An outlier is a consultant whose clinical outcomes data lies outside of the expected range, which is based on the national average. This may be due to data quality/completeness, unusual or complex patient casemix that cannot be adjusted for risk or performance issues.
There will inevitably be a small number of outliers, which is where the consultant’s data is outside an expected range. It is really important that people understand that somebody could be an outlier because they take on difficult cases. It doesn’t necessarily mean there is a performance issue. Where someone is an outlier, it is important that expert colleagues review the data so that the issued are properly understood by all.
Outlier policies are defined and professionally led by the specialist societies/audit suppliers. HQIP has developed guidance related to Individual Outlier Management.
The publication of consultant outcomes data has stimulated specialist societies to take ownership of the setting and monitoring of clinical standards, including drawing up and implementing outlier policies and improving clinical governance. These developments will protect patients and improve quality.
Each specialty has been asked to publish data showing, for each consultant, how many times they have performed a procedure and what their mortality rate is for that procedure
Each specialty has decided which procedures to include, and what measure of mortality to show, based upon what is most relevant to their patients and what data are collected
Some specialties have published additional information. For example, Urology have decided to specifically published details on length of stay in hospital and Thyroid and Endocrine have decided to publish ‘readmission to hospital’ as an outcome indicator. In future, it is expected that specialties should publish more data as the process evolves
Data is will be refreshed annually
This initiative relates to England only. Some audits that collect UK-wide data will be publishing data for consultants practicing in Scotland, Wales and/or Northern Ireland where those consultants have given permission for their data to be included
It is expected that the results of this data will reassure patients that the quality of clinical care is high
Variation within the expected range is relatively small and could be due to a number of factors. It would therefore not be reliable to ‘rank’ consultant performance using the data
The publication of this data will help assist patients in having an informed conversation with their consultant or GP about the procedure or operation they are due to have
All individual analyses are supported by thorough narratives explaining how to understand results
This ‘pilot approach’ to presenting data will generate a variety of examples from which best practice can be determined going forward in consultation with patients and thorough robust research
NHS Choices, a site with extensive experience in presenting information in a way that patients and the public can understand, is acting as the central hub of information
Specialist societies and audits are being encouraged to be innovative in the way that data are presented in this first instance, so presentation of results among specialties differs slightly. However, most patients will be interested in viewing the specialty relevant to them, so adverse effects of their being different from one another should be minimal
Where possible, data are adjusted to take into consideration the risk of a procedure on patients with different risk factors.
Improvements in risk adjustment methodologies will be stimulated by putting data into the public domain and HQIP is currently developing guidance to guide audits in COP in relation to risk-adjustment methods and development.