October 2004 Screening and Surveillance of routine data Adrian Cook.
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Transcript of October 2004 Screening and Surveillance of routine data Adrian Cook.
October 2004
Screening and Surveillance of routine data
Adrian Cook
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Outline
• What is the Healthcare Commission
who we are, what we do, screening/surveillance
• Methods of Analysis
data, funnel plots, process control
• Applications
inspections, investigations
• Example
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Who we are
Commission for Healthcare Audit and Inspection (CHAI)
Health and Social Care Act 2003, started 1 April 2004
Commission for
Health Improvement
CHI
National Care
Standards Council
NCSCAudit
Commission
Healthcare Commission
550 staff, 100 in information and analysis
4
What we do
Exists to promote improvements in the quality of NHS and independent healthcare across England and Wales
Patient and Staff Surveys
Clinical Audit
Complaints
State of Healthcare Report
Acute Hospital Portfolio
Inspections Investigations
Star ratings
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Screening and Surveillance
• Screening
analysis of data to target inspections
• Surveillance
ongoing, background monitoring of routinely-collected data, used to initiate work
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Data and Types of Analysis
• Mortality, including post-discharge• Readmissions, length of stay
Outcomes
Unit of analysis• Trust, specialty, consultant team
Techniques
• Indirect standardisation
• Adjustment for overdispersion
HES safe haven
ONS linked deaths
Birth registrations
Death registrations
Compendium
Surveys
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Methods of Analysis – funnel plots
Comparisons between institutionsreadmissions
0
0.5
1
1.5
2
2.5
3
0 1000 2000 3000 4000 5000 6000 7000
expected deaths
SA
R
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Methods of Analysis – funnel plots
Comparisons between institutionsFigure 1. General surgery - All trusts
0
0.5
1
1.5
2
2.5
3
0 100 200 300 400 500 600 700
expected deaths
SM
R
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Analysis – statistical process control
Analysis within an organisation, over time
Post-surgical infection rate
0123
456
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Date
LL
R
Warning
Alarm
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Applications – targeted inspections
HES
Compendium
AHP
Surveys
+++
DH developmental standards
Domain scores
Indicators
Analysis
Criteria
Screening
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Applications - Investigations
HES
ONS
Extract from trust
Initial requestPreliminary
Analysis
No further action
Detailed Analysis
Investigation
Surveillance
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Example - General surgery mortality
Comparison between institutionsFigure 1. General surgery - All trusts
0
0.5
1
1.5
2
2.5
3
0 100 200 300 400 500 600 700
expected deaths
SM
R
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Example - General surgery mortality
Comparison between consultant teamsFigure 2. General surgery - All consultant teams in England
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
0 10 20 30 40 50 60 70 80 90
expected deaths
SM
R
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Consultant team 1
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Consultant team 2
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Summary
• Lots of activity
• Promising methods
• Screening/Surveillance needs validation
• Comments welcome
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THANK YOU