A description of what we have done at one English health authority to advance clinical outcome measurement

1. Using clinical dashboards to
benchmark quality
Dr Quentin D Sandifer
Deputy Regional Director of Public
Health
May 14 2009

2. Our story so far…
In the beginning

5. Our story so far…
The dashboard today

6. Clinical Indicator Quality Domain
1 Unplanned readmissions within 28 Efficiency
days
2 Risk adjusted mortality – all Effectiveness
admissions
3 Rate of MRSA bacteraemia Patient Experience,
Safety
4 Rate of C. difficile cases Patient Experience,
Safety
5 Hip fracture repaired within 48 hours Timeliness
6 Incidence of catheter associated UTIs Safety
7 Rate of drugs, medicaments and Safety
biological substances causing
adverse effects in therapeutic use
8 Incidence of pressure ulers Patient Experience,
Safety
9 Patient satisfaction Patient experience
10 Rates of complications of medical and Safety,
surgical care Effectiveness

7. Clinical Quality Dashboard - Surrey & Sussex Healthcare NHS Trust
Surrey & Sussex Healthcare
Estimated rate of MRSA Risk-adjusted mortality- all Rate of complications of Incidence of Catheter Hip Fracture repaired <48hrs
Associated UTIs per 10,000
bacteraemia reported per admissions medical and surgical care per (%)
Bed Days
10,000 admissions 10,000 episodes
2.5 100%
250 300
20 Trust
SHA 90%
18
250 2.0 80%
200
16
14 70%
200
12 150 1.5 60%
10 150 50%
8 100 1.0 40%
100
6 30%
Please note scale for estimated rates of MRSA and C Diff vary dependiing on Trust selected.
4 50 0.5 20%
Tru st
50
Trust Trust
2 SHA 10%
Tru st l i
m
i t SHA SHA
0 0 0 0.0 0%
A M J J A S O N D J F M
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
AMJ JASONDJFMAMJ JASONDJF
MAMJ JASO JFMAMJJAS
ND Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q1 Q2 Q3 Q4Q1 Q2 Q3 Q4Q1 Q2 Q3 Q4Q1 Q2 Q3Q4
2005/06 2006/07 2007-08 08-09 2004/05 2005/06 2006/07 2007/08 2004/05 2005/06 2006/07 2007/08 2008/09
2008-09 2004/05 2005/06 2006/07 2007/08
Estimated rate of C-Diff cases Rate of drugs, medicaments & Patient satisfaction: Overall
Unplanned readmissions Incidence of Pressure
(aged 2+) per 1,000 ordinary biological substances causing Ulcers per 10,000 Bed Days Score (HCC patient survey
<28 days (%)*
admissions (attributable to adverse effects in therapeutic 2007)
Trust) use per 10,000 episodes Trust SHA
12 80 7 Trust England best England worst
7
100
70 6
6 10
60
5 5
better ->
8
50
4 4
6 40 %
3 3
30
<-worse
4
2 2
T st
ru 20
SHA
1 2
L ca re h
o l t
St c 10 1
Trust
Na n l i i
o
i L
t a mt
SHA 0
0 0
0 0
Q'tion 66
Q'tion 67
Q'tion 68
Q'tion 69
Q'tion 70
Q'tion 71
A M J J A S O N D J F M AMJJASONDJFMAMJ JASO JFMAMJJASON
ND DJFMAMJ JAS Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2008-09 2005/06 2006/07 2007-08 08-09 2004/05 2005/06 2006/07 2007/08 2004/05 2005/06 2006/07 2007/08

8. Our story so far…
And more

9. Work in progress
~ Commissioner based dashboards
– Stroke
– Dementia
~ Practice level diabetes dashboard
~ Cardiac Dashboard
~ Maternity Dashboard
~ Nursing metrics - community
~ Systems to identify early warning signs