Performance assessment A performance assessment framework is a collation of statistics across a district or within a hospital and is far removed from the practice of an individual practitioner

Areas of performance monitoring Health improvement Health outcomes of health care Fair access Effective delivery appropriate care Efficiency Patient /carer experience

Health improvement This reflects the general aim of the health service to improve the health of the population Many factors beyond the health service influence the health of populations

Examples of health improvement indicators Standardized all-cause mortality ratio (stratified by age) Cancer registration rates Deaths from malignant neoplasms Deaths from all circulatory diseases <75 Deaths from suicide Standardized mortality rate from accidents

Health outcomes of healthcare This measures the success of NHS in reducing risk factors and level of disease, impairment and premature death and improvement in QoL for patients

Examples of health outcome indicators Emergency admission in patients over 75 Y Emergency psychiatric readmission Infant mortality 5 year survival rates (for cancers) Avoidable mortality Hospital deaths after surgery or heart attacks Complications of treatments/ 28 day emergency readmission rate

Fair access This measures the fairness of service provision in relation to need, geography, socio-economic status, age, sex and ethnicity

Examples Inpatient waiting lists to reflect variations in the supply and demand for services Registration of adults and children with dentists Early detection of cancer Disease prevention(% of children immunized in a district

Effective delivery of appropriate care This is a measure of the extent to which local services are clinically effective, appropriate to local health needs, timely and in line with evidence based standards

Examples Discharge from hospital within 65D after emergency admission for stroke and 28D after fractured neck femur Inappropriately used surgery Surgery rates- age standardized elective rates for CABG total hip or knee replacement, cataract replacement Early detection of cancer

Efficiency This measures the extent to which the NHS provides efficient services, including cost per unit of care or outcome

Examples Case mix adjusted length of stay Unit cost of maternity service Unit cost of specialist mental health service Percentage of generic prescribing

Patient/ carer experience The perception of responsiveness to individual needs and preferences The continuity of service provision Patient involvement Good information and choice Waiting and accessibility

Clinical indicators “health outcome” and “health improvement” indicators are influenced by many more factors than simply clinical care It will be useful to gauge the quality of local health services

Examples of clinical indicators Deaths in hospital within 30 days of surgery: emergency and non emergency admission Deaths in hospital within 30 days of emergency admission with a hip fracture for patients 65Y and over Deaths in hospital within 30 days of emergency admission with a heart attack in patients with 50Y and over Emergency readmission to hospital within 28 day of discharge from hospital Discharge to usual place of residence within 56D of emergency admission from there with a stroke for patients aged 50 and over

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