Investigating the use of Hospital Episode Statistics data to measure variation in Performance and Quality in Colorectal Surgery
Author(s)
Burns, Elaine
Type
Thesis
Abstract
This thesis provides a comprehensive overview of general and subspecialist colorectal
surgery in England. It examines variation in provision and outcome of colorectal surgery in
structure, process and outcome factors at the patient, consultant team and NHS Trust levels.
Finally, this thesis examines the potential role of increasing surgical caseload to reduce any
demonstrable variation and improve outcome. To address these questions, current issues in
surgical quality as well as the coding accuracy reported in the published literature have been
reviewed. Colorectal resection and the more specialised procedure of restorative
proctocolectomy were examined from the Hospital Episode Statistics dataset. Novel
outcome measures were derived using longitudinal analysis. Regression analysis was used to
understand the predictors of process factors and outcome measures.
I have defined new outcome measures and demonstrated considerable variation in these new
measures and in more traditional accepted measures in both general and subspecialist
colorectal surgery from routinely collected datasets. Routinely collected data offer an
exciting potential data source for measuring performance and quality. If data accuracy can be
assured, measures such as reoperation may be used alongside established measures of quality
in a meaningful way to benchmarking performance of surgical providers. The methods
described in this thesis can be applied to a broad range of surgical specialties.
Though volume may have a role in determining outcome and reducing variation in
subspecialist colorectal surgery, it is by no means the panacea to improve quality across all
providers in general colorectal care. The impact of volume on outcome in more general colorectal surgery is less clear. Though centralisation is likely to have benefits, further
evidence of the optimum way to implement such changes is needed rather than
indiscriminately increasing volume across all providers for general colorectal surgical care.
surgery in England. It examines variation in provision and outcome of colorectal surgery in
structure, process and outcome factors at the patient, consultant team and NHS Trust levels.
Finally, this thesis examines the potential role of increasing surgical caseload to reduce any
demonstrable variation and improve outcome. To address these questions, current issues in
surgical quality as well as the coding accuracy reported in the published literature have been
reviewed. Colorectal resection and the more specialised procedure of restorative
proctocolectomy were examined from the Hospital Episode Statistics dataset. Novel
outcome measures were derived using longitudinal analysis. Regression analysis was used to
understand the predictors of process factors and outcome measures.
I have defined new outcome measures and demonstrated considerable variation in these new
measures and in more traditional accepted measures in both general and subspecialist
colorectal surgery from routinely collected datasets. Routinely collected data offer an
exciting potential data source for measuring performance and quality. If data accuracy can be
assured, measures such as reoperation may be used alongside established measures of quality
in a meaningful way to benchmarking performance of surgical providers. The methods
described in this thesis can be applied to a broad range of surgical specialties.
Though volume may have a role in determining outcome and reducing variation in
subspecialist colorectal surgery, it is by no means the panacea to improve quality across all
providers in general colorectal care. The impact of volume on outcome in more general colorectal surgery is less clear. Though centralisation is likely to have benefits, further
evidence of the optimum way to implement such changes is needed rather than
indiscriminately increasing volume across all providers for general colorectal surgical care.
Date Issued
2012
Date Awarded
2013-01
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Faiz, Omar
Aylin, Paul
Darzi, Ara
Publisher Department
Surgery and Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)