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Improving information for quality
Nick Black
London School of Hygiene & Tropical Medicine
and
Chair, NHSE National Advisory Group on Clinical Audit &
Enquiries
Insufficient attention been paid to
effectiveness in past...
Lots of useful indicators ...

Safety
Experience
(Organisational efficiency)

(Staff experience)
Need to (and can) consider effectiveness of
care
• Outcomes
– Survival
– Morbidity/disability
– Health-related quality of life

• Processes
– adherence to evidence-based clinical guidelines or
quality standards (NICE)
Adult critical care
-hospital mortality ratio (2010-11)

MKHFT
Bowel cancer (2011)
- adjusted 90 day post-operative mortality (%)

MKHFT
Patient reported outcome for hip replacement (post-op Oxford Hip Score)

45
Buckinghamshire
Burton
Colchester

40

Dudley Group

35

Basildon & Thurrock
East Lancashire

Blackpool
30
0

200

400
600
Number of operations

800
Neonatal care
(2011)

MKHFT

Proportion mothers
receiving antenatal
steroids
Diabetes care: all 9 care processes* completed (2011)

MK PCT
*NICE recommended care processes: urinary albumin, eye screening, foot exam,
smoking review, BMI, cholesterol, blood creatinine, HbA1c, BP
National clinical audits in England
Clinical area

Number

Peri & neo-natal

2

Children

7

Adult acute & emergency care

10

Long term conditions

10

Surgery/interventional procedures

7

Renal disease

3

Cancer

4

Trauma

3

Psychological conditions/treatments

3

Blood transfusion

1

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Nicholas Black: Improving information for quality

  • 1. Improving information for quality Nick Black London School of Hygiene & Tropical Medicine and Chair, NHSE National Advisory Group on Clinical Audit & Enquiries
  • 2. Insufficient attention been paid to effectiveness in past...
  • 3. Lots of useful indicators ... Safety Experience (Organisational efficiency) (Staff experience)
  • 4. Need to (and can) consider effectiveness of care • Outcomes – Survival – Morbidity/disability – Health-related quality of life • Processes – adherence to evidence-based clinical guidelines or quality standards (NICE)
  • 5. Adult critical care -hospital mortality ratio (2010-11) MKHFT
  • 6. Bowel cancer (2011) - adjusted 90 day post-operative mortality (%) MKHFT
  • 7. Patient reported outcome for hip replacement (post-op Oxford Hip Score) 45 Buckinghamshire Burton Colchester 40 Dudley Group 35 Basildon & Thurrock East Lancashire Blackpool 30 0 200 400 600 Number of operations 800
  • 9. Diabetes care: all 9 care processes* completed (2011) MK PCT *NICE recommended care processes: urinary albumin, eye screening, foot exam, smoking review, BMI, cholesterol, blood creatinine, HbA1c, BP
  • 10. National clinical audits in England Clinical area Number Peri & neo-natal 2 Children 7 Adult acute & emergency care 10 Long term conditions 10 Surgery/interventional procedures 7 Renal disease 3 Cancer 4 Trauma 3 Psychological conditions/treatments 3 Blood transfusion 1