Analysing Clinical Indicator Reports

Analysing Clinical Indicator Reports

UTS CRICOS 00099FAnalysing Clinical Indicator Reports(A framework for Assessment 3)92022 Improving Quality and Safety in Health CareAutumn 2020Clinical indicators Rarely provide definitive answers Usually suggest the next best question to ask that ultimately will give the answer required Designed to indicate potential problems that might need addressing Screen, flag, draw attention to a specific clinical issue Must be understood in context Used for comparative internal or external benchmarking (comparing performance metrics toindustry bests and/or best practices)Information about ACHS Clinical Indicator Program The ACHS Clinical Indicator Program is a data repository, analysis and reporting service provided to>800 member HCOs. https://www.achs.org.au/programs-services/clinical-indicator-program/cip-overview It provides a national clinical benchmarking service comparative information on the processes andoutcomes of health care. Participating HCOs are able to submit CI data for inclusion in an extensivedatabase. Data are aggregated and analysed six-monthly and results are provided in the form ofcomparative reports. These reports compare results across all contributing HCOs as well as providinga comparison with peer HCOs based on a number of variables. There are 20 Clinical Indicator (CI) sets and over 300 CIs to choose from. There is no requirement that an organisation monitor a specific number of CIs. HCOs are required toconsider CIs that relate to the health services they provide and are appropriate to their size and typeof organisation.Current ACHS indicator setsv Anaesthesia & Perioperative Carev Emergency Medicinev Day Patientv Gastrointestinal Endoscopyv Gynaecologyv Hospital in the Homev Hospital-Widev Infection Controlv Rehabilitation Medicinev Intensive Carev Mental Healthv Maternityv Oral Healthv Paediatricsv Pathologyv Radiation Oncologyv Radiologyv Cancer Care (new in 2020)Source:ACHS (2019) AustralasianClinical Indicator Report (20thed) 2011-2018 (p. 21)https://www.achs.org.au/programsservices/clinical-indicator-program/aciraustralasian-clinical-indicator-report/Describing indicatorsExample Intensive Care Access and Exit Block indicators1.1 ICU adult non-admission due to inadequate resources (L)1.2 ICU elective adult surgical cases deferred or cancelled due to unavailability of bed (L)1.3 ICU adult transfer to another facility / ICU due to unavailability of bed (L)1.4 ICU adult discharge delay more than 12 hours (L) Primarily structural indicators (lack of resources: staffing, ICU beds, equipment) Relationships between indicators: delays in discharging ICU patients into the ward (e.g. possiblybecause of hospital bed block) likely impacts on delays in admitting patients to ICU.Quality implications: if critically-ill patients cannot be rapidly admitted to the ICU from ED or thewards, that impacts on their outcomes. Also, ICU services are costly, need to be appropriatelyallocated to patients in need of intensive care, not less-ill patients waiting for a bed in the wards.Defining & calculating indicator ratesExample (Day Patient set)5.1 Unplanned return to operating room on same day as initial procedure (L)Quality implications: Returning to the operating room may reflect possible problems in theperformance of procedures. Numerator: Number of patients having an unplanned return to the operating room/procedure room(as defined in the manual) during the same admission Denominator: Number of patients who have an operation/procedure performed in the day procedurefacility Rate = Numerator / Denominator x 100%Analysing aggregate rates & reporting numbersExample (Emergency medicine set)Quality implications: Thrombolytic therapy is life-saving for STEMI patients, especially < 30 mins.Data interpretation: The aggregate rate here (across all reporting HCOs) is low at 43.8%. Even if a HCO is performing at average, it may indicate a need for improvement, as this could reflectpoor care processes (e.g. unfamiliarity of staff with the procedure), or This could be because organisations are increasingly performing surgery (percutaneouscoronary intervention) instead of thrombolysis if they have the facilities to do so. It is also difficult to interpret the data because the number of HCOs reporting is so small (12 out of 96possible HCOs in 2018). IndicatorHCOs2018 Aggregate rate %2.1 STEMI patients who receive thrombolytic therapy within 30 minutes (H)1243.8 Understanding rate comparisons & statistical significanceExample (Hospital-Wide set)Quality implications: Falls resulting in fracture are a serious adverse event, often resulting in patientshaving to transition from independence to assisted living. Your rate (0.02%) is much higher than (0.009%) but is this statistically significant? The 99% confidence interval for your rate shows the estimated range of your true rate (taking intoaccount random variation) As your confidence interval does not include the aggregate rate, we would conclude that we are 99%certain that your rate of inpatient falls here are statistically higher than the other organisations thatsubmitted data for this indicator. Indicator Number / DescriptionYourrate99% confidenceinterval for your rateNumber of orgssubmitting dataAggregaterate4.2 Inpatient falls resulting in fracture or closed head injury (L)0.02%(0.01 0.48)3660.009% Source: The ACHS Clinical Indicator Program User Guide (2017)Analysis of indicator report: Framework for Assessment 31. Introduce yourself and state your student number. Tell me which report you are analysing which indicator set, and whichtime period.2. You will want to talk about all indicators in the report, but start with the indicators most in need of attention. These are theindicators in bold, where the difference between the healthcare organisation (HCO) rate and the aggregate rate (average ofall reporting HCOs) is statistically significant (the 99% confidence interval does not include the aggregate rate).3. For each of these indicators, report on the following questions: What does the result mean in plain language? (e.g. how many more or fewer patients experienced xyz compared to?) What are the quality implications of this result for patients, for staff and for the HCOs? (You may want to look up moreinformation and the research around this indicator if you are not so familiar with it). What are some possible reasons for this result? (You may want to consider: factors that lead to this indicator being highor low; the results from other indicators reported; as well as how many organisations have reported their data for thisindicator).4. Finally, make recommendations about practical actions you think the HCO should take, based on your interpretation of thisreport. (This may include seeking out more information from staff or other data sources; monitoring indicators morecarefully over the next few months; sharing the good news to raise morale or validate a QI project; convening a taskforce toinvestigate and improve certain indicators; and so on.)Source: The ACHS Clinical Indicator Program User Guide (2017)

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