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Every death counts: investigating the role of “avoidable” and “unavoidable” deaths to compare hospital quality. The case of circulatory diseases in England.

Bojke, Chris and Castelli, Adriana and Nizalova, Olena (2018) Every death counts: investigating the role of “avoidable” and “unavoidable” deaths to compare hospital quality. The case of circulatory diseases in England. Working paper. Centre for Health Economics, University of York (Unpublished) (Access to this publication is currently restricted. You may be able to access a copy if URLs are provided) (KAR id:77851)

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Language: English

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Abstract

Since the 19th century, standardised mortality rates have frequently been used as an indicator of quality for the purposes of rating hospital quality. Despite being a measurable and clearly meaningful metric, there has been a sustained opposition to this practice. Lilford and Pronovost, for example, describes them as ‘a bad idea that won’t go away’, arguing that there is simply too much noise to avoid spurious conclusions. In response to these objections, we explore the economic and econometric issues of using avoidable deaths as signals of hospital quality. We illustrate this with an econometric estimation of mortality of inpatients with circulatory diseases treated in hospitals in England. Using data for 2003/04 to 2008/09 period from the Hospital Episode Statistics (HES), we obtain Empirical Bayesian Estimates of hospital specific effects on the probability of in-hospital deaths by exploiting the panel data nature of the HES dataset and using a random effects specification and adjusting for case-mix, improvements over time and other ‘noise’. We find statistically significant differences between hospitals. It is not clear however that this is a valid reason for ignoring exploration of variations in death rates in conditions that are considered ‘non-amenable’.

Item Type: Monograph (Working paper)
Uncontrolled keywords: avoidable mortality, mortality, hospital quality, empirical Bayesian estimates, circulatory diseases
Subjects: H Social Sciences
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Olena Nizalova
Date Deposited: 25 Oct 2019 19:01 UTC
Last Modified: 28 Oct 2019 10:01 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/77851 (The current URI for this page, for reference purposes)
Nizalova, Olena: https://orcid.org/0000-0002-1704-2632
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