 0.75 | 4 | 6 | 0.792 | 0.822 |
24 | Cancer of breast | 64126 | 0.74 | 2 | 1 | 0.916 | 0.850 |
29 | Prostate cancer | 24092 | 0.76 | 3 | 1 | 0.886 | 0.865 |
32 | Cancer of bladder | 44288 | 0.71 | 1 | 0 | 0.872 | 0.874 |
38 | Non-Hodgkin's lymphoma | 19413 | 0.69 | 0 | 5 | 0.802 | 0.841 |
39 | Leukaemias | 12466 | 0.77 | 0 | 1 | 0.781 | 0.820 |
42 | Secondary malignancies | 69303 | 0.77 | 5 | 4 | 0.748 | 0.770 |
44 | Neoplasms unspec nature or uncertain behaviour | 18982 | 0.63 | 2 | 1 | 0.805 | 0.840 |
50 | Diabetes mellitus with complications | 36837 | 0.74 | 1 | 0 | 0.824 | 0.846 |
55 | Fluid and electrolyte disorders | 29705 | 0.81 | 0 | 1 | 0.795 | 0.824 |
59 | Deficiency and other anaemia | 48896 | 0.61 | 0 | 1 | 0.756 | 0.802 |
85 | Coma, stupor and brain damage | 4286 | 0.92 | 0 | 0 | 0.801 | 0.815 |
96 | Heart valve disorders | 30708 | 0.77 | 1 | 2 | 0.775 | 0.788 |
100 | Acute myocardial infarction | 91802 | 0.72 | 1 | 1 | 0.740 | 0.781 |
101 | Coronary atherosclerosis and other heart disease | 250183 | 0.66 | 1 | 2 | 0.784 | 0.805 |
103 | Pulmonary heart disease | 26937 | 0.78 | 0 | 1 | 0.754 | 0.776 |
106 | Cardiac dysrhythmias | 174923 | 0.72 | 1 | 2 | 0.828 | 0.860 |
107 | Cardiac arrest and ventricular fibrillation | 8118 | 0.89 | 2 | 2 | 0.739 | 0.764 |
108 | Congestive heart failure, non-hypertensive | 108541 | 0.63 | 4 | 1 | 0.637 | 0.702 |
109 | Acute cerebrovascular disease | 102295 | 0.86 | 3 | 0 | 0.744 | 0.761 |
114 | Peripheral and visceral atherosclerosis | 44090 | 0.94 | 1 | 3 | 0.908 | 0.914 |
115 | Aortic, peripheral and visceral artery aneurysms | 26538 | 0.93 | 1 | 1 | 0.871 | 0.887 |
116 | Aortic & peripheral arterial embolism or thrombosis | 32881 | 0.75 | 1 | 1 | 0.882 | 0.892 |
117 | Other circulatory disease | 20452 | 0.80 | 0 | 1 | 0.849 | 0.862 |
122 | Pneumonia | 128867 | 0.74 | 2 | 0 | 0.753 | 0.785 |
127 | COPD and bronchiectasis | 82898 | 0.60 | 0 | 2 | 0.701 | 0.761 |
129 | Aspiration pneumonitis | 4485 | 0.79 | 1 | 1 | 0.644 | 0.688 |
130 | Pleurisy, pneumothorax, pulmonary collapse | 24798 | 0.78 | 0 | 0 | 0.812 | 0.827 |
133 | Other lower respiratory disease | 99460 | 0.77 | 1 | 0 | 0.854 | 0.866 |
145 | Intestinal obstruction without hernia | 34802 | 0.76 | 1 | 1 | 0.813 | 0.836 |
146 | Diverticulosis and diverticulitis | 35917 | 0.70 | 0 | 0 | 0.814 | 0.828 |
149 | Biliary tract disease | 135587 | 0.80 | 1 | 0 | 0.894 | 0.899 |
150 | Liver disease, alcohol-related | 5133 | 0.69 | 0 | 2 | 0.678 | 0.758 |
151 | Other liver diseases | 14584 | 0.80 | 1 | 0 | 0.771 | 0.807 |
153 | Gastrointestinal haemorrhage | 37229 | 0.71 | 0 | 1 | 0.738 | 0.764 |
155 | Other gastrointestinal disorders | 45487 | 0.91 | 0 | 0 | 0.907 | 0.908 |
157 | Acute and unspecified renal failure | 8804 | 0.73 | 0 | 0 | 0.723 | 0.760 |
158 | Chronic renal failure | 14570 | 0.75 | 0 | 2 | 0.846 | 0.872 |
159 | Urinary tract infections | 62382 | 0.77 | 0 | 0 | 0.817 | 0.836 |
226 | Fracture of neck of femur (hip) | 74557 | 0.73 | 0 | 2 | 0.719 | 0.732 |
233 | Intracranial injury | 56535 | 0.95 | 0 | 1 | 0.939 | 0.941 |
237 | Complication of device, implant or graft | 76079 | 0.69 | 0 | 0 | 0.821 | 0.833 |
238 | Complications surgical procedures or medical care | 67106 | 0.76 | 0 | 0 | 0.827 | 0.833 |
249 | Shock | 3150 | 0.80 | 1 | 0 | 0.716 | 0.733 |
Total all CCS diagnostic groups |
2494613
|
0,86
|
49
|
64
|
0.852
|
0.867
|
H/SMR model quality metrics
Died model 1 | Died model 2 | |||
---|---|---|---|---|
Decile | Observed | Expected | Observed | Expected |
1 | 138 | 268 | 134 | 231 |
2 | 498 | 786 | 469 | 677 |
3 | 1057 | 1464 | 997 | 1295 |
4 | 1888 | 2485 | 1721 | 2197 |
5 | 3609 | 4038 | 3002 | 3544 |
6 | 6181 | 6399 | 5299 | 5599 |
7 | 10486 | 10026 | 8999 | 8843 |
8 | 16797 | 15578 | 14890 | 14337 |
9 | 28064 | 26026 | 27112 | 25084 |
10 | 60625 | 62273 | 66720 | 67535 |
Percentage mismatch | 5,75% | 4,23% |
Sensitivity of the model to the review period of adjustment
Model 1 | Model 2 | Difference | In favour of | |
---|---|---|---|---|
Overall c-statistic | ||||
1 year period | 0.857 | 0.866 | 0.009 | model 2 |
2 year period | 0.856 | 0.865 | 0.009 | model 2 |
5 year period | 0.852 | 0.867 | 0.015 | model 2 |
% decile match hosmer lemeshow test
| ||||
1 y period | 93.85% | 94.13% | 0.28% | model 2 |
2 year period | 93.82% | 94.41% | 0.59% | model 2 |
5 year period | 94.25% | 95.77% | 1.52% | model 2 |
Nagelkerke R square
| ||||
1 year period | 0.269 | 0.285 | 0.016 | model 2 |
2 year period | 0.266 | 0.284 | 0.018 | model 2 |
5 year period | 0.259 | 0.282 | 0.023 | model 2 |