High hospital standardized mortality ratio does not always indicate low quality.

: Hospital standardized mortality ratio (HSMR) is increasingly used to assess quality of care. At Frederiksberg Hospital HSMR increased significantly during the first and second quarter in 2012. We therefore reviewed records of all deceased, including patients deceased during the comparative period in 2011 (n = 413). Information about cancer and infection with Clostridium difficile was specifically noted. We found that the increasing HSMR reflected an increase in the number of terminal cancer patients. Thus, insufficient adjustment for a change in case-mix explained the higher HSMR.