mortality indicators and acute trust quality - ian diley
DESCRIPTION
PHREE Spring Conference 2014TRANSCRIPT
Mortality indicators and Acute Trust qualityIs mortality a good indicator of the clinical quality of NHS hospitals? A cross sectional study of outlier trusts for mortality indices using quality dashboards
Ian Diley – Public Health Registrar, East of EnglandDr Padmanabhan Badrinath – Consultant in Public Health Medicine, Suffolk County CouncilDr Sarah Annon – Foundation Doctor, East of England
BasildonBlackpool
BuckinghamshireBurton
ColchesterDudley
East LancashireGeorge Eliot
MedwayNorthern Lincolnshire
North CumbriaSherwoodTameside
United Lincolnshire
Objectives• Are high mortality indices results associated with increased
numbers of quality alerts/alarms?
Design• Comparison between Keogh Review trusts and all NHS acute
trusts: proportion of ATQD indicators rated amber or red (alert/alarm)
Participants and Setting• All NHS acute trusts in England
Main outcome measure• Proportion of alerts and alarms identified in Summer 2013
ATQD
100%
50%
Results
Ranked results for all acute trusts in England for the proportion of combined amber and red, and green rated results in the Summer 2013 Acute Trust Quality Dashboard
0%
Better Worse
Proportion of alert/alarm results
Proportion of better than expected results
Proportion of as expected results
Keogh Review trust
NHS Acute trusts
Overall Red results Red or amber results Green results
Sum Proportion (95% CI) Sum Proportion (95% CI) Sum Proportion (95% CI)
Keogh Review trust indicators
n=1,278
139 10.9% (9.2% - 12.6%) 185 14.5% (12.6% - 16.4%) 269 21.1% (18.9% - 23.3%)
All acute trust indicators
n=11,838
1,213 10.3% (9.7% - 10.9%) 1,664 14.1% (13.5% - 14.7%) 2,635 22.3% (21.5% - 23.1%)
Overall Red results Red or amber results Green results
Sum Proportion (95% CI) Sum Proportion (95% CI) Sum Proportion (95% CI)
Keogh Review trust indicators
n=1,278
139 10.9% (9.2% - 12.6%) 185 14.5% (12.6% - 16.4%) 269 21.1% (18.9% - 23.3%)
All acute trust indicators
n=11,838
1,213 10.3% (9.7% - 10.9%) 1,664 14.1% (13.5% - 14.7%) 2,635 22.3% (21.5% - 23.1%)
Domain 1 Red results Red or amber results Green resultsSum Proportion (95% CI) Sum Proportion (95% CI) Sum Proportion (95% CI)
Keogh Review trust indicators
n=209
23 11.0% (0%-23.8%) 30 14.4% (9.7%-19.1%) 18 8.6% (0%-21.5%)
All acute trust indicators
n=1,934
80 4.1% (1.9%-8.5%) 133 6.9% (5.7%-8.1%) 249 12.9% (8.7%-17.0%)
Domain 3
Keogh Review trust indicators
n=385
11 2.9% (0%-12.7%) 23 6.0% (3.6%-8.4%) 54 14.0% (4.8%-23.2%)
All acute trust indicators
n=3,498
197 5.6% (2.4%-8.9%) 340 9.7% (8.7%-10.7%) 472 13.5% (10.4%-16.6%)
Domain 1 – Preventing people from dying prematurely; Domain 3 – Helping people to recover from episodes of ill health or following injury
Conclusions
No evidence that Keogh Review trusts were quality outliers (as defined by ATQD)
Conclusions
No evidence that Keogh Review trusts were quality outliers (as defined by ATQD)
i.e. no association between persistent excess mortality rates and poor performance on the ATQD
Conclusions
No evidence that Keogh Review trusts were quality outliers (as defined by ATQD)
Primary/community care no poorer in Keogh Review trust localities
i.e. no association between persistent excess mortality rates and poor performance on the ATQD
Conclusions
No evidence that Keogh Review trusts were quality outliers (as defined by ATQD)
Primary/community care no poorer in Keogh Review trust localities
Mortality indicators alone are not good markers of care quality
i.e. no association between persistent excess mortality rates and poor performance on the ATQD
Conclusions
No evidence that Keogh Review trusts were quality outliers (as defined by ATQD)
Primary/community care no poorer in Keogh Review trust localities
Mortality indicators alone are not good markers of care quality
Future quality monitoring systems should follow depth used in Keogh method
i.e. no association between persistent excess mortality rates and poor performance on the ATQD