The Insights Series30-day mortality following hospitalisation,

five clinical conditions, NSW, July 2009 – June 2012

Acute myocardial infarction, ischaemic stroke,

haemorrhagic stroke, pneumonia and hip fracture surgery

Performance Profile:

Western NSW Local Health District

Bathurst Base Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Bath

urs

t B

ase H

osp

ital

Dashb

oard

Hospital-specific risk-standardised mortality ratios (RSMRs) report the ratio of actual or ‘observed’ number of deaths

to the ‘expected’ number of deaths. A hierarchical logistic regression model draws on the NSW patient population’s

characteristics and outcomes to estimate the expected number of deaths for each hospital, given its case mix.

A ratio less than 1.0 indicates lower-than-expected mortality, and a ratio higher than 1.0 indicates higher-than-expected

mortality. Small deviations from 1.0 are not considered to be meaningful. Funnel plots with 90% and 95% control limits

around the NSW rate are used to identify hospitals with higher and lower mortality.

This measure is not designed to compare hospitals and cannot be used to measure the number of avoidable deaths.

RSMRs do not distinguish deaths that are avoidable from those that are a reflection of the natural course of illness.

They do not provide, by themselves, a diagnostic of quality and safety of care.

Risk-standardised mortality ratios (RSMRs) for five conditions, dashboard

Lower mortality No difference Higher mortality Range within 90% control limits

RSMR July 2009 to June 2012

NSW

RSMRs for three-year periods

How to interpret the dashboard

NSW average for index cases

mortality is lower than expected mortality is higher than expected

The length of the bar for each condition reflects the tolerance

for variation around the NSW average. It is wider for hospitals

admitting a small number of patients.

If a hospital's RSMR lies on the grey bar, its mortality is within the range of

values expected for an average NSW hospital of similar size.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Notes: RSMR data are for patients with a hospitalisation noting the relevant condition as principal diagnosis.

Patients include those discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care. Deaths are from any cause,

in or out of hospital within 30 days of the hospitalisation admission date.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

for five conditions.

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au

Acute myocardial infarction (AMI) 260 patients

Ischaemic stroke 82 patients

Haemorrhagic stroke < 50 patients

Pneumonia 393 patients

Hip fracture < 50 patients

2000-02 2003-05 2006-08 2009-11

Bathurst Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Bath

urs

t B

ase H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Total Acute Myocardial Infarction (AMI) hospitalisations

Acute Myocardial Infarction (AMI) patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Bathurst Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Bathurst Base Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

325

260

105

155

37,794

29,223

18,303

10,920

15-55 56-65 66-74 75-82 83+

19 20 19 23 19

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

54Hypertension

30STEMI

12Dysrhythmia

15Congestive heart failure

9Renal failure

5Hypotension

2Dementia

3Cerebrovascular disease

2Malignancy (cancer)

2Shock

0Alzheimer's disease

58

32

21

17

13

11

3

3

3

2

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Bathurst Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Bath

urs

t B

ase H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for Acute Myocardial Infarction (AMI)5

Adjusted for average age and Charlson comorbidity score

Bathurst Base Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 260 Acute Myocardial Infarction (AMI) index cases4

5%

54%

8%

38%

8%

46%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Bathurst Base Hospital profile July 2009 - June 2012

Hospital-level Acute Myocardial Infarction (AMI) risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Bath

urs

t B

ase H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Bathurst Base Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Shellharbour Hospital

Mount Druitt Hospital

Belmont Hospital

Ryde Hospital

Bowral and District Hospital

Grafton Base Hospital

RSMR = 0.79Bathurst Base Hospital

Goulburn Base Hospital

Broken Hill Base Hospital

Griffith Base Hospital

Hawkesbury District Health Service

Bega District Hospital

Murwillumbah District Hospital

Armidale and New England Hospital

0 10 20 30 40 50

Deaths

0

1

2

3

4

5

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150

Expected number of deaths within 30 days

Bathurst Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Bath

urs

t B

ase H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.66 0.65 0.79

2000-02 2003-05 2006-08 2009-11

1.12 1.48 0.85 0.79

Bathurst Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Bath

urs

t B

ase H

osp

ital

Ischaem

ic s

tro

ke

Total ischaemic stroke hospitalisations

Ischaemic stroke patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Bathurst Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Bathurst Base Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

88

82

78

4

15,299

14,205

11,757

2,448

15-63 64-72 73-79 80-85 86+

27 18 21 20 15

20 18 20 21 21

0 10 20 30 40 50 60 70 80 90 100

50Female

4Renal failure

2Congestive heart failure

6Malignancy (cancer)

47

10

7

4

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Bathurst Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Bath

urs

t B

ase H

osp

ital

Ischaem

ic s

tro

ke

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for ischaemic stroke5

Adjusted for average age and Charlson comorbidity score

Bathurst Base Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 82 ischaemic stroke index cases4

10%

75%

0%

25%

0%

75%

(67%)

(2%)

(31%)

(2%)

(51%)

0

80

85

90

95

100

0 10 20 30

0

80

85

90

95

100

0 10 20 30

Bathurst Base Hospital profile July 2009 - June 2012

Hospital-level ischaemic stroke risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Bath

urs

t B

ase H

osp

ital

Ischaem

ic s

tro

ke

Bathurst Base Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Ryde Hospital

Shellharbour Hospital

Bowral and District Hospital

Belmont Hospital

Griffith Base Hospital

Broken Hill Base Hospital

Moruya District Hospital

Goulburn Base Hospital

RSMR = 0.87Bathurst Base Hospital

Hawkesbury District Health Service

Kempsey Hospital

Armidale and New England Hospital

Grafton Base Hospital

0 10 20 30 40 50

Deaths

0

1

2

3

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 25 50 75 100 125

Expected number of deaths within 30 days

Bathurst Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Bath

urs

t B

ase H

osp

ital

Ischaem

ic s

tro

ke

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.73 0.82 0.87

2000-02 2003-05 2006-08 2009-11

0.86 1.72 0.71 0.87

Bathurst Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Bath

urs

t B

ase H

osp

ital

Pneum

onia

Total pneumonia hospitalisations

Pneumonia patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Bathurst Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Bathurst Base Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

453

393

363

30

50,644

44,059

39,655

4,404

18-51 52-67 68-77 78-85 86+

27 23 18 18 13

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

11Dysrhythmia

11Chronic obstructive pulmonary disease

8Renal failure

10Congestive heart failure

4Hypotension

6Malignancy (cancer)

3Dementia

2Cerebrovascular disease

0Liver disease

1Shock

0Alzheimer's disease

1Parkinson's disease

17

16

16

15

12

9

7

3

2

2

1

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Bathurst Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Bath

urs

t B

ase H

osp

ital

Pneum

onia

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for pneumonia5

Adjusted for average age and Charlson comorbidity score

Bathurst Base Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 393 pneumonia index cases4

9%

54%

0%

46%

5%

57%

(66%)

(3%)

(31%)

(6%)

(54%)

