Using routine intelligence to target inspection of healthcare providers in England
Using routine intelligence to target inspection of healthcare providers in England
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DOI：
10.1136/qshc.2007.024802
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发表时间：
2009-06-01
影响因子：
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通讯作者：
Bharania, S.
中科院分区：
文献类型：
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作者：
Bardsley, M.;Spiegelhalter, D. J.;Bharania, S.
背景资料：英格兰国家卫生服务的国家监管机构医疗保健委员会必须评估提供者（NHS trusts）对符合核心标准的方式，针对适当的地方检查资源。Objectives：开发和评估系统，针对检查在2006年的44个标准，在567个医疗机构。广泛的现有信息被组织成一系列与标准对应的指标（称为项目）。每个项目都在一个共同的量表（修改后的Z分数）上进行评分，这些分数被汇总，以表明所有信托和标准的未申报不合规风险。此外，当地的定性情报进行编码和scored.Results：使用的信息集包括463 875观察结构在1689个具体项目，来自83个不同的数据流。对10%风险评分最高的信托（该信托已宣布遵守标准）和另外10%的信托进行了后续检查，这些信托从其余信托中随机选择。确定目标的成功与否是通过检查后“合格”的信任声明的数量来衡量的。在基于风险的样本中，检验标准合格的比例（26%）显著高于随机样本（13%）。针对不同的标准和护理sectors.Conclusion之间的成功率：这种创新的方法，利用信息，有针对性的检查活动实现了其总体目标。这一方法在某些标准和某些情况下比在其他情况下效果更好，目前正在根据取得的经验加以改进。随着现代监管机构努力在其活动中做到有的放矢和相称，这类应用日益重要。
Background: The Healthcare Commission, the national regulator for the National Health Service in England, has to assess providers (NHS trusts) on compliance with core standards in a way that targets appropriate local inspection resources.Objectives: To develop and evaluate a system for targeting inspections in 2006 of 44 standards in 567 healthcare organisations.Methods: A wide range of available information was structured as a series of indicators (called items) that mapped to the standards. Each item was scored on a common scale (a modified Z-score), and these scores were aggregated to indicate risks of undeclared noncompliance for all trusts and standards. In addition, local qualitative intelligence was coded and scored.Results: The information sets used comprised 463 875 observations structured in 1689 specific items, drawn from 83 different data streams. Follow-up inspections were undertaken on the 10% of trusts with the highest-risk scores (where the trust had declared compliance with a standard) and an additional 10% of trusts randomly selected from the remainder. The success of the targeting was measured by the number of trust declarations that were "qualified" following inspection. In the risk-based sample, the proportion of inspected standards that were qualified (26%) was significantly higher than in the random sample (13%). The success rate for targeting varied between standards and care sectors.Conclusion: This innovative approach to using information to target inspection activity achieved its overall aims. The method worked better for some standards and in some settings than for others, and is being improved in the light of experience gained. Such applications are increasingly important as modern regulators strive to be targeted and proportionate in their activities.