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Objective To assess the validity of case mix adjustment methods used to derive standardised mortality ratios for hospitals, by examining the consistency of relations between risk factors and mortality across hospitals. Design Retrospective analysis of routinely collected hospital data comparing observed deaths with deaths predicted by the Dr Foster Unit case mix method. Setting Four acute National Health Service hospitals in the West Midlands (England) with case mix adjusted standardised, mortality ratios ranging from 88 to 140. Participants 96 948 (April 2005 to March 2006), 126 695 (April 2006 to March 2007), and 62 639 (April to October 2007) admissions to the four hospitals. Main outcome measures Presence of large interaction effects between case mix variable and hospital in a logistic regression model indicating non-constant risk relations, and plausible mechanisms that could give rise to these effects. Results Large significant (PS0.0001) interaction effects were seen with several case mix adjustment variables. For two of these variables--the Charlson (comorbidity) index and emergency admission--interaction effects could be explained credibly by differences in clinical coding and admission practices across hospitals. Conclusions The Dr Foster Unit hospital standardised mortality ratio is derived from an internationally adopted/ adapted method, which uses at least two variables (the Charlson comorbidity index and emergency admission) that are unsafe for case mix adjustment because their inclusion may actually increase the very bias that case mix adjustment is intended to reduce. Claims that variations in hospital standardised mortality ratios from Dr Foster Unit reflect differences in quality of care are less than credible. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Using Hospital Mortality Rates to Judge Hospital Performance: A Bad Idea That Just Won't Go Away," by R. Lilford et al, and the editorial "Assessing the Quality of Hospitals," by N. Black, both published in the April 20, 2010 issue.

The authors discuss the use of the hospital standardised mortality ratio as a basis for evaluating hospital care quality. The ratio focuses on the number of patients who die in a hospital as compared to the number who would be expected to die based on diagnosis. They comment on how the constant risk fallacy indicates that risk measurements may not correlate with patient outcomes and suggest that mortality may not reflect hospital quality.

The article discusses issues related to the misuse of alcohol in Great Britain. It has been stated that more than a million admissions a year occur in hospitals of the National Health Service (NHS) in England because of consumption of alcohol. It has been stated that the Office for National Statistics show that drinking levels have not increased in the past decade, but alcohol induced hospital admission is still too high and there is need for greater efforts to reduce hazardous drinking. It has been stated that the Scottish government has increased price of alcohol to cut its sale across the board and David Cameron, prime minister of Great Britain should also do something same to prevent alcohol related hazards.

The article presents abstracts on medical topics which include a research regarding the roles of melody and rhythm for improving speech production in stroke patients with non-fluent aphasia, the association of tamoxifen with congenital abnormalities, and a biochemical study of rotator cuff tears with the use of human cadaver for production of an improved rotational range of shoulder motion.

A letter to the editor is presented in response to the article "Using Hospital Mortality Rates to Judge Hospital Performance: A Bad Idea That Just Won't Go Away," by R. Lilford et al, and the editorial "Assessing the Quality of Hospitals," by N. Black, both published in the April 20, 2010 issue.

A letter to the editor is presented in response to the article "Using Hospital Mortality Rates to Judge Hospital Performance: A Bad idea That Just Won't Go Away," by R. Lilford et al, and the editorial "Assessing the Quality of Hospitals," by N. Black, both published in the April 20, 2010 issue and "Patient Coding and the Ratings Game," by N. Hawkes, published in the April 23, 2010 issue.

A letter to the editor is presented in response to the article "Using Hospital Mortality Rates to Judge Hospital Performance: A Bad Idea That Just Won't Go Away," by R. Lilford et al, and the editorial "Assessing the Quality of Hospitals," by N. Black, both published in the April 20, 2010 issue and "Patient Coding and the Ratings Game," by N. Hawkes, published in the April 23, 2010 issue.

A letter to the editor is presented in response to the article "Using Hospital Mortality Rates to Judge Hospital Performance: A Bad idea That Just Won't Go Away," by R. Lilford et al, and the editorial "Assessing the quality of hospitals," by N. Black, both published in the April 20, 2010 issue.

A letter to the editor is presented in response to the article "Using Hospital Mortality Rates to Judge Hospital Performance: A Bad Idea That Just Won't Go Away," by R. Lilford et al, and the editorial "Assessing the Quality of Hospitals," by N. Black, both published in the April 20, 2010 issue.

A letter to the editor is presented in response to the article "Using Hospital Mortality Rates to Judge Hospital Performance: A Bad Idea That Just Won't Go Away," by R. Lilford et al, and the editorial "Assessing the Quality of Hospitals," by N. Black, both published in the April 20, 2010 issue.

The article discusses various reports published within the issue, including one by Mohammed Mohammed on hospital mortality ratios, another by John Wright and Kaveh G. Shojania on the evaluation of hospital care and another by Silvio Garattini and Iain Chalmers on drug trial procedures.