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How do time trends in inhospital mortality compare? A retrospective study of England and Scotland over 17 years using administrative data
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  • Published on:
    Key differences between England and Scotland Mortality
    • John L Harden, National Clinical Lead for Quality and Safety Scottish Government
    • Other Contributors:
      • Roger Black, Head of Service, National Information and Intelligence
      • Robyn Munro, Princial Analyst, Quality Indicators Team, Information Services Division

    We write to highlight some questions which arise from the recently published paper entitled “How do time trends in in-hospital mortality compare? A retrospective study of England and Scotland over 17 years using administrative data” by María José Aragón and Martin Chalkley in BMJ Open 2018;8:e017195.

    Seeking to understand variations in hospital associated mortality is a worthy endeavour and we welcome the authors’ contribution. They are clearly aware of the importance of case mix adjustment when studying comparative mortality, but may not have been able to take account of differences in the way hospital activity data are collected in the two health care systems.

    The recording of comorbidity in English HES data may be more complete than in our SMR01s. The reason for this is the financial incentive to fully cover background risk in England. Whilst Scottish data are getting better, the practical consequence of this for the York study is that they will have underestimated the risk of death for our patients, thereby increasing the relative mortality parameters used to calculate the risk adjusted trends used in the plots shown.

    The paper suggests “If for example alternative settings to which terminally ill patients can be discharged have expanded faster in England than in Scotland, we would observe the kind of differential trend of in-hospital mortality established by our analysis. The second, more worrying possibility is that there remains some element o...

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    Conflict of Interest:
    None declared.