0

75

80

85

90

95

100

0 10 20 30

0

75

80

85

90

95

100

0 10 20 30

Bathurst Base Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Bath

urs

t B

ase H

osp

ital

Pneum

onia

Bathurst Base Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Ryde Hospital

Hawkesbury District Health Service

Bowral and District Hospital

Belmont Hospital

Goulburn Base Hospital

Mount Druitt Hospital

Shellharbour Hospital

RSMR = 1.28Bathurst Base Hospital

Grafton Base Hospital

Griffith Base Hospital

Murwillumbah District Hospital

Bega District Hospital

Armidale and New England Hospital

Broken Hill Base Hospital

0 20 40 60 80 100

Deaths

0

1

2

3

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150 200

Expected number of deaths within 30 days

Bathurst Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Bath

urs

t B

ase H

osp

ital

Pneum

onia

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.87 1.07 1.28

2000-02 2003-05 2006-08 2009-12

1.26 0.93 1.40 1.28

Cowra District Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Co

wra

Dis

tric

t H

osp

ital

Dashb

oard

Hospital-specific risk-standardised mortality ratios (RSMRs) report the ratio of actual or ‘observed’ number of deaths

to the ‘expected’ number of deaths. A hierarchical logistic regression model draws on the NSW patient population’s

characteristics and outcomes to estimate the expected number of deaths for each hospital, given its case mix.

A ratio less than 1.0 indicates lower-than-expected mortality, and a ratio higher than 1.0 indicates higher-than-expected

mortality. Small deviations from 1.0 are not considered to be meaningful. Funnel plots with 90% and 95% control limits

around the NSW rate are used to identify hospitals with higher and lower mortality.

This measure is not designed to compare hospitals and cannot be used to measure the number of avoidable deaths.

RSMRs do not distinguish deaths that are avoidable from those that are a reflection of the natural course of illness.

They do not provide, by themselves, a diagnostic of quality and safety of care.

Risk-standardised mortality ratios (RSMRs) for five conditions, dashboard

Lower mortality No difference Higher mortality Range within 90% control limits

RSMR July 2009 to June 2012

NSW

RSMRs for three-year periods

How to interpret the dashboard

NSW average for index cases

mortality is lower than expected mortality is higher than expected

The length of the bar for each condition reflects the tolerance

for variation around the NSW average. It is wider for hospitals

admitting a small number of patients.

If a hospital's RSMR lies on the grey bar, its mortality is within the range of

values expected for an average NSW hospital of similar size.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Notes: RSMR data are for patients with a hospitalisation noting the relevant condition as principal diagnosis.

Patients include those discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care. Deaths are from any cause,

in or out of hospital within 30 days of the hospitalisation admission date.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

for five conditions.

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au

Acute myocardial infarction (AMI) 64 patients

Ischaemic stroke < 50 patients

Haemorrhagic stroke < 50 patients

Pneumonia 143 patients

Hip fracture < 50 patients

2000-02 2003-05 2006-08 2009-11

Cowra District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Co

wra

Dis

tric

t H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Total Acute Myocardial Infarction (AMI) hospitalisations

Acute Myocardial Infarction (AMI) patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Cowra District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Cowra District Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

76

64

11

53

37,794

29,223

18,303

10,920

15-55 56-65 66-74 75-82 83+

22 25 23 20 9

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

58Hypertension

38STEMI

17Dysrhythmia

8Congestive heart failure

3Renal failure

3Hypotension

2Dementia

0Cerebrovascular disease

3Malignancy (cancer)

5Shock

0Alzheimer's disease

58

32

21

17

13

11

3

3

3

2

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Cowra District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Co

wra

Dis

tric

t H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for Acute Myocardial Infarction (AMI)5

Adjusted for average age and Charlson comorbidity score

Cowra District Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

( ) The risk-adjusted survival for index cases at 30 days for this hospital is 100%

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 64 Acute Myocardial Infarction (AMI) index cases4

8%

40%

20%

40%

40%

60%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Cowra District Hospital profile July 2009 - June 2012

Hospital-level Acute Myocardial Infarction (AMI) risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Co

wra

Dis

tric

t H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Cowra District Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Cessnock District Hospital

Young Health Service

Mudgee District Hospital

RSMR = 1.31Cowra District Hospital

Forbes District Hospital

Parkes District Hospital

Inverell District Hospital

0 5 10 15 20 25

Deaths

0

1

2

3

4

5

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150

Expected number of deaths within 30 days

Cowra District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Co

wra

Dis

tric

t H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

1.03 1.36 1.31

2000-02 2003-05 2006-08 2009-11

0.81 1.72 1.17 1.31

Cowra District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Co

wra

Dis

tric

t H

osp

ital

Pneum

onia

Total pneumonia hospitalisations

Pneumonia patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Cowra District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Cowra District Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

163

143

133

10

50,644

44,059

39,655

4,404

18-51 52-67 68-77 78-85 86+

14 22 24 26 14

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

6Dysrhythmia

22Chronic obstructive pulmonary disease

8Renal failure

4Congestive heart failure

3Hypotension

8Malignancy (cancer)

7Dementia

1Cerebrovascular disease

1Liver disease

0Shock

1Alzheimer's disease

0Parkinson's disease

17

16

16

15

12

9

7

3

2

2

1

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Cowra District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Co

wra

Dis

tric

t H

osp

ital

Pneum

onia

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for pneumonia5

Adjusted for average age and Charlson comorbidity score

Cowra District Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 143 pneumonia index cases4

10%

50%

0%

50%

7%

50%

(66%)

(3%)

(31%)

(6%)

(54%)

0

75

80

85

90

95

100

0 10 20 30

0

75

80

85

90

95

100

0 10 20 30

Cowra District Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Co

wra

Dis

tric

t H

osp

ital

Pneum

onia

Cowra District Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Cessnock District Hospital

Mudgee District Hospital

Inverell District Hospital

RSMR = 1.20Cowra District Hospital

Singleton District Hospital

Young Health Service

Muswellbrook District Hospital

Tumut Health Service

Gunnedah District Hospital

Parkes District Hospital

Moree District Hospital

Forbes District Hospital

Kurri Kurri District Hospital

Deniliquin Health Service

0 10 20 30 40 50

Deaths

0

1

2

3

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150 200

Expected number of deaths within 30 days

Cowra District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Co

wra

Dis

tric

t H

osp

ital

Pneum

onia

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.91 0.98 1.20

2000-02 2003-05 2006-08 2009-12

1.16 1.15 0.75 1.20

Dubbo Base Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Dub

bo

Base H

osp

ital

Dashb

oard

Hospital-specific risk-standardised mortality ratios (RSMRs) report the ratio of actual or ‘observed’ number of deaths

to the ‘expected’ number of deaths. A hierarchical logistic regression model draws on the NSW patient population’s

characteristics and outcomes to estimate the expected number of deaths for each hospital, given its case mix.

