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:

Northern NSW Local Health District

Ballina District Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Balli

na 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) 101 patients

Ischaemic stroke < 50 patients

Haemorrhagic stroke < 50 patients

Pneumonia 143 patients

Hip fracture < 50 patients

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

Ballina District Hospital profile July 2009 - June 2012

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

Balli

na 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

Ballina District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Ballina District Hospital NSW

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

165

101

16

85

37,794

29,223

18,303

10,920

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

16 16 20 21 28

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

32Hypertension

33STEMI

10Dysrhythmia

10Congestive heart failure

7Renal failure

3Hypotension

2Dementia

4Cerebrovascular disease

4Malignancy (cancer)

1Shock

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

Ballina District Hospital profile July 2009 - June 2012

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

Balli

na 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

Ballina 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 Acute Myocardial Infarction (AMI) index cases4

6%

17%

33%

50%

17%

50%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Ballina 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

Balli

na D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Ballina 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

Kempsey Hospital

Maclean District Hospital

Lithgow Health Service

Moruya District Hospital

Milton and Ulladulla Hospital

Blue Mountains District Anzac Memorial Hospital

RSMR = 0.87Ballina District Hospital

Casino and District Memorial Hospital

Bateman's Bay 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

Ballina District Hospital profile July 2009 - June 2012

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

Balli

na 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

0.79 0.71 0.87

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

0.50 0.93 0.98 0.87

Ballina District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Balli

na 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

Ballina District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Ballina District Hospital NSW

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

160

143

105

38

50,644

44,059

39,655

4,404

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

17 14 26 23 20

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

14Dysrhythmia

24Chronic obstructive pulmonary disease

8Renal failure

13Congestive heart failure

5Hypotension

9Malignancy (cancer)

3Dementia

3Cerebrovascular disease

0Liver disease

0Shock

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

Ballina District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Balli

na 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

Ballina 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

12%

71%

0%

29%

0%

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

Ballina District Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Balli

na D

istr

ict

Ho

sp

ital

Pneum

onia

Ballina 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

Blue Mountains District Anzac Memorial Hospital

Bateman's Bay District Hospital

Kempsey Hospital

Queanbeyan Health Service

Maclean District Hospital

RSMR = 1.24Ballina District Hospital

Moruya District Hospital

Macksville District Hospital

Lithgow Health Service

Casino and District Memorial Hospital

Milton and Ulladulla Hospital

Cooma 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

Ballina District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Balli

na 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

1.10 1.07 1.24

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

2.21 1.52 1.34 1.24

Casino and District Memorial Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Casin

o a

nd

Dis

tric

t M

em

orial 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) 58 patients

Ischaemic stroke < 50 patients

Haemorrhagic stroke < 50 patients

Pneumonia 156 patients

Hip fracture < 50 patients

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

Casino and District Memorial Hospital profile July 2009 - June 2012

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

Casin

o a

nd

Dis

tric

t M

em

orial 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

Casino and District Memorial Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Casino and District Memorial Hospital NSW

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

83

58

12

46

37,794

29,223

18,303

10,920

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

22 17 10 22 28

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

36Hypertension

50STEMI

21Dysrhythmia

16Congestive heart failure

9Renal failure

9Hypotension

10Dementia

9Cerebrovascular disease

3Malignancy (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

Casino and District Memorial Hospital profile July 2009 - June 2012

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

Casin

o a

nd

Dis

tric

t M

em

orial 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

Casino and District Memorial 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 58 Acute Myocardial Infarction (AMI) index cases4

9%

20%

20%

60%

0%

80%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Casino and District Memorial Hospital profile July 2009 - June 2012

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

of expected deaths, NSW public hospitals

Casin

o a

nd

Dis

tric

t M

em

orial H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Casino and District Memorial 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

Kempsey Hospital

Maclean District Hospital

Lithgow Health Service

Moruya District Hospital

Milton and Ulladulla Hospital

Blue Mountains District Anzac Memorial Hospital

Ballina District Hospital

RSMR = 0.76Casino and District Memorial Hospital

Bateman's Bay 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

Casino and District Memorial Hospital profile July 2009 - June 2012

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

Casin

o a

nd

Dis

tric

t M

em

orial 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

1.14 1.03 0.76

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

0.93 0.00 0.38 0.76

Casino and District Memorial Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Casin

o a

nd

Dis

tric

t M

em

orial 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

Casino and District Memorial Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Casino and District Memorial Hospital NSW

