October 2004

Screening and Surveillance of routine data

Adrian Cook

2

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

3

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

9

Analysis – statistical process control

Analysis within an organisation, over time

Post-surgical infection rate

0123

456

19

/10

/20

04

21

/10

/20

04

23

/10

/20

04

25

/10

/20

04

27

/10

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04

29

/10

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04

31

/10

/20

04

02

/11

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04

04

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04

06

/11

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04

08

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04

10

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04

12

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04

14

/11

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16

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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

13

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

14

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