This study will be available on bmj.com on Monday 29 March 2004.
League tables of hospital death rates, comparing hospitals in England, have been published by health service commentators. The rationale for publication is that differences in death rates may indicate differences in quality of hospital care, yet provision and use of different facilities for the care of the dying varies geographically.
Terminally ill patients need care, and if that is not provided at home, in nursing homes or hospices, they may be cared for in NHS hospitals. Hospitals with the highest in-hospital death rates tend to be in areas with little provision of hospices and nursing homes.
Using published figures, researchers analysed in-hospital death rates at 20 NHS hospitals in England, selected because they had the highest or lowest published death rates. They allowed for geographic differences in the percentage of deaths occurring in hospital in each catchment area.
Geographical differences in the provision of facilities for the dying are a plausible explanation for some of the differences between hospitals in their death rates, say the authors.
Calculation of in-hospital death rates, aggregated across a wide clinical spectrum, including a mixture of admissions for treatment, cure, and palliative and terminal care, gives rates that are difficult to interpret as quality measures, they conclude. They may be particularly misleading about the performance of hospitals in areas with limited provision of hospices and nursing homes.