International quality measurement work is moving beyond the consideration of health system or national level variations to understand variations within countries and enable more meaningful cross-country comparison. Hospital performance is one key area where policy makers are increasing their focus on reducing variation, lifting the overall standards of care while minimizing the widespread differences in access and quality of care that are evident within health systems.

In 2014 the OECD launched the Hospital Performance Project to better understand performance across countries and strengthen international comparisons. From 2015-2018 the OECD developed a method for measuring hospital level acute myocardial infarction 30-day mortality for international comparison. The methodological development and pilot data collections undertaken over this time have resulted in robust and feasible approach to ongoing routine international hospital level data collections on AMI 30-day mortality rates with potential applications to other subnational level indicators. This paper discusses the development of this measurement including technical as well as practical aspects of collecting, displaying, and analysing such data.