A ratio less than 1.0 indicates lower-than-expected mortality, and a ratio higher than 1.0 indicates higher-than-expected

mortality. Small deviations from 1.0 are not considered to be meaningful. Funnel plots with 90% and 95% control limits

around the NSW rate are used to identify hospitals with higher and lower mortality.

This measure is not designed to compare hospitals and cannot be used to measure the number of avoidable deaths.

RSMRs do not distinguish deaths that are avoidable from those that are a reflection of the natural course of illness.

They do not provide, by themselves, a diagnostic of quality and safety of care.

Risk-standardised mortality ratios (RSMRs) for five conditions, dashboard

Lower mortality No difference Higher mortality Range within 90% control limits

RSMR July 2009 to June 2012

NSW

RSMRs for three-year periods

How to interpret the dashboard

NSW average for index cases

mortality is lower than expected mortality is higher than expected

The length of the bar for each condition reflects the tolerance

for variation around the NSW average. It is wider for hospitals

admitting a small number of patients.

If a hospital's RSMR lies on the grey bar, its mortality is within the range of

values expected for an average NSW hospital of similar size.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Notes: RSMR data are for patients with a hospitalisation noting the relevant condition as principal diagnosis.

Patients include those discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care. Deaths are from any cause,

in or out of hospital within 30 days of the hospitalisation admission date.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

for five conditions.

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au

Acute myocardial infarction (AMI) 487 patients

Ischaemic stroke 270 patients

Haemorrhagic stroke 71 patients

Pneumonia 526 patients

Hip fracture 321 patients

2000-02 2003-05 2006-08 2009-11

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Dub

bo

Base H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Total Acute Myocardial Infarction (AMI) hospitalisations

Acute Myocardial Infarction (AMI) patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Dubbo Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Dubbo Base Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

673

487

162

325

37,794

29,223

18,303

10,920

15-55 56-65 66-74 75-82 83+

18 22 19 21 21

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

65Hypertension

22STEMI

23Dysrhythmia

21Congestive heart failure

18Renal failure

9Hypotension

3Dementia

3Cerebrovascular disease

2Malignancy (cancer)

3Shock

0Alzheimer's disease

58

32

21

17

13

11

3

3

3

2

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Dub

bo

Base H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for Acute Myocardial Infarction (AMI)5

Adjusted for average age and Charlson comorbidity score

Dubbo Base Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 487 Acute Myocardial Infarction (AMI) index cases4

8%

65%

3%

33%

13%

63%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Dubbo Base Hospital profile July 2009 - June 2012

Hospital-level Acute Myocardial Infarction (AMI) risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Dub

bo

Base H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Dubbo Base Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Lismore Base Hospital

The Tweed Hospital

Shoalhaven and District Memorial Hospital

Tamworth Base Hospital

Maitland Hospital

Port Macquarie Base Hospital

RSMR = 1.06Dubbo Base Hospital

Manning Base Hospital

Coffs Harbour Base Hospital

Wagga Wagga Base Hospital

Orange Base Hospital

0 10 20 30 40 50

Deaths

0

1

2

3

4

5

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150

Expected number of deaths within 30 days

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Dub

bo

Base H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

1.09 1.09 1.06

2000-02 2003-05 2006-08 2009-11

1.07 1.57 1.17 1.06

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Dub

bo

Base H

osp

ital

Ischaem

ic s

tro

ke

Total ischaemic stroke hospitalisations

Ischaemic stroke patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Dubbo Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Dubbo Base Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

293

270

135

135

15,299

14,205

11,757

2,448

15-63 64-72 73-79 80-85 86+

28 17 23 17 15

20 18 20 21 21

0 10 20 30 40 50 60 70 80 90 100

39Female

9Renal failure

4Congestive heart failure

2Malignancy (cancer)

47

10

7

4

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Dub

bo

Base H

osp

ital

Ischaem

ic s

tro

ke

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for ischaemic stroke5

Adjusted for average age and Charlson comorbidity score

Dubbo Base Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 270 ischaemic stroke index cases4

16%

52%

9%

39%

0%

50%

(67%)

(2%)

(31%)

(2%)

(51%)

0

80

85

90

95

100

0 10 20 30

0

80

85

90

95

100

0 10 20 30

Dubbo Base Hospital profile July 2009 - June 2012

Hospital-level ischaemic stroke risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Dub

bo

Base H

osp

ital

Ischaem

ic s

tro

ke

Dubbo Base Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

RSMR = 1.53Dubbo Base Hospital

Coffs Harbour Base Hospital

Shoalhaven and District Memorial Hospital

Port Macquarie Base Hospital

Tamworth Base Hospital

Lismore Base Hospital

Manning Base Hospital

The Tweed Hospital

Wagga Wagga Base Hospital

Orange Base Hospital

Maitland Hospital

0 10 20 30 40 50

Deaths

0

1

2

3

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 25 50 75 100 125

Expected number of deaths within 30 days

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Dub

bo

Base H

osp

ital

Ischaem

ic s

tro

ke

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

1.22 1.45 1.53

2000-02 2003-05 2006-08 2009-11

1.19 1.90 0.89 1.53

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

Dub

bo

Base H

osp

ital

Haem

orr

hag

ic s

tro

ke

Total haemorrhagic stroke hospitalisations

Haemorrhagic stroke patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Dubbo Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Dubbo Base Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

80

71

21

50

6,573

5,681

4,148

1,533

15-62 63-73 74-80 81-85 86+

24 17 24 23 13

20 21 21 19 19

0 10 20 30 40 50 60 70 80 90 100

42Female

4History of haemorrhagic stroke

7Malignancy (cancer)

10Congestive heart failure

46

8

6

6

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

Dub

bo

Base H

osp

ital

Haem

orr

hag

ic s

tro

ke

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for haemorrhagic stroke5

Adjusted for average age and Charlson comorbidity score

Dubbo Base Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 71 haemorrhagic stroke index cases4

25%

56%

11%

33%

22%

89%

(76%)

(3%)

(21%)

(20%)

(75%)

0

50

55

60

65

70

75

80

85

90

95

100

0 10 20 30

0

50

55

60

65

70

75

80

85

90

95

100

0 10 20 30

Dubbo Base Hospital profile July 2009 - June 2012

Hospital-level haemorrhagic stroke risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Dub

bo

Base H

osp

ital

Haem

orr

hag

ic s

tro

ke

Dubbo Base Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Port Macquarie Base Hospital

Lismore Base Hospital

Coffs Harbour Base Hospital

Shoalhaven and District Memorial Hospital

The Tweed Hospital

Orange Base Hospital

Manning Base Hospital

Tamworth Base Hospital

Wagga Wagga Base Hospital

RSMR = 0.76Dubbo Base Hospital

0 10 20 30 40 50

Deaths

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 25 50 75 100 125

Expected number of deaths within 30 days

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

Dub

bo

Base H

osp

ital

Haem

orr

hag

ic s

tro

ke

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.75 0.78 0.76

2000-02 2003-05 2006-08 2009-11

1.11 1.01 1.05 0.76

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Dub

bo

Base H

osp

ital

Pneum

onia

Total pneumonia hospitalisations

Pneumonia patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Dubbo Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Dubbo Base Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

