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Health Serv Res. 2008 Feb;43(1 Pt 1):10-31.

Intelligent information: a national system for monitoring clinical performance.

Author information

1
Dr. Foster Unit at Imperial College, Department of Primary Care and Social Medicine, Imperial College London, First floor, Jarvis House, 12 Smithfield Street, London EC1A 9LA, U.K.

Abstract

OBJECTIVE:

To use statistical process control charts to monitor in-hospital outcomes at the hospital level for a wide range of procedures and diagnoses.

DATA SOURCES:

Routine English hospital admissions data.

STUDY DESIGN:

Retrospective analysis using risk-adjusted log-likelihood cumulative sum (CUSUM) charts, comparing each hospital with the national average and its peers for in-hospital mortality, length of stay, and emergency readmission within 28 days.

DATA COLLECTION:

Data were derived from the Department of Health administrative hospital admissions database, with monthly uploads from the clearing service.

PRINCIPAL FINDINGS:

The tool is currently being used by nearly 100 hospitals and also a number of primary care trusts responsible for purchasing hospital care. It monitors around 80 percent of admissions and in-hospital deaths. Case-mix adjustment gives values for the area under the receiver operating characteristic curve between 0.60 and 0.86 for mortality, but the values were poorer for readmission.

CONCLUSIONS:

CUSUMs are a promising management tool for managers and clinicians for driving improvement in hospital performance for a range of outcomes, and interactive presentation via a web-based front end has been well received by users. Our methods act as a focus for intelligently directed clinical audit with the real potential to improve outcomes, but wider availability and prospective monitoring are required to fully assess the method's utility.

PMID:
18300370
PMCID:
PMC2323144
DOI:
10.1111/j.1475-6773.2007.00742.x
[Indexed for MEDLINE]
Free PMC Article

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