Introducing HSMR+: Professor Jones’ review validates HSMR+ as the new benchmark in mortality data analysis

An independent review by Simon Jones – an expert in health services research – was essential in helping to inform these enhancements. Professor Jones’ review advised that removing palliative care leads to a fairer model. His evaluation focused on the model’s changes to risk adjustment, confirming their effectiveness in providing a more precise analysis of hospital performance. By critically assessing the changes, the independent review provided an objective endorsement, reinforcing the model’s credibility.

This independent scrutiny was crucial for fostering trust among healthcare providers, regulators, and stakeholders, ensuring the HSMR+ model is a robust tool for improving patient care and hospital accountability.

The independent review

Professor Jones, a renowned expert in population health at New York University’s Grossman School of Medicine, oversaw the review of the existing HSMR model. It served as a critical component in validating the changes made to the existing HSMR model. His insights ensured that HSMR+ is both scientifically robust and relevant for today’s healthcare landscape.

The review, conducted as an independent consultancy, seeks to evaluate these concerns comprehensively and is not endorsed by NYU Langone Health or NYU Grossman School of Medicine. The aim is to ensure that the HSMR is derived through a scientifically robust process that maintains its validity and utility for its users.

The review’s focus looked at palliative care’s inclusion as a risk factor in the HSMR. Historically, the HSMR included palliative care in its risk adjustment to account for the higher mortality risks associated with end-of-life care. However, stakeholders across the healthcare sector raised concerns about the fairness of this approach. Inconsistent coding practices between hospitals and the potential for bias prompted a re-evaluation of this aspect of the model.

Background on palliative care

Palliative care serves as an indicator of death, and, if unbiased, would be a valuable factor to include in mortality risk adjustment models. The inclusion could help ensure the appropriate allocation of resources and provide a more accurate assessment of hospital performance.

However, stakeholders involved with the HSMR have raised significant concerns regarding the inclusion of palliative care as a risk factor in the model. These concerns stem from inconsistencies in how palliative care is recorded and coded across different healthcare providers. Such variability can lead to questions about the fairness of the current risk adjustment approach, as it may introduce biases that distort the HSMR’s accuracy.

Methodology

To determine whether palliative care should continue to be included in the HSMR risk adjustment model, the review employed a multifaceted approach:

• Stakeholder engagement: Direct consultations with key stakeholders involved in the HSMR, including trust leads and academics, to gather insights on their experiences and perceptions regarding the palliative care flag in the HSMR model.
• Impact analysis: A detailed assessment of the potential effects of removing the palliative care flag from the HSMR model, including any changes in model performance and accuracy.
• Comparative analysis: A review of how other mortality indicators and international healthcare systems approach the inclusion of palliative care in their risk adjustment models.

These approaches provided a comprehensive understanding of the implications of including or excluding palliative care from the HSMR model and informed the final recommendations.

Professor Jones’ review confirmed palliative care’s inclusion could indeed introduce biases into the HSMR, leading to skewed data that might not accurately reflect hospital performance. As a result, Telstra Health UK decided to remove palliative care from the HSMR+ risk adjustment model.

This change, while significant, was carefully balanced to ensure palliative care’s importance and visibility were not diminished. Instead, Telstra Health UK has provided specialised tools to interrogate the HSMR+, that allow hospitals to continue analysing palliative care data, ensuring that this critical area remains in focus.

In addition to addressing the concerns around palliative care, HSMR+ incorporates several key updates to improve the model’s overall accuracy and applicability. Among these is the transition from the Carstairs deprivation metric to the more comprehensive Index of Multiple Deprivation, providing a better reflection of socioeconomic factors in mortality rates.

The introduction of the Elixhauser-Bottle Comorbidity Index further enhances the model by offering a more detailed assessment of patient risk profiles, accounting for a broader range of comorbidities, and the inclusion of the Dr Foster global frailty score accounts for more complex and elderly patients.

Stay ahead with HSMR+

HSMR+ is more than just an update – it represents a new era in healthcare analytics. By addressing the major concerns raised by stakeholders, Telstra Health UK has developed a model that is not only more accurate but more relevant to today’s healthcare environment. Professor Jones’ independent review underscores the model’s potential to improve patient care and hospital accountability, making HSMR+ an invaluable tool for hospitals and regulatory bodies.

With HSMR+, Telstra Health UK reaffirms its position as a leader in healthcare analytics, providing hospitals with the tools they need to achieve excellence in patient care and performance. The new model is set to become the new gold standard in mortality data analysis, guiding healthcare providers toward a future of continuous improvement and better patient outcomes.

What the experts say

“The introduction of HSMR+ marks a great step forward in mortality data analysis with our independent review addressing critical concerns around fairness in risk adjustment. By refining the approach to key factors such as palliative care, HSMR+ offers a more precise and equitable tool for assessing hospital performance, ultimately contributing to improved patient care and greater accountability within the healthcare system.” - Simon Jones, population health expert, NYU Grossman School of Medicine