Clinical quality registries: urgent reform is required to enable best practice and best care

Abstract

Clinical quality registries (CQRs) systematically collect data on pre‐agreed markers of quality of care for a given procedure, that can be reliably and reproducibly defined and collected across multiple sites. Data is then risk adjusted, and comparisons may be used to benchmark performance. These data then inform quality improvement initiatives. CQRs require an overarching independent governance structure and surety of funding. CQRs rely upon whole of population enrolment to minimize the risk of selection bias, and often rely on the secondary use of sensitive health information, meaning that the processes for ethical review and consent to participation are different to clinical trials. Despite several local examples of CQR improving practice in Australia and Aotearoa New Zealand, providing substantial cost–benefit to the community, there remain significant barriers to CQR implementation and functions. These include the difficulty of accurate data capture, lack of a fit for purpose ethical review system, the constraints of existing Qualified Privilege legislations and the need for protected funding. Whilst the Australian Government has released a 10‐year strategy for CQR reform, and the Aotearoa New Zealand Government has included registries in the planned Health New Zealand reforms for the public sector, we believe more urgent implementation of strategies to overcome these barriers is needed if CQRs are to have the impact on quality of care our Communities deserve.

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“…Registries monitor outcomes for numerous and varied patient populations, including specific diseases, events and medical procedures 3–5. A common purpose of such clinical registries is to monitor the quality of participating healthcare providers, including health systems, sites and individual medical practitioners, to identify underperformers that can be targeted for quality improvement 2 6–8…”

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“…These data can be used to improve the quality of care by identifying deviations in clinical outcomes. 5 They can also be used to measure the efficiency and costeffectiveness of a healthcare system. 6 The length of hospital stay (LOS) is a globally accepted indicator of hospital efficiency that clinical quality registries can readily calculate and collect.…”

“…Clinical quality registries collate and benchmark indicators of quality of care across healthcare systems. These data can be used to improve the quality of care by identifying deviations in clinical outcomes 5 . They can also be used to measure the efficiency and cost‐effectiveness of a healthcare system 6 …”

“…These data can be used to improve the quality of care by identifying deviations in clinical outcomes. 5 They can also be used to measure the efficiency and cost‐effectiveness of a healthcare system. 6 …”