Intelligent Information: A National System for Monitoring Clinical Performance
- 6 June 2007
- journal article
- research article
- Published by Wiley in Health Services Research
- Vol. 43 (1p1), 10-31
- https://doi.org/10.1111/j.1475-6773.2007.00742.x
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.Keywords
This publication has 25 references indexed in Scilit:
- Learning from death: a hospital mortality reduction programmeJournal of the Royal Society of Medicine, 2006
- Monitoring changes in hospital standardised mortality ratiosBMJ, 2005
- Mortality After Noncardiac SurgeryMedical Care, 2005
- New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortalityJournal of Clinical Epidemiology, 2004
- A hierarchical Poisson mixture regression model to analyse maternity length of hospital stayStatistics in Medicine, 2002
- Differences in clinical performanceBritish Journal of Surgery, 2002
- Monitoring surgical performance using risk-adjusted cumulative sum chartsBiostatistics, 2000
- Evaluations of methods for statistical surveillanceStatistics in Medicine, 1992
- Optimal Stopping Times for Detecting Changes in DistributionsThe Annals of Statistics, 1986
- Fast Initial Response for CUSUM Quality-Control Schemes: Give Your CUSUM A Head StartTechnometrics, 1982