Press: Popularising hospital performance data

Abstract

esistance to the health reforms of the 1990s has taken many forms, but among general practitioners a recurrent theme has been the threat to personal care and the doctor-patient relationship. Matthews and Bain have set out to show us what it means to be a family doctor in Scotland, in the words of 11 general practitioners practising in a variety of settings. These chatty interview accounts of general practice in deprived inner cities, suburbs, rural villages, and remote Scottish islands and highlands vividly illustrate the meaning of personal care.

Using hierarchical models to analyse clinical indicators: a comparison of the gamma-Poisson and beta-binomial models

“…Competition arising from the publication of league tables can create perverse incentives [4,19]. For example, doctors, health care providers and hospitals may be enticed to fabricate or manipulate their data or alternatively take`lower risk' patients to improve their reported performance [2,4,12,20].…”

“…A more conservative significance level may be used but this increases the widths of the confidence intervals. The confidence intervals for the hospitals at the top and bottom of some performance tables overlap and publishing tables ranking the performances can be meaningless [17,20,25,26].…”

Comparison of Surgical Risk Score, POSSUM and p-POSSUM in higher-risk surgical patients

“…Surgeons are under increasing pressure to release measures of outcome to enable monitoring of the quality of healthcare delivery1. The impetus for this has been clinical governance, recent media attention on surgical outcomes and requirements for revalidation1–4. Surgical audit, involving morbidity and mortality as a minimum, is routine in most surgical units5.…”

Promoting normality in childbirth

“…Unfortunately, with ranking of performance, there is an implicit assumption that providers located towards the bottom provide a worse service. A cult of naming and shaming "poor performers" has evolved, 13 with blame often apportioned to individuals. Such apportioning of blame is generally unfair as it ignores the fact that modern medicine is a complex process and that outcomes are influenced by referral patterns, team responsibilities, and the availability of paramedical and other resources.…”