675

526

408

118

50,644

44,059

39,655

4,404

18-51 52-67 68-77 78-85 86+

24 25 19 20 13

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

22Dysrhythmia

24Chronic obstructive pulmonary disease

21Renal failure

16Congestive heart failure

11Hypotension

10Malignancy (cancer)

5Dementia

2Cerebrovascular disease

2Liver disease

2Shock

1Alzheimer's disease

1Parkinson's disease

17

16

16

15

12

9

7

3

2

2

1

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Dub

bo

Base H

osp

ital

Pneum

onia

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for pneumonia5

Adjusted for average age and Charlson comorbidity score

Dubbo Base Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 526 pneumonia index cases4

9%

55%

4%

41%

8%

45%

(66%)

(3%)

(31%)

(6%)

(54%)

0

75

80

85

90

95

100

0 10 20 30

0

75

80

85

90

95

100

0 10 20 30

Dubbo Base Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Dub

bo

Base H

osp

ital

Pneum

onia

Dubbo Base Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Shoalhaven and District Memorial Hospital

Manning Base Hospital

Coffs Harbour Base Hospital

Port Macquarie Base Hospital

Tamworth Base Hospital

Wagga Wagga Base Hospital

The Tweed Hospital

RSMR = 0.92Dubbo Base Hospital

Orange Base Hospital

Maitland Hospital

Lismore Base Hospital

0 20 40 60 80 100

Deaths

0

1

2

3

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150 200

Expected number of deaths within 30 days

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Dub

bo

Base H

osp

ital

Pneum

onia

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.87 1.04 0.92

2000-02 2003-05 2006-08 2009-12

1.67 1.22 1.29 0.92

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

Dub

bo

Base H

osp

ital

Hip

fra

ctu

re s

urg

ery

Total hip fracture surgery hospitalisations

Hip fracture surgery patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Dubbo Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Dubbo Base Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

335

321

96

225

16,355

15,836

10,739

5,097

50-75 76-82 83-86 87-89 90+

25 24 17 14 20

19 23 20 15 22

0 10 20 30 40 50 60 70 80 90 100

33Male

18Dementia

12Dysrhythmia

9Renal failure

12Acute respiratory tract infection

9Congestive heart failure

13Ischemic heart disease

2Malignancy (cancer)

28

23

18

13

12

10

9

4

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

Dub

bo

Base H

osp

ital

Hip

fra

ctu

re s

urg

ery

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission not applicable for hip fracture surgery

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for hip fracture surgery5

Adjusted for average age and Charlson comorbidity score

Dubbo Base Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 321 hip fracture surgery index cases4

7%

21%

0%

79%

21%

(50%)

(0%)

(50%)

(27%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Dubbo Base Hospital profile July 2009 - June 2012

Hospital-level hip fracture surgery risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Dub

bo

Base H

osp

ital

Hip

fra

ctu

re s

urg

ery

Dubbo Base Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Orange Base Hospital

Coffs Harbour Base Hospital

Tamworth Base Hospital

Lismore Base Hospital

Port Macquarie Base Hospital

Maitland Hospital

RSMR = 1.19Dubbo Base Hospital

Manning Base Hospital

Wagga Wagga Base Hospital

The Tweed Hospital

Shoalhaven and District Memorial Hospital

0 10 20 30 40 50

Deaths

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 20 40 60 80 100

Expected number of deaths within 30 days

Dubbo Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

Dub

bo

Base H

osp

ital

Hip

fra

ctu

re s

urg

ery

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

1.09 1.14 1.19

2000-02 2003-05 2006-08 2009-11

1.48 1.22 1.06 1.19

Forbes District Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Fo

rbes D

istr

ict

Ho

sp

ital

Dashb

oard

Hospital-specific risk-standardised mortality ratios (RSMRs) report the ratio of actual or ‘observed’ number of deaths

to the ‘expected’ number of deaths. A hierarchical logistic regression model draws on the NSW patient population’s

characteristics and outcomes to estimate the expected number of deaths for each hospital, given its case mix.

A ratio less than 1.0 indicates lower-than-expected mortality, and a ratio higher than 1.0 indicates higher-than-expected

mortality. Small deviations from 1.0 are not considered to be meaningful. Funnel plots with 90% and 95% control limits

around the NSW rate are used to identify hospitals with higher and lower mortality.

This measure is not designed to compare hospitals and cannot be used to measure the number of avoidable deaths.

RSMRs do not distinguish deaths that are avoidable from those that are a reflection of the natural course of illness.

They do not provide, by themselves, a diagnostic of quality and safety of care.

Risk-standardised mortality ratios (RSMRs) for five conditions, dashboard

Lower mortality No difference Higher mortality Range within 90% control limits

RSMR July 2009 to June 2012

NSW

RSMRs for three-year periods

How to interpret the dashboard

NSW average for index cases

mortality is lower than expected mortality is higher than expected

The length of the bar for each condition reflects the tolerance

for variation around the NSW average. It is wider for hospitals

admitting a small number of patients.

If a hospital's RSMR lies on the grey bar, its mortality is within the range of

values expected for an average NSW hospital of similar size.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Notes: RSMR data are for patients with a hospitalisation noting the relevant condition as principal diagnosis.

Patients include those discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care. Deaths are from any cause,

in or out of hospital within 30 days of the hospitalisation admission date.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

for five conditions.

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au

Acute myocardial infarction (AMI) 52 patients

Ischaemic stroke < 50 patients

Haemorrhagic stroke < 50 patients

Pneumonia 101 patients

Hip fracture < 50 patients

2000-02 2003-05 2006-08 2009-11

Forbes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Fo

rbes D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Total Acute Myocardial Infarction (AMI) hospitalisations

Acute Myocardial Infarction (AMI) patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Forbes District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Forbes District Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

65

52

10

42

37,794

29,223

18,303

10,920

15-55 56-65 66-74 75-82 83+

25 8 29 21 17

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

23Hypertension

35STEMI

15Dysrhythmia

12Congestive heart failure

4Renal failure

6Hypotension

2Dementia

6Cerebrovascular disease

6Malignancy (cancer)

0Shock

0Alzheimer's disease

58

32

21

17

13

11

3

3

3

2

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Forbes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Fo

rbes D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for Acute Myocardial Infarction (AMI)5

Adjusted for average age and Charlson comorbidity score

Forbes District Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 52 Acute Myocardial Infarction (AMI) index cases4

6%

33%

33%

33%

0%

67%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Forbes District Hospital profile July 2009 - June 2012

Hospital-level Acute Myocardial Infarction (AMI) risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Fo

rbes D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Forbes District Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Cessnock District Hospital

