Yonsei Med J.
2025 Mar;66(3):179-186. 10.3349/ymj.2023.0545.
Development and Application of New Risk-Adjustment Models to Improve the Current Model for Hospital Standardized Mortality Ratio in South Korea
- Affiliations
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- 1HIRA Policy Research Institute, Health Insurance Review & Assessment Service, Wonju, Korea
- 2Medical Record Team, SMG-SNU Boramae Medical Center, Seoul, Korea
- 3Medical Records Department, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- 4Department of Health Insurance Review, Seoul National University Hospital, Seoul, Korea
- 5Department of Health Information Management, ChungAng University Hospital, Seoul, Korea
- 6Department of Insurance, Seoul National University Bundang Hospital, Seongnam, Korea
- 7Medical Records Team, Wonju Severance Christian Hospital, Wonju, Korea
- 8Medical Information Team, Dankook University Hospital, Cheonan, Korea
- KMID: 2565535
- DOI: http://doi.org/10.3349/ymj.2023.0545
Abstract
- Purpose
This study assessed the validity of the hospital standardized mortality ratio (HSMR) risk-adjusted model by comparing models that include clinical information and the current model based on administrative information in South Korea.
Materials and Methods
The data of 53976 inpatients were analyzed. The current HSMR risk-adjusted model (Model 1) adjusts for sex, age, health coverage, emergency hospitalization status, main diagnosis, surgery status, and Charlson Comorbidity Index (CCI) using administrative data. As candidate variables, among clinical information, the American Society of Anesthesiologists score, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) 3, present on admission CCI, and cancer stage were collected. Surgery status, intensive care in the intensive care unit, and CCI were selected as proxy variables among administrative data. In-hospital death was defined as the dependent variable, and a logistic regression analysis was performed. The statistical performance of each model was compared using C-index values.
Results
There was a strong correlation between variables in the administrative data and those in the medical records. The C-index of the existing model (Model 1) was 0.785; Model 2, which included all clinical data, had a higher C-index of 0.857. In Model 4, in which APACHE II and SAPS 3 were replaced with variables recorded in the administrative data from Model 2, the C-index further increased to 0.863.
Conclusion
The HSMR assessment model improved when clinical data were adjusted. Simultaneously, the validity of the evaluation method could be secured even if some of the clinical information was replaced with the information in the administrative data.
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