Hospital Standardized Mortality Ratios (HSMR) 

One of the visions of the Danish health care system is to achieve and maintain a high professional level on an international scale. To achieve this, tools for ongoing monitoring of quality improving interventions and health care efforts in general are necessary. Internationally, death during or after hospitalization is frequently used as a measure of the quality of the overall efforts of the health care system. 

HSMR is the number of deaths in a hospital as a percentage of the expected number of deaths calculated on the basis of the national average:
HSMR = (number of observed deaths / number of expected deaths) x 100%


To monitor mortality in relation to the diagnoses most often related to death within 30 days of hospitalization in Danish hospitals.


HSMR has been calculated on a quarterly basis for the Danish hospitals since 2007. In the current model, 2008 is used as the year of reference used to calculate the expected number of deaths. In addition to the HSMR value, the department has also developed a control card - a cumulative sum chart (CUSUM chart), where the HSMR-related mortality of each hospital is compared with the hospital’s mortality in 2010.


Both HSMR and CUSUM cards are calculated once a quarter based on data from the Danish National Registry of Patients.
See HSMR figures here 


Consultant Mette Nørgaard, PhD, Centre for Clinical Epidemiology and Biostatistics, North; E-mail: