A focus on quality : improving health care in Scotland / [Scottish Executive Health Department].

  • Scotland. Health Department.
Date:
2001
Catalogue details

Licence: Open Government Licence

Credit: A focus on quality : improving health care in Scotland / [Scottish Executive Health Department]. Source: Wellcome Collection.

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    This approach will require new investment and careful implementation. However, it will improve the quality of the data available at all levels, as well as reducing bureaucracy by minimising the duplication of gathering information for both clinical care and national statistics. In this way, data which looks at aggregate trends and comparisons such as the clinical outcome indicators will become part of a much wider process, with staff in the NHS in Scotland continuously involved in monitoring and reacting to evidence about their own performance. Origins The Clinical Outcomes Working Group was set up by CRAG in 1992 to produce comparative clinical outcome indicators for Scotland (an earlier committee had clarified the desirable characteristics of such indicators). The Group was able to deliver the first clinical outcome indicators relatively quickly because of Scotland’s outstanding legacy of high quality national health care data sets: e in 1993, the first report showed indicators such as mortality within 30 days of admission with stroke at Health Board level” e in 1994, the first indicators at hospital and Trust level were published e indicators published since 1993 are set out below (see Figure 2) The basic pattern for Scotland's current configuration of national data sets was laid down in the 1960s. A commitment was made to hold centrally details of all patient admissions to NHSiS hospitals in electronic form, including patient identifiers such as name and date of birth to allow record linkage between different patient admission records. Cancer registration records already held patient identification details and a unique feature of the Scottish initiative was the involvement of the Registrar General for Scotland, which made extracts of death records available for linkage. In this way, there was potential for linkage between hospital admission records (eg to calculate readmission rates) and death records (to calculate mortality rates). During the 1970s and early 1980s, linkage was carried out primarily as a basis for epidemiological studies. In the late 1980s, it was decided to permanently link Scotland's centrally held data sets to produce summary histories of patient hospital experience and mortality. These patient histories allowed outcome indicators such as hospital survival rates to be calculated. Scotland's centrally held linked health data sets are equalled in very few other places in the world. The most valuable (but under recognised) aspect of Scotland's central data holdings are their high quality. Condensing the complexities of a patient's treatment in hospital to standard diagnostic and procedural codes that will allow comparative analysis is not an easy task. The fact that Scotland's national data holdings are of a sufficient quality to support the production of clinical outcome indicators is more than anything due to decades of painstaking work on the part of clinical coding staff. Again, this is an achievement with very few parallels elsewhere in the world. 18