Hospital deaths - the missing link: measuring outcomes in hospital activity data

Although fairly detailed information on NHS inputs can be identified, little or no corresponding data on outcomes are available to those concerned with the management and delivery of health care. The absence of any significant outcome data is a longstanding problem which has so far been largely by-passed. Non-financial systems in hospitals are directed mainly at the task of logging and tracking patients. They are designed to generate the routine administrative data which is demanded of local Health Authorities, and to enable the construction of various performance indicators. Despite this apparent restriction, it has proved possible to extract information on one health outcome – death. This Discussion Paper describes the analysis of mortality data embedded in the 1985 HIPE sample. Death rates by consultant specialty and diagnostic category are presented for 14 Regional Health Authorities. Standardised mortality rates are also listed for 192 local Health Authorities. Crude rates vary from 2.5 to 14.3 deaths per 100 admissions with a national average of 5.5. There is wide variation too in standardised mortality rates – ranging from 50% below the national average to 50% above. Proper monitoring and control of hospital services requires the measurement of outcomes. Without such measures, decision makers will continue to reply on imperfect indicators of activity and performance. The potential already exists to redress this information deficit. This paper may help to encourage such a process.