HOSPITAL death rates figures for Wales are misleading and do not provide an accurate measure of quality of care, according to an independent report.
An investigation into the Risk Adjusted Mortality Index (RAMI) by Stephen Palmer, professor of epidemiology at Cardiff University, concludes the measure is not useful as a ‘smoke alarm’ to highlight potential failings of care at a hospital.
He believes case note reviews of all hospital deaths provide a much clearer picture of quality of care and a more accurate identification of problems, and he said Wales is “ahead of the game” in the UK in developing such an approach.
He recommends this be allied to participation in national clinical audits, or reviews of outcomes for patients, by hospital specialities, for UK-wide comparison.
NHS England medical director Sir Bruce Keogh raised his concerns about perceived high rates in some Welsh health boards last March, after he was passed figures by Cynon Valley MP Ann Clwyd, whose calls for an investigation provoked the wrath of First Minister Carwyn Jones.
The situation became confused shortly afterwards when four sets of Welsh hospital death rates data, with three different criteria were published. Some hospitals seemingly performed well by one RAMI measure, but not by another.
A new system of measuring quality of care is being developed, based on a range of criteria.
Professor Palmer believes RAMI to be so affected by non-healthcare issues, it is impossible to judge a hospital’s performance based on a single score.
“I see no advantage in publishing overall RAMI and I see potential harm in diverting attention from more meaningful measures of outcomes of healthcare,” he said.
“In place of RAMI, the public should take assurance about the safety and quality of hospital care from the fact that Wales is already undertaking medical record reviews of all deaths in hospital.”
He is however, recommending a standardised review programme be introduced quickly, to eliminate variations in measurements.
RAMI figures began to be published following the Mid-Staffs NHS Trust scandal, and Wales’ deputy chief medical officer Dr Chris Jones said it was done “because we felt we had to, and to be transparent too”.