Young Health Service

Mudgee District Hospital

Cowra District Hospital

RSMR = 1.08Forbes District Hospital

Parkes District Hospital

Inverell District Hospital

0 5 10 15 20 25

Deaths

0

1

2

3

4

5

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150

Expected number of deaths within 30 days

Forbes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Fo

rbes D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.76 0.84 1.08

2000-02 2003-05 2006-08 2009-11

0.45 1.93 0.95 1.08

Forbes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Fo

rbes D

istr

ict

Ho

sp

ital

Pneum

onia

Total pneumonia hospitalisations

Pneumonia patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Forbes District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Forbes District Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

106

101

94

7

50,644

44,059

39,655

4,404

18-51 52-67 68-77 78-85 86+

22 14 30 22 13

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

5Dysrhythmia

5Chronic obstructive pulmonary disease

4Renal failure

10Congestive heart failure

9Hypotension

5Malignancy (cancer)

6Dementia

2Cerebrovascular disease

1Liver disease

0Shock

2Alzheimer's disease

0Parkinson's disease

17

16

16

15

12

9

7

3

2

2

1

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Forbes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Fo

rbes D

istr

ict

Ho

sp

ital

Pneum

onia

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for pneumonia5

Adjusted for average age and Charlson comorbidity score

Forbes District Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 101 pneumonia index cases4

6%

67%

33%

0%

0%

83%

(66%)

(3%)

(31%)

(6%)

(54%)

0

75

80

85

90

95

100

0 10 20 30

0

75

80

85

90

95

100

0 10 20 30

Forbes District Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Fo

rbes D

istr

ict

Ho

sp

ital

Pneum

onia

Forbes District Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Cessnock District Hospital

Mudgee District Hospital

Inverell District Hospital

Cowra District Hospital

Singleton District Hospital

Young Health Service

Muswellbrook District Hospital

Tumut Health Service

Gunnedah District Hospital

Parkes District Hospital

Moree District Hospital

RSMR = 0.81Forbes District Hospital

Kurri Kurri District Hospital

Deniliquin Health Service

0 10 20 30 40 50

Deaths

0

1

2

3

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150 200

Expected number of deaths within 30 days

Forbes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Fo

rbes D

istr

ict

Ho

sp

ital

Pneum

onia

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.55 0.63 0.81

2000-02 2003-05 2006-08 2009-12

1.00 0.00 1.22 0.81

Mudgee District Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Mud

gee D

istr

ict

Ho

sp

ital

Dashb

oard

Hospital-specific risk-standardised mortality ratios (RSMRs) report the ratio of actual or ‘observed’ number of deaths

to the ‘expected’ number of deaths. A hierarchical logistic regression model draws on the NSW patient population’s

characteristics and outcomes to estimate the expected number of deaths for each hospital, given its case mix.

A ratio less than 1.0 indicates lower-than-expected mortality, and a ratio higher than 1.0 indicates higher-than-expected

mortality. Small deviations from 1.0 are not considered to be meaningful. Funnel plots with 90% and 95% control limits

around the NSW rate are used to identify hospitals with higher and lower mortality.

This measure is not designed to compare hospitals and cannot be used to measure the number of avoidable deaths.

RSMRs do not distinguish deaths that are avoidable from those that are a reflection of the natural course of illness.

They do not provide, by themselves, a diagnostic of quality and safety of care.

Risk-standardised mortality ratios (RSMRs) for five conditions, dashboard

Lower mortality No difference Higher mortality Range within 90% control limits

RSMR July 2009 to June 2012

NSW

RSMRs for three-year periods

How to interpret the dashboard

NSW average for index cases

mortality is lower than expected mortality is higher than expected

The length of the bar for each condition reflects the tolerance

for variation around the NSW average. It is wider for hospitals

admitting a small number of patients.

If a hospital's RSMR lies on the grey bar, its mortality is within the range of

values expected for an average NSW hospital of similar size.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Notes: RSMR data are for patients with a hospitalisation noting the relevant condition as principal diagnosis.

Patients include those discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care. Deaths are from any cause,

in or out of hospital within 30 days of the hospitalisation admission date.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

for five conditions.

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au

Acute myocardial infarction (AMI) 52 patients

Ischaemic stroke < 50 patients

Haemorrhagic stroke < 50 patients

Pneumonia 181 patients

Hip fracture < 50 patients

2000-02 2003-05 2006-08 2009-11

Mudgee District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Mud

gee D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Total Acute Myocardial Infarction (AMI) hospitalisations

Acute Myocardial Infarction (AMI) patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Mudgee District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Mudgee District Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

77

52

15

37

37,794

29,223

18,303

10,920

15-55 56-65 66-74 75-82 83+

23 19 21 13 23

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

44Hypertension

48STEMI

8Dysrhythmia

10Congestive heart failure

8Renal failure

2Hypotension

4Dementia

6Cerebrovascular disease

2Malignancy (cancer)

2Shock

0Alzheimer's disease

58

32

21

17

13

11

3

3

3

2

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Mudgee District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Mud

gee D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for Acute Myocardial Infarction (AMI)5

Adjusted for average age and Charlson comorbidity score

Mudgee District Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

( ) The risk-adjusted survival for index cases at 30 days for this hospital is 100%

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 52 Acute Myocardial Infarction (AMI) index cases4

10%

40%

20%

40%

20%

80%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Mudgee District Hospital profile July 2009 - June 2012

Hospital-level Acute Myocardial Infarction (AMI) risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Mud

gee D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Mudgee District Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Cessnock District Hospital

Young Health Service

RSMR = 1.30Mudgee District Hospital

Cowra District Hospital

Forbes District Hospital

Parkes District Hospital

Inverell District Hospital

0 5 10 15 20 25

Deaths

0

1

2

3

4

5

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150

Expected number of deaths within 30 days

Mudgee District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Mud

gee D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

1.27 1.22 1.30

2000-02 2003-05 2006-08 2009-11

2.43 1.07 1.21 1.30

Mudgee District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Mud

gee D

istr

ict

Ho

sp

ital

Pneum

onia

Total pneumonia hospitalisations

Pneumonia patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Mudgee District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Mudgee District Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

209

181

167

14

50,644

44,059

39,655

4,404

18-51 52-67 68-77 78-85 86+

19 23 22 22 14

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

9Dysrhythmia

22Chronic obstructive pulmonary disease

7Renal failure

14Congestive heart failure

5Hypotension

8Malignancy (cancer)

4Dementia

3Cerebrovascular disease

2Liver disease

1Shock

0Alzheimer's disease

2Parkinson's disease

17

16

16

15

12

9

7

3

2

2

1

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Mudgee District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Mud

gee D

istr

ict

Ho

sp

ital

Pneum

onia

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for pneumonia5

Adjusted for average age and Charlson comorbidity score

Mudgee District Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 181 pneumonia index cases4

11%

60%

5%

35%

5%

60%

(66%)

(3%)

(31%)

(6%)

(54%)

0

75

80

85

90

95

100

0 10 20 30

0

75

80

85

90

95

100

0 10 20 30

Mudgee District Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Mud

gee D

istr

ict

Ho

sp

ital

Pneum

onia

Mudgee District Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Cessnock District Hospital