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

169

156

142

14

50,644

44,059

39,655

4,404

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

22 19 22 15 21

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

12Dysrhythmia

24Chronic obstructive pulmonary disease

6Renal failure

10Congestive heart failure

8Hypotension

8Malignancy (cancer)

10Dementia

4Cerebrovascular disease

3Liver disease

1Shock

0Alzheimer's disease

3Parkinson'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

Casino and District Memorial Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Casin

o a

nd

Dis

tric

t M

em

orial 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

Casino and District Memorial 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 156 pneumonia index cases4

9%

79%

7%

14%

0%

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

Casino and District Memorial Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Casin

o a

nd

Dis

tric

t M

em

orial H

osp

ital

Pneum

onia

Casino and District Memorial 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

Blue Mountains District Anzac Memorial Hospital

Bateman's Bay District Hospital

Kempsey Hospital

Queanbeyan Health Service

Maclean District Hospital

Ballina District Hospital

Moruya District Hospital

Macksville District Hospital

Lithgow Health Service

RSMR = 0.87Casino and District Memorial Hospital

Milton and Ulladulla Hospital

Cooma 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

Casino and District Memorial Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Casin

o a

nd

Dis

tric

t M

em

orial 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

0.83 0.87 0.87

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

0.78 1.36 0.95 0.87

Grafton Base Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Gra

fto

n 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) 215 patients

Ischaemic stroke 54 patients

Haemorrhagic stroke < 50 patients

Pneumonia 291 patients

Hip fracture < 50 patients

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

Grafton Base Hospital profile July 2009 - June 2012

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

Gra

fto

n 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

Grafton Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Grafton Base Hospital NSW

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

268

215

91

124

37,794

29,223

18,303

10,920

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

18 20 17 20 26

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

46Hypertension

28STEMI

24Dysrhythmia

19Congestive heart failure

5Renal failure

8Hypotension

6Dementia

5Cerebrovascular disease

3Malignancy (cancer)

1Shock

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

Grafton Base Hospital profile July 2009 - June 2012

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

Gra

fto

n 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

Grafton 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 215 Acute Myocardial Infarction (AMI) index cases4

7%

47%

0%

53%

7%

53%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Grafton 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

Gra

fto

n B

ase H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Grafton 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

RSMR = 0.85Grafton Base Hospital

Bathurst 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

Grafton Base Hospital profile July 2009 - June 2012

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

Gra

fto

n 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

0.92 0.84 0.86

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

0.42 0.80 0.83 0.86

Grafton Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Gra

fto

n 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

Grafton Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Grafton Base Hospital NSW

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

62

54

51

3

15,299

14,205

11,757

2,448

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

17 22 15 26 20

20 18 20 21 21

0 10 20 30 40 50 60 70 80 90 100

43Female

6Renal failure

7Congestive 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

Grafton Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Gra

fto

n 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

Grafton 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 54 ischaemic stroke index cases4

9%

40%

0%

60%

0%

20%

(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

Grafton Base Hospital profile July 2009 - June 2012

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

of expected deaths, NSW public hospitals

Gra

fto

n B

ase H

osp

ital

Ischaem

ic s

tro

ke

Grafton 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

Bathurst Base Hospital

Hawkesbury District Health Service

Kempsey Hospital

Armidale and New England Hospital

RSMR = 0.72Grafton 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

Grafton Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Gra

fto

n 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

0.69 0.71 0.72

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

1.27 1.62 1.46 0.72

Grafton Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Gra

fto

n 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

Grafton Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Grafton Base Hospital NSW

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

334

291

282

9

50,644

44,059

39,655

4,404

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

22 24 18 22 13

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

18Dysrhythmia

28Chronic obstructive pulmonary disease

10Renal failure

13Congestive heart failure

6Hypotension

7Malignancy (cancer)

