Ethical considerations for classifying patients as 'palliative' when calculating Hospital Standardised Mortality Ratios

Journal of Medical Ethics

Volumn 36, Issue 7, 2010, Pages 387-390

  Downar, James ^a,b   Sibbald, Robert ^c,d   Lazar, Neil M ^a,b  

^a UNIVERSITY HEALTH NETWORK   (Canada)

^b UNIVERSITY OF TORONTO   (Canada)

^c LONDON HEALTH SCIENCES CENTRE   (Canada)

^d UNIVERSITY OF WESTERN ONTARIO   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; DIAGNOSIS RELATED GROUP; ETHICS; HEALTH CARE QUALITY; HUMAN; MEDICAL ETHICS; MORTALITY; ORGANIZATION AND MANAGEMENT; PALLIATIVE THERAPY; STATISTICS;

DIAGNOSIS-RELATED GROUPS; ETHICS, MEDICAL; HOSPITAL MORTALITY; HUMANS; PALLIATIVE CARE; QUALITY ASSURANCE, HEALTH CARE;

EID: 77958089344     PISSN: 03066800     EISSN: 14734257     Source Type: Journal    
DOI: 10.1136/jme.2010.035451     Document Type: Article

References (22)

1. Canadian Institute for Health Information. Media website. http://secure.cihi.ca/ cihiweb/en/downloads/HSMR_InfoSheet_What_is_HSMR_for_public_May2008.pdf (accessed 19 May 2009).
2. Thomas JW, Hofer TP. Research evidence on the validity of risk-adjusted mortality rate as a measure of hospital quality of care. Med Care Res Rev 1998;55:371-404.
3. Shojania KG, Forster AJ. Hospital mortality: when failure is not a good measure of success. CMAJ 2008;179:153-7.
4. Nicholl J. Case-mix adjustment in non-randomised observational evaluations: the constant risk fallacy. J Epidemiol Community Health 2007;61:1010-13.
5. Mohammed MA, Deeks JJ, Girling A, et al. Evidence of methodological bias in hospital standardised mortality ratios: retrospective database study of English hospitals. BMJ 2009;338:b780.
6. Jarman B, Gault S, Alves B, et al. Explaining differences in English hospital death rates using routinely collected data. BMJ 1999;318:1515-20.
7. Tu JV, Donovan LR, Lee DS, et al. Effectiveness of public report cards for improving the quality of cardiac care: the EFFECT study: a randomized trial. JAMA 2009;302:2330-7.
8. CTV.ca News Staff. Experts hope report helps cut hospital mortality. http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20071129/hsmr_071129/20071129? hub=Specials. (accessed 15 June 2009).
9. Smith R. Hospital deaths are a postcode lottery. Sunday Telegraph 2008.
10. Thomas JW, Holloway JJ, Guire KE. Validating risk-adjusted mortality as an indicator for quality of care. Inquiry 1993;30:6-22.
11. Werner RM, Asch DA, Polsky D. Racial profiling: the unintended consequences of coronary artery bypass graft report cards. Circulation 2005;111:1257-63.
12. Wright J, Dugdale B, Hammond I, et al. Learning from death: a hospital mortality reduction programme. J R Soc Med 2006;99:303-8.
13. Jarman B, Bottle A, Aylin P, et al. Monitoring changes in hospital standardised mortality ratios. BMJ 2005;330:329.
14. Pitches DW, Mohammed MA, Lilford RJ. What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature. BMC Health Serv Res 2007;7:91.
15. Canadian Institute for Health Information. HSMR Home Page. 2008. http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=hsmr2008_home_e (accessed 19 May 2009).
16. Penfold RB, Dean S, Flemons W, et al. Do hospital standardized mortality ratios measure patient safety? HSMRs in the Winnipeg Regional Health Authority. Healthc Pap 2008;8:8-24;discussion 69e75.
17. McKinley J, Gibson D, Ardal S. Hospital standardized mortality ratio: the way forward in Ontario. Healthc Pap 2008;8:43-9;discussion 69-75.
18. World Health Organization Contributors. Definition of Palliative Care. http:// www.who.int/cancer/palliative/definition/en/ (accessed 10 Mar 2009).
19. Frager G. Pediatric palliative care: building the model, bridging the gaps. J Palliat Care 1996;12:9-12.
20. Chen YY, Connors AF Jr, Garland A. Effect of decisions to withhold life support on prolonged survival. Chest 2008;133:1312-18.
21. Pearson SD, Sabin JE, Emmanei E. No margin, no mission: health care organizations and the quest for ethical excellence. Oxford: Oxford University Press, 2003.
22. Winkler EC, Gruen RL. First principles: substantive ethics for healthcare organizations. J Healthc Manag 2005;50:109e19;discussion 119-20.