Outlier management for National Clinical Audits

Current guidance for England and Wales

Updated 03/01/2024: ‘NCAPOP Outlier Guidance, Identification and Management of Outliers’

HQIP has updated the outlier guidance for HQIP-commissioned audits operating in England and Wales in collaboration with NCAPOP providers, NHS England, the Care Quality Commission and Welsh Government. It is expected that the guidance will be applied in full for audit cycles beginning after January 2024. In addition, providers are asked to adopt any of the process changes where practically possible, within audit cycles that are already underway in January 2024.

• HQIP outlier guidance, updated 21 Feb 2024 (pdf)
• CQC notification template (Excel file)

The following table highlights the changes that have been made in the 3 Jan 2024 version:

• Table of changes (pdf)

Previous guidance

Updated 02/09/2021: outlier escalation guidance for England and Wales (post-COVID-19 pandemic)

HQIP has updated the outlier guidance for HQIP-commissioned audits operating in England and Wales in collaboration with NHS England/Improvement, the Care Quality Commission and Welsh Government. The guidance applies to any data from patient cohorts with a collection starting from 01/11/2017 (England) and from 01/11/2018 (Wales).

• HQIP outlier guidance 2 Sept 2021

Updated 14/07/2020: outlier escalation guidance for England and Wales during the COVID-19 pandemic

HQIP has modified the outlier management notification stages for alarms (i.e. Table 1) for HQIP-commissioned audits operating in England and Wales in collaboration with NHS England/Improvement, the Care Quality Commission and Welsh Government.

• Guidance on modifying outlier escalation processes during the pandemic in England
• Guidance on modifying outlier escalation processes during the pandemic in Wales

For information about the standard outlier process, please see the post-COVID-19 outlier management information above.

Updated 02/04/2020 (see section 10):

HQIP COVID-19 guidance to NCAPOP (audit and CORP) Providers

Pre-COVID-19:

Outlier management can help to inform local quality improvement by targeting efforts and monitoring improvement or decline over time. All National Clinical Audits in the NCAPOP should:

1. Once established, undertake outlier analyses and notification for each national reporting cycle

2. Develop and follow a project-specific outlier policy which should be available publicly on their project webpage. This is normally based on the HQIP guidance.

The outlier guidance applies to:

• Comparisons of healthcare providers (general practices, hospitals, trusts, clinical networks, but not individual practitioners) using batches of data collected over an appropriate defined period (and not continuous monitoring); and
• Both outcome and process measures of performance (referred to as ‘performance indicators’)

Building on successful examples of sharing ‘alert’ level data, HQIP agreed to support extending ‘alert’ level data across all NCAPOP audits as appropriate.

For further information, NCAPOP audits should consult the HQIP Provider Technical Manual.