The Guidelines and performance measures allow us to reduce variation in the provision of care and to provide reassurance to all that care is optimum.
In England we continue to look at clinical performance and have focused of the three main tenants of quality; clinical effectiveness, safety and patient experience from institution down to individual. Institutional effectiveness has been looked at in relation to targets which are “must do”, such as primary angioplasty times (previously thrombolysis) and performance against standards such as time to scan for stroke. Next come such measures as the percentage of patients admitted to a dedicated stroke unit and the use of cognitive behavioural interventions. In relation to individual performance, we have looked at mortality rates following open-heart surgery. This year, under the government’s transparency agenda, individual results are to be published from additional national interventional audits. More are to follow and virtually all the national audits and registries will be published with a high degree of granularity in the next few years.
In primary care the quality and outcomes framework, which is a remuneration package for primary care physicians, is used to manage performance and has driven up the quality of the services offered. It is based on a basket of process measures, which are managed by the National Institute for Health and Care Excellence (NICE), and are renegotiated to drive increasing improvement that is evident by improved performance against the indicators.
With recent changes in government policy, increasing interest has focused on the quality of commissioning and measures have been derived from NICE Quality Standards (in effect an amalgamation of guidelines into 12 standards) to assess this. Further, with the introduction in the UK this year of medical revalidation, there is an increased emphasis on individual information to support re licensing.
Overall, therefore, we have a dual track of the increasing development of guidance and the condensation of these into easily manageable standards and the measurement of performance, at many levels, against these standards.
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