Monitoring quality of care: making the most of data
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The document discusses the Nuffield Trust's efforts to monitor the quality of healthcare using various data-driven techniques and tools. It highlights the importance of continuous monitoring and data evaluation to identify potential problems and improve care delivery, despite limitations in data accuracy. Ultimately, it emphasizes that while health service data may not directly measure quality, it can guide assessments and encourage improvements.
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Monitoring quality of care: making the most of data
- 1. Monitoring quality of care: making the most of data Chris Sherlaw-Johnson, Senior Research Analyst, Nuffield Trust
- 2. © Nuffield Trust A selection of what we are doing at the Nuffield Trust QualityWatch: http://www.qualitywatch.org.uk/ Evaluating the impact of social action on hospital activity Evaluating the impact of new primary care services in outer North East London Understanding the capability of routine data for identifying where people have experienced severe harm Providing evidence and tools to support the delivery of Combined Geriatric Assessment (CGA) in hospitals Understanding the interface between ambulance services and acute trusts by using linked data Using data to understand effective initiatives for the care of older people
- 4. © Nuffield Trust Monitoring activity Regulation of services - CQC Clinical standards and national performance within a clinical specialty - national audits Performance within hospitals Performance within clinical units Evaluation of new services or procedures, e.g. Vanguards
- 5. © Nuffield Trust What we want to measure Available data Indicators “Not everything that can be counted counts, and not everything that counts can be counted.” (Einstein)
- 6. © Nuffield Trust 20 40 60 80 100 120 140 160 180 0 200 400 600 800 1000 1200 1400 Standardisedratio Expected admissions Emergency admissions for patients with fractured neck of femur by local authority: 2013/14 Source: Hospital Episode Statistics
- 7. © Nuffield Trust Headlines “NHS hit by new hospital deaths cover up” (Daily Mail) “2,500 die at horror hospital” (Sunday Express) “Killing season on NHS wards” (Daily Mail) “13,000 died needlessly at 14 worst NHS trusts” “We have 6,000 avoidable deaths every year” (Jeremy Hunt)
- 8. © Nuffield Trust Following up potential concerns Data monitoring Potential concern Clear false positive Can we correct the data? Can we enhance the monitoring methodology? No concerns identified Investigate Areas of improvement identified Improvement actions
- 9. © Nuffield Trust Continuous monitoring tools Shewhart-type charts (e.g. c-chart, p-chart, g-chart) Exponentially weighted moving average (EWMA) Variable life-adjusted display (VLAD) Cumulative sum (CUSUM) Sequential Probability Ratio Test (SPRT) Resetting Sequential Probability Ratio Test (RSPRT) Scan charts
- 10. © Nuffield Trust 0 2 4 6 8 10 12 0 2 4 6 8 10 12 Month Observed Expected Example: Emergency admissions to hospital from 40- bed nursing home
- 11. © Nuffield Trust 0 2 4 6 8 10 12 0 2 4 6 8 10 12 CUSUM Control limit Alert Reset to zero
- 12. © Nuffield Trust Continuous monitoring Why? Making use of time series rather than isolated snapshots Monitoring/evaluating as soon as data become available Detecting problems or improvements quickly Could be valuable when data sparse or limited Uses Monitoring of outcomes Evaluation of changes to care delivery Comparisons with others / against one’s own past history
- 13. © Nuffield Trust Conclusions In most instances, health service data does not measure quality of care but tells you where to look for potential problems If data is there, it can be helpful to use it, even if not entirely accurate. Using data may provide the biggest incentive to improving it Continuous monitoring techniques are valuable when the data can be regularly updated Enabling local understanding of methods and their implementation is highly important