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This is the same problem for all methods of standardisation.
We have described methods of standardisation in an epidemiological setting to ensure accuracy and consistency.
Figures 2 and 3 compare the different methods of standardisation of hospital mortality rates in the HES data.
Misspecification of the model is likely to lead to invalid comparisons between centres for all methods of standardisation, including our proposed DRS method.
A large simulation study comparing all methods of standardisation, reflecting real life data with missing values, and looking at outcomes such as the detection of outliers would be necessary.
In conclusion, it should be reiterated that all methods of standardisation require specification of a 'risk' model, and the choice of this model is probably more important than the method of standardisation.
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4 The indirect method of standardisation was used to determine the standardised mortality ratio (SMR) for this cohort.
The indirect method of standardisation was used for internal comparisons[ 15].
This method of standardisation, which has been used before, uses 20 mg of enalapril as reference dose [ 15].
The direct method of standardisation was used and the WHO world population was used as the standard population.
We used the direct method of standardisation as described by Beaghole et al 28 for standard Portuguese population.
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