5Dementia

4Cerebrovascular disease

2Liver 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

Grafton Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Gra

fto

n 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

Grafton 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 291 pneumonia index cases4

10%

48%

3%

48%

7%

55%

(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

Grafton Base Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Gra

fto

n B

ase H

osp

ital

Pneum

onia

Grafton 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

Bathurst Base Hospital

RSMR = 1.09Grafton 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

Grafton Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Gra

fto

n 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

0.93 1.10 1.09

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

1.25 1.29 1.02 1.09

Lismore Base Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Lis

mo

re 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) 553 patients

Ischaemic stroke 168 patients

Haemorrhagic stroke 97 patients

Pneumonia 382 patients

Hip fracture 376 patients

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

Lismore Base Hospital profile July 2009 - June 2012

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

Lis

mo

re 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

Lismore Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Lismore Base Hospital NSW

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

774

553

207

346

37,794

29,223

18,303

10,920

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

17 19 18 23 22

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

51Hypertension

25STEMI

23Dysrhythmia

17Congestive heart failure

15Renal failure

6Hypotension

3Dementia

1Cerebrovascular disease

3Malignancy (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

Lismore Base Hospital profile July 2009 - June 2012

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

Lis

mo

re 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

Lismore 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 553 Acute Myocardial Infarction (AMI) index cases4

8%

55%

7%

39%

16%

55%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Lismore 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

Lis

mo

re B

ase H

osp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Lismore 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 = 1.11Lismore 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

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

Lismore Base Hospital profile July 2009 - June 2012

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

Lis

mo

re 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

1.05 1.01 1.11

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

1.05 1.17 1.01 1.11

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Lis

mo

re 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

Lismore Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Lismore Base Hospital NSW

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

183

168

118

50

15,299

14,205

11,757

2,448

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

24 17 18 26 15

20 18 20 21 21

0 10 20 30 40 50 60 70 80 90 100

43Female

8Renal 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

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Lis

mo

re 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

Lismore 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 168 ischaemic stroke index cases4

17%

79%

0%

21%

7%

72%

(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

Lismore Base Hospital profile July 2009 - June 2012

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

of expected deaths, NSW public hospitals

Lis

mo

re B

ase H

osp

ital

Ischaem

ic s

tro

ke

Lismore 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

Dubbo Base Hospital

Coffs Harbour Base Hospital

Shoalhaven and District Memorial Hospital

Port Macquarie Base Hospital

Tamworth Base Hospital

RSMR = 1.47Lismore 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

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

Lis

mo

re 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

1.29 1.42 1.47

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

1.49 1.63 1.16 1.47

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

Lis

mo

re B

ase 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

Lismore Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Lismore Base Hospital NSW

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

108

97

63

34

6,573

5,681

4,148

1,533

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

16 23 18 29 14

20 21 21 19 19

0 10 20 30 40 50 60 70 80 90 100

34Female

6History of haemorrhagic stroke

4Malignancy (cancer)

5Congestive heart failure

46

8

6

6

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

Lis

mo

re B

ase 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

Lismore 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 97 haemorrhagic stroke index cases4

41%

78%

0%

23%

28%

70%

(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

Lismore Base Hospital profile July 2009 - June 2012

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

of expected deaths, NSW public hospitals

Lis

mo

re B

ase H

osp

ital

Haem

orr

hag

ic s

tro

ke

Lismore 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

RSMR = 1.26Lismore 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

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

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

Lis

mo

re B

ase 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

1.22 1.24 1.26

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

1.26 1.54 1.38 1.26

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Lis

mo

re 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

Lismore Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Lismore Base Hospital NSW

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

461

382

328

54

50,644

44,059

39,655

4,404

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

23 18 23 23 13

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

23Dysrhythmia

14Chronic obstructive pulmonary disease

21Renal failure

12Congestive heart failure

10Hypotension

12Malignancy (cancer)

5Dementia

3Cerebrovascular disease

2Liver disease

1Shock

1Alzheimer'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

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Lis

mo

re 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

Lismore 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 382 pneumonia index cases4

11%

72%

7%

21%

12%

56%

(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

Lismore Base Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Lis

mo

re B

ase H

osp

ital

Pneum

onia

Lismore 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

Dubbo Base Hospital

Orange Base Hospital

Maitland Hospital

RSMR = 1.08Lismore 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

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Lis

mo

re 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

1.05 1.18 1.08

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

1.46 1.43 0.94 1.08

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

Lis

mo

re B

ase 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

Lismore Base Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Lismore Base Hospital NSW

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

387

376

171

205

16,355

15,836

10,739

5,097

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

18 23 20 19 20

19 23 20 15 22

0 10 20 30 40 50 60 70 80 90 100

27Male

23Dementia

13Dysrhythmia

7Renal failure

9Acute respiratory tract infection

5Congestive heart failure

9Ischemic 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

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

Lis

mo

re B

ase 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

Lismore 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 376 hip fracture surgery index cases4

7%

41%

0%

59%

33%

(50%)

(0%)

(50%)

(27%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Lismore Base Hospital profile July 2009 - June 2012

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

of expected deaths, NSW public hospitals

Lis

mo

re B

ase H

osp

ital

Hip

fra

ctu

re s

urg

ery

Lismore 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

RSMR = 1.23Lismore 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

Lismore Base Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

Lis

mo

re B

ase 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

1.05 1.04 1.23

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

1.05 1.66 1.00 1.23

Maclean District Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Macle

an 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) 100 patients

Ischaemic stroke < 50 patients

Haemorrhagic stroke < 50 patients

Pneumonia 130 patients

Hip fracture < 50 patients

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

Maclean District Hospital profile July 2009 - June 2012

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

Macle

an 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

Maclean District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Maclean District Hospital NSW

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

120

100

30

70

37,794

29,223

18,303

10,920

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

5 19 26 24 26

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

50Hypertension

26STEMI

28Dysrhythmia

17Congestive heart failure

11Renal failure

12Hypotension

3Dementia

5Cerebrovascular 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

Maclean District Hospital profile July 2009 - June 2012

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

Macle

an 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

Maclean 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 100 Acute Myocardial Infarction (AMI) index cases4

10%

50%

0%

50%

10%

80%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Maclean 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

Macle

an D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Maclean 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

Kempsey Hospital

RSMR = 1.21Maclean District Hospital

Lithgow Health Service

Moruya District Hospital

Milton and Ulladulla Hospital

Blue Mountains District Anzac Memorial Hospital

Ballina District Hospital

Casino and District Memorial Hospital

Bateman's Bay 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

Maclean District Hospital profile July 2009 - June 2012

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

Macle

an 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

1.32 1.14 1.21

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

1.14 1.75 0.95 1.21

Maclean District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Macle

an 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

Maclean District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Maclean District Hospital NSW

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

142

130

101

29

50,644

44,059

39,655

4,404

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

13 25 21 28 12

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

15Dysrhythmia

23Chronic obstructive pulmonary disease

12Renal failure

17Congestive heart failure

8Hypotension

11Malignancy (cancer)

8Dementia

4Cerebrovascular 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

Maclean District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Macle

an 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

Maclean 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 130 pneumonia index cases4

15%

25%

10%

65%

10%

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

Maclean District Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Macle

an D

istr

ict

Ho

sp

ital

Pneum

onia

Maclean 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

Blue Mountains District Anzac Memorial Hospital

Bateman's Bay District Hospital

Kempsey Hospital

Queanbeyan Health Service

RSMR = 1.33Maclean District Hospital

Ballina District Hospital

Moruya District Hospital

Macksville District Hospital

Lithgow Health Service

Casino and District Memorial Hospital

Milton and Ulladulla Hospital

Cooma 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

Maclean District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Macle

an 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

1.43 1.48 1.33

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

1.42 1.35 0.92 1.33

Murwillumbah District Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

Murw

illum

bah 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) 65 patients

Ischaemic stroke < 50 patients

Haemorrhagic stroke < 50 patients

Pneumonia 217 patients

Hip fracture < 50 patients

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

Murwillumbah District Hospital profile July 2009 - June 2012

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

Murw

illum

bah 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

Murwillumbah District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Murwillumbah District Hospital NSW