RSMR = 1.29Mudgee District Hospital

Inverell District Hospital

Cowra District Hospital

Singleton District Hospital

Young Health Service

Muswellbrook District Hospital

Tumut Health Service

Gunnedah District Hospital

Parkes District Hospital

Moree District Hospital

Forbes District Hospital

Kurri Kurri District Hospital

Deniliquin Health Service

0 10 20 30 40 50

Deaths

0

1

2

3

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150 200

Expected number of deaths within 30 days

Mudgee District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Mud

gee D

istr

ict

Ho

sp

ital

Pneum

onia

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

1.03 1.15 1.29

2000-02 2003-05 2006-08 2009-12

1.14 0.99 1.41 1.29

Orange Health Service summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Ora

ng

e H

ealth S

erv

ice

Dashb

oard

Hospital-specific risk-standardised mortality ratios (RSMRs) report the ratio of actual or ‘observed’ number of deaths

to the ‘expected’ number of deaths. A hierarchical logistic regression model draws on the NSW patient population’s

characteristics and outcomes to estimate the expected number of deaths for each hospital, given its case mix.

A ratio less than 1.0 indicates lower-than-expected mortality, and a ratio higher than 1.0 indicates higher-than-expected

mortality. Small deviations from 1.0 are not considered to be meaningful. Funnel plots with 90% and 95% control limits

around the NSW rate are used to identify hospitals with higher and lower mortality.

This measure is not designed to compare hospitals and cannot be used to measure the number of avoidable deaths.

RSMRs do not distinguish deaths that are avoidable from those that are a reflection of the natural course of illness.

They do not provide, by themselves, a diagnostic of quality and safety of care.

Risk-standardised mortality ratios (RSMRs) for five conditions, dashboard

Lower mortality No difference Higher mortality Range within 90% control limits

RSMR July 2009 to June 2012

NSW

RSMRs for three-year periods

How to interpret the dashboard

NSW average for index cases

mortality is lower than expected mortality is higher than expected

The length of the bar for each condition reflects the tolerance

for variation around the NSW average. It is wider for hospitals

admitting a small number of patients.

If a hospital's RSMR lies on the grey bar, its mortality is within the range of

values expected for an average NSW hospital of similar size.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Notes: RSMR data are for patients with a hospitalisation noting the relevant condition as principal diagnosis.

Patients include those discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care. Deaths are from any cause,

in or out of hospital within 30 days of the hospitalisation admission date.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

for five conditions.

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au

Acute myocardial infarction (AMI) 313 patients

Ischaemic stroke 182 patients

Haemorrhagic stroke 71 patients

Pneumonia 507 patients

Hip fracture 393 patients

2000-02 2003-05 2006-08 2009-11

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Ora

ng

e H

ealth S

erv

ice

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Total Acute Myocardial Infarction (AMI) hospitalisations

Acute Myocardial Infarction (AMI) patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Orange Health Service

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Orange Health Service NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

470

313

219

94

37,794

29,223

18,303

10,920

15-55 56-65 66-74 75-82 83+

23 23 19 17 18

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

53Hypertension

36STEMI

21Dysrhythmia

11Congestive heart failure

13Renal failure

12Hypotension

2Dementia

4Cerebrovascular disease

1Malignancy (cancer)

4Shock

1Alzheimer's disease

58

32

21

17

13

11

3

3

3

2

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Ora

ng

e H

ealth S

erv

ice

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for Acute Myocardial Infarction (AMI)5

Adjusted for average age and Charlson comorbidity score

Orange Health Service

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 313 Acute Myocardial Infarction (AMI) index cases4

7%

73%

5%

23%

14%

64%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Orange Health Service profile July 2009 - June 2012

Hospital-level Acute Myocardial Infarction (AMI) risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Ora

ng

e H

ealth S

erv

ice

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Orange Health Service NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Lismore Base Hospital

The Tweed Hospital

Shoalhaven and District Memorial Hospital

Tamworth Base Hospital

Maitland Hospital

Port Macquarie Base Hospital

Dubbo Base Hospital

Manning Base Hospital

Coffs Harbour Base Hospital

Wagga Wagga Base Hospital

RSMR = 0.95Orange Base Hospital

0 10 20 30 40 50

Deaths

0

1

2

3

4

5

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150

Expected number of deaths within 30 days

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Ora

ng

e H

ealth S

erv

ice

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.93 1.03 0.95

2000-02 2003-05 2006-08 2009-11

0.76 1.33 1.21 0.95

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Ora

ng

e H

ealth S

erv

ice

Ischaem

ic s

tro

ke

Total ischaemic stroke hospitalisations

Ischaemic stroke patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Orange Health Service

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Orange Health Service NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

199

182

163

19

15,299

14,205

11,757

2,448

15-63 64-72 73-79 80-85 86+

18 16 22 23 21

20 18 20 21 21

0 10 20 30 40 50 60 70 80 90 100

52Female

13Renal failure

5Congestive heart failure

4Malignancy (cancer)

47

10

7

4

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Ora

ng

e H

ealth S

erv

ice

Ischaem

ic s

tro

ke

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for ischaemic stroke5

Adjusted for average age and Charlson comorbidity score

Orange Health Service

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 182 ischaemic stroke index cases4

14%

68%

0%

32%

0%

52%

(67%)

(2%)

(31%)

(2%)

(51%)

0

80

85

90

95

100

0 10 20 30

0

80

85

90

95

100

0 10 20 30

Orange Health Service profile July 2009 - June 2012

Hospital-level ischaemic stroke risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Ora

ng

e H

ealth S

erv

ice

Ischaem

ic s

tro

ke

Orange Health Service NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Dubbo Base Hospital

Coffs Harbour Base Hospital

Shoalhaven and District Memorial Hospital

Port Macquarie Base Hospital

Tamworth Base Hospital

Lismore Base Hospital

Manning Base Hospital

The Tweed Hospital

Wagga Wagga Base Hospital

RSMR = 1.03Orange Base Hospital

Maitland Hospital

0 10 20 30 40 50

Deaths

0

1

2

3

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 25 50 75 100 125

Expected number of deaths within 30 days

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Ora

ng

e H

ealth S

erv

ice

Ischaem

ic s

tro

ke

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

1.03 1.03 1.03

2000-02 2003-05 2006-08 2009-11

1.13 1.26 1.33 1.03

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

Ora

ng

e H

ealth S

erv

ice

Haem

orr

hag

ic s

tro

ke

Total haemorrhagic stroke hospitalisations

Haemorrhagic stroke patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Orange Health Service

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Orange Health Service NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

83

71

45

26

6,573

5,681

4,148

1,533

15-62 63-73 74-80 81-85 86+

18 28 14 20 20

20 21 21 19 19

0 10 20 30 40 50 60 70 80 90 100

46Female

7History of haemorrhagic stroke

3Malignancy (cancer)

8Congestive heart failure

46

8

6

6

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

Ora

ng

e H

ealth S

erv

ice

Haem

orr

hag

ic s

tro

ke

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for haemorrhagic stroke5

Adjusted for average age and Charlson comorbidity score

Orange Health Service

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 71 haemorrhagic stroke index cases4

