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Your life in their hands Mortality as a measure of clinical performance

Your life in their hands Mortality as a measure of clinical performance. David Prytherch, Jeff Sirl, Paul Weaver, Paul Meredith, Michael Booth. Why look at Clinical Outcomes?.

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Your life in their hands Mortality as a measure of clinical performance

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  1. Your life in their hands Mortality as a measure of clinical performance • David Prytherch, Jeff Sirl, Paul Weaver, Paul Meredith, Michael Booth

  2. Why look at Clinical Outcomes? ………Hospitals and the NHS could tell you about throughput (number of patients treated), bed occupancy (the proportion of beds occupied in the hospital), and, latterly, the costs involved. But, generally speaking, quality of outcome was a closed book. Chapter 27 para 2 “Learning from Bristol”: The Report of the Public Inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984 to 1995 I Kennedy, HMSO 2001

  3. Why Mortality? At national level, the indicators of performance should be comprehensible to the public as well as to healthcare professionals. They should be fewer and of high quality, rather than numerous but of questionable or variable quality. Recommendations para 153 “Learning from Bristol”: The Report of the Public Inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984 to 1995 I Kennedy, HMSO 2001

  4. Why Case-mix adjust? …… Variables such as case mix and where possible, in the case of surgery, operative risk must be allowed for, so that, wherever feasible, it is possible to compare like with like. Chapter 27 para 49 “Learning from Bristol”: The Report of the Public Inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984 to 1995 I Kennedy, HMSO 2001

  5. How to collect the data? For the future the multiple methods and systems for collecting data must be reduced. Data must be collected as the by-product of clinical care. Summary para 96 “Learning from Bristol”: The Report of the Public Inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984 to 1995 I Kennedy, HMSO 2001

  6. What modelling provides: Stratified (=case mix adjusted model) enables: • Comparison of expected and observed outcomes • Comparison of outcomes / performance between hospitals and clinicians • Meaningful league tables based on clinical performance • Better understanding of the process of clinical care? Provides a ruler

  7. An interesting question Previous / existing models (General Surgery) require data beyond that routinely stored in “core” systems. Can useful models be constructed from the more limited data set stored in “core” systems?

  8. General Surgery

  9. results adapted from: Towards a national clinical minimum dataset for general surgery. D. R. Prytherch, J. S. Sirl, P. C. Weaver, P. Schmidt, B. Higgins, G.L Sutton British Journal of Surgery, in print 5 year period, 1st August 1997 to 31st July 2002 28925 General Surgical in-patient episodes with necessary data Models constructed from years 1 and 2 and tested prospectively against years 3, 4 and 5

  10. Data items used in BHOM models for General Surgery: • Urea • Na • K • Haemoglobin • White Cell Count • Age on admission • Sex • BUPA operative severity score • Mode of admission – elective or emergency • Mortality at discharge

  11. General Surgery Study Final 6 month period 1st February – 31st July 2002 2 = 1.56, 6 d.f, P = 0.96, no evidence of lack of fit

  12. General Medicine

  13. General Medicine Study Data from HIS and Biochemistry and Haematology modules of pathology system 4 year period, 1st January 1998 - 31st December 2001 37283 discharges from GM with necessary data Models constructed from 3 months (Jan – Mar 01) and tested prospectively against the other 45 months of the study.

  14. Data items used in BHOM models for General Medicine: • Urea • Albumin • Creatinine • Na • K • Haemoglobin • White Cell Count • Age on admission • Sex • Mortality at discharge

  15. General Medicine Study Final 3 month period1st October – 31st December 2001 2 = 6.71 10 d.f P = 0.75 no evidence of lack of fit

  16. How applicable are the models?

  17. Conclusions Clinical data obtained from a single venesection Clinical data are used operationally in care of individuals No “extra” effort is required to collect data Clinical data used are subject to extensive quality assurance Available in all hospitals Candidate National Clinical Minimum dataset

  18. Sources of funding Portsmouth NHS R&D Consortium Portsmouth Hospitals NHS Trust University of Portsmouth

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