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

76

65

12

53

37,794

29,223

18,303

10,920

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

25 23 15 17 20

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

45Hypertension

48STEMI

15Dysrhythmia

9Congestive heart failure

8Renal failure

12Hypotension

5Dementia

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

Murwillumbah District Hospital profile July 2009 - June 2012

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

Murw

illum

bah 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

Murwillumbah 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 65 Acute Myocardial Infarction (AMI) index cases4

8%

20%

40%

40%

20%

80%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

Murwillumbah 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

Murw

illum

bah D

istr

ict

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

Murwillumbah 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

Shellharbour Hospital

Mount Druitt Hospital

Belmont Hospital

Ryde Hospital

Bowral and District Hospital

Grafton Base Hospital

Bathurst Base Hospital

Goulburn Base Hospital

Broken Hill Base Hospital

Griffith Base Hospital

Hawkesbury District Health Service

Bega District Hospital

RSMR = 1.14Murwillumbah 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

Murwillumbah District Hospital profile July 2009 - June 2012

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

Murw

illum

bah 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

1.02 1.08 1.14

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

0.45 0.78 0.90 1.14

Murwillumbah District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Murw

illum

bah 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

Murwillumbah District Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

Murwillumbah District Hospital NSW

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

245

217

193

24

50,644

44,059

39,655

4,404

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

24 24 13 20 19

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

15Dysrhythmia

15Chronic obstructive pulmonary disease

5Renal failure

16Congestive heart failure

10Hypotension

4Malignancy (cancer)

7Dementia

2Cerebrovascular disease

0Liver disease

1Shock

2Alzheimer'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

Murwillumbah District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Murw

illum

bah 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

Murwillumbah 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 217 pneumonia index cases4

10%

68%

9%

23%

0%

68%

(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

Murwillumbah District Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

Murw

illum

bah D

istr

ict

Ho

sp

ital

Pneum

onia

Murwillumbah 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

Ryde Hospital

Hawkesbury District Health Service

Bowral and District Hospital

Belmont Hospital

Goulburn Base Hospital

Mount Druitt Hospital

Shellharbour Hospital

Bathurst Base Hospital

Grafton Base Hospital

Griffith Base Hospital

RSMR = 1.13Murwillumbah 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

Murwillumbah District Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

Murw

illum

bah 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

0.94 1.04 1.13

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

0.84 1.14 0.78 1.13

The Tweed Hospital summary dashboard, July 2009 - June 2012

30-day mortality following hospitalisation for five conditions

The T

weed

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) 584 patients

Ischaemic stroke 173 patients

Haemorrhagic stroke 91 patients

Pneumonia 714 patients

Hip fracture 353 patients

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

The Tweed Hospital profile July 2009 - June 2012

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

The T

weed

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

The Tweed Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

The Tweed Hospital NSW

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

711

584

399

185

37,794

29,223

18,303

10,920

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

14 21 19 22 24

19 21 20 19 21

0 10 20 30 40 50 60 70 80 90 100

56Hypertension

30STEMI

21Dysrhythmia

18Congestive heart failure

9Renal failure

8Hypotension

4Dementia

2Cerebrovascular disease

3Malignancy (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

The Tweed Hospital profile July 2009 - June 2012

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

The T

weed

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

The Tweed 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 584 Acute Myocardial Infarction (AMI) index cases4

7%

72%

0%

28%

12%

74%

(64%)

(6%)

(31%)

(14%)

(61%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

The Tweed Hospital profile July 2009 - June 2012

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

of expected deaths, NSW public hospitals

The T

weed

Ho

sp

ital

Acute

Myo

card

ial In

farc

tio

n (A

MI)

The Tweed 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

RSMR = 1.02The 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

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

The Tweed Hospital profile July 2009 - June 2012

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

The T

weed

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

0.98 0.93 1.02

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

0.72 0.81 0.74 1.02

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

The T

weed

Ho

sp

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

The Tweed Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

The Tweed Hospital NSW

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

184

173

117

56

15,299

14,205

11,757

2,448

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

19 21 24 20 17

20 18 20 21 21

0 10 20 30 40 50 60 70 80 90 100

42Female

3Renal failure

6Congestive heart failure

5Malignancy (cancer)

