Detection and management of outliers for national clinical audits: Implementation guide for NCAPOP providers
The latest version of the ‘Detection and management of outliers for National Clinical Audits’ was published in May 2017. This was designed to be usable for all National Clinical Audits. This new document provides additional further guidance specifically for National Clinical Audit and Patient Outcomes Programme (NCAPOP) providers. It outlines our expectations of NCAPOP providers in relation to outliers and gives further detail on how NCAPOP providers might put the guidance into practice.
Outlier analyses have traditionally been considered primarily a quality assurance activity. The effective operation of an outlier policy also provides opportunities for national clinical audits to support quality improvement. Whilst other less restrictive approaches to differentiating healthcare providers (e.g. quartile ranges) provide a wider scope for supporting quality improvement, outlier based approaches still make an important contribution. Healthcare providers need to demonstrate that they have taken appropriate steps to investigate and respond appropriately and proportionately to outliers. Outliers can help to inform local quality improvement by targeting efforts and inform monitoring of improvement or decline over time.
The latest version of the ‘Detection and management of outliers for National Clinical Audits’ updated the 2011 Department of Health guidance ‘Detection and Management of Outliers for National Clinical Audits’. It explains the expectations required of national clinical audit providers and healthcare provider organisations in relation to the identification of outliers by national clinical audits and comes into force in relation to any data from patient cohorts with a collection start starting from November 2017. We consulted with NHS England, the National Advisory Group on Clinical Audit and Enquiries (NAGCAE), NHS Improvement and the Care Quality Commission as part of our revision of the guidance. It is applicable to all NCAs, whether or not they are commissioned as part of the NCAPOP programme and is therefore necessarily broad.
The HQIP NCAPOP programme team has produced this further additional guidance for the NCAPOP providers describing our expectations as commissioners. Key points from this supplementary guidance include the requirement to notify HQIP of any confirmed alarm level outliers and further advice regarding our expectations of how NCAPOP providers should develop their working relationship with CQC.
In October 2018 additional implementation guidance for outliers in Wales was produced.
To download a copy of each guide click on the links below: