Can hospital data detect poor performin...( Can routine hospital data be used to de...),Health

For over 20 years, routine data sources such as the hospital episode statistics have been widely perceived as being of little value because of problems with completeness and accuracy, and the Department of Health has in the past dismissed their use for identifying poor quality services.

But, despite these concerns, hospital episode statistics data were used to investigate hospital level death rates after heart surgery in the Bristol inquiry, and more recently death rates for individual cardiac consultants have been published.

A paper published online by the BMJ today extends this theme to more general measures of clinical quality where death may not be the outcome.

The authors investigated whether routinely collected data from hospital episode statistics could be used to identify the gynaecologist Rodney Ledward, who was suspended in 1996 and was the subject of the Ritchie inquiry into quality and practice within the NHS.

The research team compared the performance of 142 gynaecology consultants with the performance of Ledward over a five year period, to determine if Ledward was a statistical outlier according to seven indicators from hospital episode statistics. The indicators were specifically chosen for their potential link with poor quality of service.

Their analysis identified Ledward as an outlier in three of the five years. Eight other consultants were also identified as outliers, but the researchers strongly caution against over-interpreting these consultants as having "poor" performance because valid reasons may exist that could credibly explain their results.

For example, cancer specialists may have high values for several indicators (such as surgical complications and long stays in hospital) because they carry out difficult operations on very ill patients, say the authors. The method therefore needs to be refin
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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
14-Apr-2005