Authors:
Sue M Evans PhD, Ian A Scott MEd, MHA, FRACP, Niall P Johnson PhD, Peter A Cameron MB BS, MD, FACEM, John J McNeil MSc, PhD, FRACP
Abstract
- Australia is developing a national performance framework aimed at measuring health outcomes across the health system.
- Clinical registries provide a clinically credible means of monitoring health care processes and outcomes, yet only five Australian registries currently have national coverage.
- At a national level, clinical registry development should be prioritised to target conditions or procedures that are suspected of being associated with large variations in processes or outcomes of care and that impact significantly on health care costs and patient morbidity.
- Registries should also aim to capture information across care interfaces and to monitor the medium and long-term safety and effectiveness of specific devices, procedures and drugs.
The final report of the National Health and Hospitals Reform Commission, released in 2009, recommended that, in promoting better quality care, “we have systems in place to provide comparative clinical performance data back to health services and hospitals, clinical units and clinicians.”1
Also in 2009, the Australian Institute of Health and Welfare (AIHW) released a report proposing 55 quality indicators for national reporting on safety and quality (Box).2 However, of the 31 hospital and specialised health service-specific indicators, only two indicators (22 and 25) are currently being reported nationally.3 Most cannot be measured in an epidemiologically sound manner (ie, reproducibly and accurately) within the available routinely collected data sources without extensive development of both the indicator and the systems to collect it.2 Most importantly, the AIHW indicators omit key outcome measures for hospital activities associated with high cost, such as cardiac surgery, trauma care and intensive care, where poor quality care can impose a significant ongoing burden on the community.
Given these deficiencies, attention has turned towards developing clinical registries from which robust quality indicators can be derived.4 In this article, we outline the rationale for developing registries, and a framework to ensure they are strategically developed to provide the best return on investment.