Measuring the quality and safety of hospital care using specialty-specific indicators based on routinely collected administrative data: a feasibility study

Abstract

Using administrative data to measure the quality and safety of hospital care offers many opportunities. However, progress has been limited to few countries and predominantly to a small subset of broad measures, such as Hospital Standardised Mortality Rates. In this thesis, I investigate the potential advantages and feasibility – in terms of validity and applicability – of specialty-specific indicators. In the first part of my PhD work, I examine the case for specialty-specific indicators. I also present potential applications which overcome some of the existing shortcomings of previous uses of indicators based on administrative data. In the next stage of the project I focus on assessing feasibility by focusing on two specialties – stroke and obstetric care – conducting systematic reviews and consulting with experts to develop two indicator sets. As part of this, I identified the shortcomings in current use of indicators in these specialties. To investigate the limitations of these indicators, I applied the indicator definitions to English hospital administrative data (Hospital Episode Statistics, HES) and evaluated whether they can be used to discriminate between hospitals based on their performance and, importantly, to understand the effect of differences in coding practice. The final aspect of the research was to investigate alternative applications for the indicators which can overcome some of the shortcomings highlighted in both the prior analyses and existing literature. In doing so, I raise serious, robust shortcomings on the quality and safety of weekend care.