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Posted on 07 Apr 2021

The 2017 Targeting zero report made several recommendations relating to mortality measures and was particularly critical of the use of the Hospital Standardised Mortality Ratio (HSMR). Targeting zero noted the inherent difficulty of using HSMRs to detect and address specific safety and quality issues in hospitals, because of its broad scope. 

Feedback from the sector has confirmed that there are several challenges with this “all cause” mortality indicator from an interpretation and actionability perspective, including the impact of coding guidelines on the level of risk assigned to different episodes, and the effect of changes in casemix not accounted for by the national risk model.

However, sector consultation has also indicated that there is a genuine demand for a high-level mortality indicator to be made available to health service boards and executives. 

To address this, VAHI has engaged the Commonwealth Scientific and Industrial Research Organisation (CSIRO) to conduct an in-depth review of HSMR, to assess the evidence on such measures, and options for alternative approaches to health-service-wide mortality monitoring. 

The final recommendations will be presented by June 2021 and we look forward to sharing the insights and consulting on next steps with health services.

For more information about VAHI’s review of HSMR, please contact Adina Hamilton, Acting Director of Health System Insights branch via

Page last updated: 07 Apr 2021