37%

77%

8%

15%

19%

69%

(76%)

(3%)

(21%)

(20%)

(75%)

0

50

55

60

65

70

75

80

85

90

95

100

0 10 20 30

0

50

55

60

65

70

75

80

85

90

95

100

0 10 20 30

Orange Health Service profile July 2009 - June 2012

Hospital-level haemorrhagic stroke risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Ora

ng

e H

ealth S

erv

ice

Haem

orr

hag

ic s

tro

ke

Orange Health Service NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Port Macquarie Base Hospital

Lismore Base Hospital

Coffs Harbour Base Hospital

Shoalhaven and District Memorial Hospital

The Tweed Hospital

RSMR = 1.11Orange Base Hospital

Manning Base Hospital

Tamworth Base Hospital

Wagga Wagga Base Hospital

Dubbo Base Hospital

0 10 20 30 40 50

Deaths

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 25 50 75 100 125

Expected number of deaths within 30 days

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

Ora

ng

e H

ealth S

erv

ice

Haem

orr

hag

ic s

tro

ke

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

1.08 1.09 1.11

2000-02 2003-05 2006-08 2009-11

1.28 1.32 1.09 1.11

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Ora

ng

e H

ealth S

erv

ice

Pneum

onia

Total pneumonia hospitalisations

Pneumonia patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Orange Health Service

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Orange Health Service NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

585

507

455

52

50,644

44,059

39,655

4,404

18-51 52-67 68-77 78-85 86+

21 22 22 21 14

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

21Dysrhythmia

17Chronic obstructive pulmonary disease

18Renal failure

12Congestive heart failure

11Hypotension

6Malignancy (cancer)

5Dementia

4Cerebrovascular disease

2Liver disease

3Shock

1Alzheimer's disease

1Parkinson's disease

17

16

16

15

12

9

7

3

2

2

1

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Ora

ng

e H

ealth S

erv

ice

Pneum

onia

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for pneumonia5

Adjusted for average age and Charlson comorbidity score

Orange Health Service

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 507 pneumonia index cases4

10%

73%

0%

27%

8%

53%

(66%)

(3%)

(31%)

(6%)

(54%)

0

75

80

85

90

95

100

0 10 20 30

0

75

80

85

90

95

100

0 10 20 30

Orange Health Service profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Ora

ng

e H

ealth S

erv

ice

Pneum

onia

Orange Health Service NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Shoalhaven and District Memorial Hospital

Manning Base Hospital

Coffs Harbour Base Hospital

Port Macquarie Base Hospital

Tamworth Base Hospital

Wagga Wagga Base Hospital

The Tweed Hospital

Dubbo Base Hospital

RSMR = 1.02Orange Base Hospital

Maitland Hospital

Lismore Base Hospital

0 20 40 60 80 100

Deaths

0

1

2

3

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150 200

Expected number of deaths within 30 days

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Ora

ng

e H

ealth S

erv

ice

Pneum

onia

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.90 1.01 1.02

2000-02 2003-05 2006-08 2009-12

1.09 1.07 1.13 1.02

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

Ora

ng

e H

ealth S

erv

ice

Hip

fra

ctu

re s

urg

ery

Total hip fracture surgery hospitalisations

Hip fracture surgery patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Orange Health Service

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Orange Health Service NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

405

393

233

160

16,355

15,836

10,739

5,097

50-75 76-82 83-86 87-89 90+

24 23 18 16 19

19 23 20 15 22

0 10 20 30 40 50 60 70 80 90 100

29Male

21Dementia

19Dysrhythmia

13Renal failure

18Acute respiratory tract infection

11Congestive heart failure

12Ischemic heart disease

4Malignancy (cancer)

28

23

18

13

12

10

9

4

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

Ora

ng

e H

ealth S

erv

ice

Hip

fra

ctu

re s

urg

ery

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission not applicable for hip fracture surgery

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for hip fracture surgery5

Adjusted for average age and Charlson comorbidity score

Orange Health Service

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 393 hip fracture surgery index cases4

10%

50%

0%

50%

43%

(50%)

(0%)

(50%)

(27%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Orange Health Service profile July 2009 - June 2012

Hospital-level hip fracture surgery risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Ora

ng

e H

ealth S

erv

ice

Hip

fra

ctu

re s

urg

ery

Orange Health Service NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

RSMR = 1.53Orange Base Hospital

Coffs Harbour Base Hospital

Tamworth Base Hospital

Lismore Base Hospital

Port Macquarie Base Hospital

Maitland Hospital

Dubbo Base Hospital

Manning Base Hospital

Wagga Wagga Base Hospital

The Tweed Hospital

Shoalhaven and District Memorial Hospital

0 10 20 30 40 50

Deaths

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 20 40 60 80 100

Expected number of deaths within 30 days

Orange Health Service profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

Ora

ng

e H

ealth S

erv

ice

Hip

fra

ctu

re s

urg

ery

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

1.48 1.56 1.53

2000-02 2003-05 2006-08 2009-11

1.19 1.25 1.44 1.53

Parkes District Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Park

es D

istr

ict

Ho

sp

ital

Dashb

oard

Hospital-specific risk-standardised mortality ratios (RSMRs) report the ratio of actual or ‘observed’ number of deaths

to the ‘expected’ number of deaths. A hierarchical logistic regression model draws on the NSW patient population’s

characteristics and outcomes to estimate the expected number of deaths for each hospital, given its case mix.

A ratio less than 1.0 indicates lower-than-expected mortality, and a ratio higher than 1.0 indicates higher-than-expected

mortality. Small deviations from 1.0 are not considered to be meaningful. Funnel plots with 90% and 95% control limits

around the NSW rate are used to identify hospitals with higher and lower mortality.

This measure is not designed to compare hospitals and cannot be used to measure the number of avoidable deaths.

RSMRs do not distinguish deaths that are avoidable from those that are a reflection of the natural course of illness.

They do not provide, by themselves, a diagnostic of quality and safety of care.

Risk-standardised mortality ratios (RSMRs) for five conditions, dashboard

Lower mortality No difference Higher mortality Range within 90% control limits

RSMR July 2009 to June 2012

NSW

RSMRs for three-year periods

How to interpret the dashboard

NSW average for index cases

mortality is lower than expected mortality is higher than expected

The length of the bar for each condition reflects the tolerance

for variation around the NSW average. It is wider for hospitals

admitting a small number of patients.

If a hospital's RSMR lies on the grey bar, its mortality is within the range of

values expected for an average NSW hospital of similar size.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Notes: RSMR data are for patients with a hospitalisation noting the relevant condition as principal diagnosis.

Patients include those discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care. Deaths are from any cause,

in or out of hospital within 30 days of the hospitalisation admission date.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

for five conditions.

