Using data to improve quality of healthcare

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In virtually every major industry, quality improvement has been based on measuring and monitoring performance. There is good evidence to show that when processes and outcome data is measured and compared, improvements are made. Healthcare has been slow to introduce systematic measurement across the sector, however internationally this is rapidly changing. In Australia, we have data available to measure quality and safety; however it is not collected systematically or consistently between states and territories. Our aim is to develop a national set of high quality, credible indicators using existing data sources to measure healthcare performance in regard to safety and quality in clinical practice. We propose a “probes in the pudding” approach, where each probe measures the performance of one aspect of the healthcare system. Coded administrative hospital data collected mainly for financial reasons has potential to be used as quality indicators. However, to provide an accurate picture, indicators must take into account people’s risk factors over which the doctor has no control but which can influence outcome. For example, a hospital in an area surrounded by a principally elderly population would be more likely to have a higher death rate than a hospital admitting younger patients. In effect, indicators must compare apples with apples. We will further test ways in which clinical patient information databases can be linked to develop quality indicators. For example, by linking pharmacy data with hospital data we can monitor whether patients are receiving appropriate medication. The most reliable data for use in measuring quality exists in registries, which have been established for a number of procedures and conditions in Australia. We will investigate ways in which registries can be better standardised at a national level. We will compare registry data with administrative hospital data to investigate how quality indicators can be developed which provide an accurate picture of the health system. This program will succeed because it can be implemented at a low cost using data readily available in most Australian health settings. The group doing the research consists of consumer advocates and people with knowledge in the use of administrative data and registries, health policy, law, research design and statistics.