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Simplistic Good and Bad Care Ratings Misleading to True Hospital Performance, Warns Ardentia

by Steve BogdonThursday, December 3, 2009

02 December, 2009 - Judging the quality of healthcare delivery based on an overall “good” or “bad” rating is both simplistic and misleading to the true performance of hospitals and acute care provision, warns Ardentia.

Recent ratings published by Doctor Foster Intelligence, which identified England’s “12 worst performing hospitals”, are based on just fifteen indicators across seven areas of healthcare.  The NHS is currently unable to provide data on a more comprehensive range of data, which would make the ratings more meaningful.

While national data sources offer a rough estimate of performance they are not refined enough or comprehensive enough to support meaningful judgments on whole hospitals.  Patient and service level reporting is crucial if trusts are to get a true indication of which areas are performing well, and where improvements can be made.

According to Ardentia, publishing potentially misleading results can lead to deeply unfair criticism of hospitals whose performance when measured by other and fuller indicators is entirely commendable.  There are many additional indicators that need to be considered in assessing a hospital’s quality, and there are areas where reporting on current indicators could be improved, such as readmissions and mortality reporting.

Mortality rates seem on face value a good indicator of poor quality, but they are notoriously difficult to use. On its own admission, DFI is only looking at deaths in hospital.  On this measure, discharging patients early or transferring them to another institution just before they died would produce a significantly understated mortality rate, resulting in a distorted picture of care quality based solely on crude death rates. Unfortunately, the information we ought to use, on deaths not just in hospital but also up to some weeks after discharge, is simply not available.

David Beeson, development director at Ardentia said: “Doctor Foster is doing a good job with the data available.  The issue is that we simply don’t have the quality or quantity of data needed to measure performance accurately and meaningfully.  Hospitals don’t fall simply into the categories ‘good’ or ‘bad’.  A hospital which is outstanding in orthopaedics may be weak in cardiology. Whole hospital comparisons make no sense: you need to go down at least to the level of individual specialties.

“Even specialties, however, may cover too wide a range. An excellent consultant may be working alongside another in the same specialty who practices different techniques.  It may be more useful to compare consultants than specialties – and we might have to go deeper still, to compare how individual consultants treat specific conditions: a consultant who is excellent in one area may be weaker in another.”

According to Ardentia, NHS suppliers must play a greater role in working together with trusts to improve the quality and quantity of data recorded, in order to get a more detailed indication of performance at a speciality or consultant level, which will help to drive real improvement.

Beeson added: “As the leading supplier of business intelligence tools to the NHS, we believe strongly that providers of information services or tools should be giving NHS organisations themselves the means to improve healthcare quality based on reliable evidence on their performance. If national or local analysis generates indicators that are of concern, our job is to assist the organisations to interpret the information so that they can deal with any anomaly.”

About Ardentia

Stafford based Ardentia employs 58 staff and works exclusively on the delivery of software for healthcare. With over 100 clients in the NHS, it is the largest dedicated supplier of such systems, with customers at all levels of the health service: hospital trusts, Primary Care Trusts, Strategic Health Authorities and national service suppliers such as Connecting for Health.
www.ardentia.co.uk

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