For over 20 years, routine data sources such as the hospital episode statistics have been widely perceived as being of little value because of problems with completeness and accuracy, and the Department of Health has in the past dismissed their use for identifying poor quality services.
A paper published online by the BMJ today extends this theme to more general measures of clinical quality where death may not be the outcome.
The authors investigated whether routinely collected data from hospital episode statistics could be used to identify the gynaecologist Rodney Ledward, who was suspended in 1996 and was the subject of the Ritchie inquiry into quality and practice within the NHS.
The research team compared the performance of 142 gynaecology consultants with the performance of Ledward over a five year period, to determine if Ledward was a statistical outlier according to seven indicators from hospital episode statistics. The indicators were specifically chosen for their potential link with poor quality of service.
Their analysis identified Ledward as an outlier in three of the five years. Eight other consultants were also identified as outliers, but the researchers strongly caution against over-interpreting these consultants as having poor performance because valid reasons may exist that could credibly explain their results.
For example, cancer specialists may have high values for several indicators, such as surgical complications and long stays in hospital, because they carry out difficult operations on very ill patients, say the authors. The method therefore needs to be refined to deal with case mix variation.
"Further evaluation of our method is warranted, but our overall approach may be potentially useful in other settings, especially where performance entails several indicator variables," they conclude.
MEDICA.de; Source: British Medical Journal