47

10

7

4

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

The T

weed

Ho

sp

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

The Tweed 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 173 ischaemic stroke index cases4

16%

67%

0%

33%

7%

56%

(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

The Tweed Hospital profile July 2009 - June 2012

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

of expected deaths, NSW public hospitals

The T

weed

Ho

sp

ital

Ischaem

ic s

tro

ke

The Tweed 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

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

RSMR = 1.32The 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

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for ischaemic stroke

The T

weed

Ho

sp

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

1.17 1.26 1.32

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

2.26 1.41 1.23 1.32

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

The T

weed

Ho

sp

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

The Tweed Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

The Tweed Hospital NSW

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

98

91

49

42

6,573

5,681

4,148

1,533

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

16 18 23 25 18

20 21 21 19 19

0 10 20 30 40 50 60 70 80 90 100

42Female

8History of haemorrhagic stroke

3Malignancy (cancer)

2Congestive heart failure

46

8

6

6

0 10 20 30 40 50 60 70 80 90 100

% of index cases with factor recorded

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

The T

weed

Ho

sp

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

The Tweed 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 91 haemorrhagic stroke index cases4

33%

80%

0%

20%

20%

77%

(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

The Tweed Hospital profile July 2009 - June 2012

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

of expected deaths, NSW public hospitals

The T

weed

Ho

sp

ital

Haem

orr

hag

ic s

tro

ke

The Tweed 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

RSMR = 0.98The Tweed Hospital

Orange 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

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for haemorrhagic stroke

The T

weed

Ho

sp

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

0.97 0.96 0.99

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

0.96 0.73 1.21 0.99

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

The T

weed

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

The Tweed Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

The Tweed Hospital NSW

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

810

714

669

45

50,644

44,059

39,655

4,404

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

21 19 22 22 17

20 20 19 22 19

0 10 20 30 40 50 60 70 80 90 100

14Dysrhythmia

9Chronic obstructive pulmonary disease

10Renal failure

10Congestive heart failure

7Hypotension

8Malignancy (cancer)

7Dementia

2Cerebrovascular disease

2Liver disease

2Shock

1Alzheimer'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

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

The T

weed

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

The Tweed 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 714 pneumonia index cases4

8%

57%

2%

41%

10%

43%

(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

The Tweed Hospital profile July 2009 - June 2012

Hospital-level pneumonia risk-standardised mortality ratio by number

of expected deaths, NSW public hospitals

The T

weed

Ho

sp

ital

Pneum

onia

The Tweed 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

RSMR = 0.86The Tweed Hospital

Dubbo 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

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for pneumonia

The T

weed

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

0.75 0.80 0.86

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

1.17 1.01 0.84 0.86

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

The T

weed

Ho

sp

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

The Tweed Hospital

NSW

% of index cases

Significant patient factors and comorbidities, index cases3

The Tweed Hospital NSW

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

361

353

202

151

16,355

15,836

10,739

5,097

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

24 28 18 11 19

19 23 20 15 22

0 10 20 30 40 50 60 70 80 90 100

29Male

28Dementia

18Dysrhythmia

9Renal failure

9Acute respiratory tract infection

7Congestive heart failure

9Ischemic heart disease

3Malignancy (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

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

The T

weed

Ho

sp

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

The Tweed 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 353 hip fracture surgery index cases4

6%

57%

0%

43%

38%

(50%)

(0%)

(50%)

(27%)

0

90

95

100

0 10 20 30

0

90

95

100

0 10 20 30

The Tweed Hospital profile July 2009 - June 2012

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

of expected deaths, NSW public hospitals

The T

weed

Ho

sp

ital

Hip

fra

ctu

re s

urg

ery

The Tweed 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

Dubbo Base Hospital

Manning Base Hospital

Wagga Wagga Base Hospital

RSMR = 0.95The 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

The Tweed Hospital profile July 2009 - June 2012

30-day mortality following hospitalisation for hip fracture surgery

The T

weed

Ho

sp

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

0.87 0.94 0.95

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

1.34 0.91 0.53 0.95