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au

Acute myocardial infarction (AMI) 52 patients

Ischaemic stroke < 50 patients

Haemorrhagic stroke < 50 patients

Pneumonia 114 patients

Hip fracture < 50 patients

2000-02 2003-05 2006-08 2009-11

Parkes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Park

es D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Total Acute Myocardial Infarction (AMI) hospitalisations

Acute Myocardial Infarction (AMI) patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Parkes District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Parkes District Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

73

52

8

44

37,794

29,223

18,303

10,920

15-55 56-65 66-74 75-82 83+

21 23 19 23 13

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

46Hypertension

42STEMI

19Dysrhythmia

8Congestive heart failure

8Renal failure

10Hypotension

2Dementia

8Cerebrovascular disease

4Malignancy (cancer)

2Shock

0Alzheimer's disease

58

32

21

17

13

11

3

3

3

2

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Parkes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Park

es D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for Acute Myocardial Infarction (AMI)5

Adjusted for average age and Charlson comorbidity score

Parkes District Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

( ) The risk-adjusted survival for index cases at 30 days for this hospital is 100%

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 52 Acute Myocardial Infarction (AMI) index cases4

4%

0%

0%

100%

0%

50%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Parkes District Hospital profile July 2009 - June 2012

Hospital-level Acute Myocardial Infarction (AMI) risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Park

es D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Parkes District Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Cessnock District Hospital

Young Health Service

Mudgee District Hospital

Cowra District Hospital

Forbes District Hospital

RSMR = 0.52Parkes District Hospital

Inverell District Hospital

0 5 10 15 20 25

Deaths

0

1

2

3

4

5

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150

Expected number of deaths within 30 days

Parkes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for Acute Myocardial Infarction (AMI)

Park

es D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.51 0.63 0.52

2000-02 2003-05 2006-08 2009-11

1.32 1.39 0.82 0.52

Parkes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Park

es D

istr

ict

Ho

sp

ital

Pneum

onia

Total pneumonia hospitalisations

Pneumonia patients

Presenting patients (index cases)1

Patients not transferred to another hospital

Patients transferred out to another hospital

This hospital NSW

Age profile, index cases 2

Parkes District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Parkes District Hospital NSW

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 1 of 4

125

114

101

13

50,644

44,059

39,655

4,404

18-51 52-67 68-77 78-85 86+

18 25 21 20 16

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

11Dysrhythmia

10Chronic obstructive pulmonary disease

4Renal failure

7Congestive heart failure

7Hypotension

5Malignancy (cancer)

2Dementia

2Cerebrovascular disease

1Liver disease

1Shock

0Alzheimer's disease

1Parkinson's disease

17

16

16

15

12

9

7

3

2

2

1

1

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Parkes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Park

es D

istr

ict

Ho

sp

ital

Pneum

onia

Percentages: index cases who died within 30 days of hospitalisation

Of all deaths:

percentage in this hospital

percentage in another hospital following transfer

percentage after discharge

percentage on day of admission

percentage within 7 days

This hospital

percentage

NSW

percentage

Survival of index cases following hospitalisation for pneumonia5

Adjusted for average age and Charlson comorbidity score

Parkes District Hospital

% S

urv

ival

Days since admission

NSW

% S

urv

ival

Days since admission

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 2 of 4

Mortality (all causes) among 114 pneumonia index cases4

6%

71%

14%

14%

0%

71%

(66%)

(3%)

(31%)

(6%)

(54%)

0

75

80

85

90

95

100

0 10 20 30

0

75

80

85

90

95

100

0 10 20 30

Parkes District Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Park

es D

istr

ict

Ho

sp

ital

Pneum

onia

Parkes District Hospital NSW hospitals 90% limits 95% limits

Hospital-specific RSMRs report the ratio of actual or ‘observed’ number of deaths to the ‘expected’ number

of deaths. A hierarchical logistic regression model draws on the NSW patient population’s characteristics and

outcomes to estimate the expected number of deaths for each hospital, given the characteristics of its patients.

Actual and expected deaths, compared to local peers

This hospital,

actual deaths

Peer group hospitals,

actual deaths

Expected deaths

(based on model)

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 3 of 4

Cessnock District Hospital

Mudgee District Hospital

Inverell District Hospital

Cowra District Hospital

Singleton District Hospital

Young Health Service

Muswellbrook District Hospital

Tumut Health Service

Gunnedah District Hospital

RSMR = 0.84Parkes District Hospital

Moree District Hospital

Forbes District Hospital

Kurri Kurri District Hospital

Deniliquin Health Service

0 10 20 30 40 50

Deaths

0

1

2

3

Ris

k s

tand

ard

ised

mo

rtalit

y r

atio

(R

SM

R)

0 50 100 150 200

Expected number of deaths within 30 days

Parkes District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Park

es D

istr

ict

Ho

sp

ital

Pneum

onia

Illustrating the effect of standardisation, July 2009 - June 2012

In order to make fair comparisons, a number of risk adjustments are made to mortality data. These take into account

patient level factors that influence the likelihood of dying. The table below illustrates the cumulative effect of the statistical

adjustments. For each ratio, hospitals are compared to the average NSW result, given their case mix.

Lower mortality No difference Higher mortality

Time series risk-standardised mortality ratio, July 2000 - June 20126

Lower mortality No difference Higher mortality

Year (financial years)

Risk-standardised mortality ratio

(1) Index cases refer to patients discharged between July 2009 and June 2012 who were initially admitted to this hospital

(regardless of whether they were subsequently transferred) in their last period of care.

(2) Age at admission date.

(3) Only those conditions that were shown to have a significant impact on mortality (P<0.05) are shown. Many are a result of

end-organ damage resulting from comorbidities, such as diabetes. A broader set of comorbidities was screened for potential

impacts on mortality. Comorbidities as recorded on patient record, with one year look back. STEMI refers to ST-elevation

myocardial infarction.

(4) Deaths are from any cause, in or out of hospital within 30 days of the index hospitalisation admission date.

(5) Kaplan-Meier survival curve for 30-day following admission for haemorrhagic stroke, adjusted for average age and average

Charlson comorbidity score. Survival curves depict the proportion of patients who were alive, day 0 – day 30.

(6) To make RSMRs comparable over time, a reference population is required. Time series RSMRs for each hospital are based

on the reference years (July 2009 - June 2012). Control limits are based on the NSW average within each period.

( ) Data for hospitals with an expected mortality of <1 are suppressed.

( ) Between 90% and 95% upper control limits; ( ) Outside 95% upper control limits.

( ) Between 90% and 95% lower control limits; ( ) Outside 95% lower control limits.

Details of analyses and risk adjustment are available in Spotlight on Measurement: risk-standardised mortality ratios

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

THE INSIGHTS SERIES: Performance Profiles - 30-day mortality December 2013 www.bhi.nsw.gov.au Page 4 of 4

Unadjusted ratio Age and sex standardised ratio Risk-standardised mortality ratio

0.57 0.63 0.84

2000-02 2003-05 2006-08 2009-12

1.05 1.13 1.44 0.84