Mortality Indicators and Acute Trust Quality - Ian Diley

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

Any [email protected]