1. October 2004 Screening and Surveillance of routine data Adrian Cook

2. 2 Outline What is the Healthcare Commission who we are, what we do, screening/surveillance Methods of Analysis data, funnel plots, process control Applications inspections, investigations Example

3. 3 Who we are Commission for Healthcare Audit and Inspection (CHAI) Health and Social Care Act 2003, started 1 April 2004 Commission for Health Improvement CHI National Care Standards Council NCSC Audit Commission Healthcare Commission 550 staff, 100 in information and analysis

4. 4 What we do Exists to promote improvements in the quality of NHS and independent healthcare across England and Wales Patient and Staff Surveys Clinical Audit Complaints State of Healthcare Report Acute Hospital Portfolio InspectionsInvestigations Star ratings

5. 5 Screening and Surveillance Screening analysis of data to target inspections Surveillance ongoing, background monitoring of routinely- collected data, used to initiate work

6. 6 Data and Types of Analysis Mortality, including post-discharge Readmissions, length of stay Outcomes Unit of analysis Trust, specialty, consultant team Techniques Indirect standardisation Adjustment for overdispersion HES safe haven ONS linked deaths Birth registrations Death registrations Compendium Surveys

7. 7 Methods of Analysis – funnel plots Comparisons between institutions

8. 8 Methods of Analysis – funnel plots Comparisons between institutions

9. 9 Analysis – statistical process control Analysis within an organisation, over time Warning Alarm

10. 10 Applications – targeted inspections HES Compendium AHP Surveys +++ DH developmental standards Domain scores Indicators Analysis Criteria Screening

11. 11 Applications - Investigations HES ONS Extract from trust Initial request Preliminary Analysis No further action Detailed Analysis Investigation Surveillance

12. 12 Example - General surgery mortality Comparison between institutions

13. 13 Example - General surgery mortality Comparison between consultant teams

14. 14 Consultant team 1

15. 15 Consultant team 2

16. 16 Summary Lots of activity Promising methods Screening/Surveillance needs validation Comments welcome

17. 17 THANK YOU