Intelligent information: a national system for monitoring clinical performance

Health Serv Res. 2008 Feb;43(1 Pt 1):10-31. doi: 10.1111/j.1475-6773.2007.00742.x.


Objective: To use statistical process control charts to monitor in-hospital outcomes at the hospital level for a wide range of procedures and diagnoses.

Data sources: Routine English hospital admissions data.

Study design: Retrospective analysis using risk-adjusted log-likelihood cumulative sum (CUSUM) charts, comparing each hospital with the national average and its peers for in-hospital mortality, length of stay, and emergency readmission within 28 days.

Data collection: Data were derived from the Department of Health administrative hospital admissions database, with monthly uploads from the clearing service.

Principal findings: The tool is currently being used by nearly 100 hospitals and also a number of primary care trusts responsible for purchasing hospital care. It monitors around 80 percent of admissions and in-hospital deaths. Case-mix adjustment gives values for the area under the receiver operating characteristic curve between 0.60 and 0.86 for mortality, but the values were poorer for readmission.

Conclusions: CUSUMs are a promising management tool for managers and clinicians for driving improvement in hospital performance for a range of outcomes, and interactive presentation via a web-based front end has been well received by users. Our methods act as a focus for intelligently directed clinical audit with the real potential to improve outcomes, but wider availability and prospective monitoring are required to fully assess the method's utility.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Benchmarking
  • Databases as Topic
  • Diagnosis-Related Groups
  • Efficiency, Organizational
  • Hospital Information Systems*
  • Hospital Mortality
  • Hospitalization / statistics & numerical data*
  • Hospitals, Public / standards*
  • Hospitals, Public / statistics & numerical data
  • Humans
  • Length of Stay
  • Medical Audit
  • Outcome Assessment, Health Care / methods*
  • Program Development
  • Public Health Informatics*
  • Retrospective Studies
  • State Medicine / standards
  • State Medicine / statistics & numerical data
  • United Kingdom / epidemiology