Concept Analysis

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Concept Analysis

Concept Analysis


In many countries, an increasing volume of information on the comparative performance of hospital services is entering the public domain and is available for patients and health professionals to use (Smith, 2002). In Europe, Scotland has pioneered the public release of clinical data and dates back to 1994 when the Clinical Resource and Audit Group (CRAG) began to publish risk adjusted clinical outcomes data for all hospital Trusts in Scotland. Five years later the Department of Health began publishing clinical outcome indicators for hospital Trusts in England and Wales as part of the Performance Assessment Framework (NHS Executive, 1999).

More recently, the government has set out plans to publish the 30-day mortality rates for cardiac surgeons in England and an independent company has started to report information on the comparative performance of National Health Service (NHS) hospital Trusts in the form of a Good Hospital Guide (Dr Foster, 2002). It is five years since the concept of clinical governance was introduced into the NHS and it might therefore be expected that significant use is made of such comparative performance data in assessing the quality of hospital care.

In spite of the considerable NHS resources now directed at recording, processing, analysing and reporting hospital performance and quality measures, it is remarkable that there has been no research conducted into how these data are used by general practitioners and their patients. The limited US evidence on this topic suggests that, although referring physicians are aware of hospital “report cards” and “physician profiles” only a small percentage report that these data influence their referral behaviour and it appears that an even smaller proportion discuss this information with their patients (Marshall, 2001; Schneider and Epstein, 1996; Marshall et al., 2000).

There are at least two key reasons why general practitioners may be expected to be interested in obtaining comparative data on the clinical performance of NHS hospital Trusts. First, in their role as gatekeepers, responsible for referring patients to secondary providers, they will use information on the quality of services to help make appropriate decisions. The renewed emphasis on enhancing patient choice in the NHS (Department of Health, 2001; Price and Pollock, 2002), emphasises their role in providing patients with reliable information on the comparative quality of providers. As comparative performance information can now be readily accessed by patients they may also seek professional guidance on how to interpret and use these data. Second, some general practitioners will also have a commissioning role and will influence the commissioning priorities of Primary Care Trusts. It is therefore likely they will be interested in obtaining information about the comparative clinical performance and quality of alternative providers.

Elsewhere we have explored the impact of published clinical outcomes data on NHS hospital Trusts (Mannion and Goddard, 2001). This article reports results from an empirical study which investigated the range and types of information used by general practitioners in Scotland to assess the quality of hospital services, especially the role of the CRAG clinical outcome indicators in ...
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