Data is too raw for open publication
A Private Healthcare Information Network report last month said there will be a limit to the amount of information that will be freely available to the public about independent practitioners’ private patient outcomes. Although consultants have welcomed this pledge, what does all this mean for them now? Jonathan Finney explains.
The focus behind the new Private Healthcare Information Network (PHIN) document is to ensure that not only is the information published on time, but that it:
Is understandable to both patients and clinicians;
Is statistically valid;
Allows comparisons between healthcare providers to inform patient choice.
As PHIN chief executive Dr Ian Gargan has pointed out, contextualisation of performance information is important.
Dr Ian Gargan
He said: ‘If we published all of the data today like a league table within schools, the patient would just look at the outcome of the mortality of a particular consultant, and they would say that consultant doesn’t have the outcome they want.
‘But that consultant might have dedicated their life to really complex cases like gynaecological surgery, so he shouldn’t, for example, be compared to a surgeon like me, who has specialised in wrists and knees – which is pretty rudimentary in comparison – so my mortality would be low.’
PHIN remains committed to the principle of publishing information for use by patients, but, as set out in detail in the document, that will be contingent on factors such as the quality and statistical power of the inbound data.
Meanwhile, it will continue to publish more detailed and wider-ranging information on its hospital and consultant ‘portal’ – which can only be accessed by those with the required permission.
The evidence-based assessment
The evidence-based assessment (EBA) presents the results of an assessment project, along with the recommendations for publication of each of the measures contained in Article 21 of the Competition and Markets Authority’s Private Healthcare Order at national, hospital and consultant level.
The document was produced following six months of discussion in a working group involving PHIN’s members and other stakeholders.
It also invited contributions, via a focused engagement and consultation process, to make sure there is sector-wide understanding of what these recommendations and guiding principles mean in practice and that the proposals have the support of our stakeholders.
What do recommendations mean for consultants?
The full EBA is available on PHIN’s website, but here we take a look at the measures that are impacted by the recommendations. These will be kept under review with stakeholders.
Length of stay measure
While the measure already published meets the requirements of the Order, PHIN was looking to enhance the information presented to further aid patient comparisons – for example, by introducing new views of the information, trends and by including case-mix adjustment.
Those ambitions remain, but, for now, it is not possible to include case-mix adjustment due to the lack of available case-mix models and under-reporting of case-mix variables, such as comorbidities and ethnicity.
However, PHIN believes publication on its portal will help drive up the quality and completeness of the required diagnostic information and can be used by hospitals and consultants for quality improvement.
Adverse event measures and PROMs
A similar lack of case-mix models and data completion at present limit what PHIN can meaningfully publish on various incidents at consultant level.
These currently include surgical site infections, re-admissions and mortalities per procedure.
As ‘unplanned transfers’ relate to processes at a hospital level rather than at consultant level, this may not currently be publicly reported at procedure level. ‘Adverse events’ (‘never events’ and ‘serious injuries’) also reflect system-wide safety issues, so publication at consultant level is not appropriate.
However, information will be presented about the sites at which a specific consultant works. For ‘returns to theatre’, rates at procedure level (‘as expected’) and rates including case-mix adjustment will be published when possible.
Patient-Reported Outcomes Measures (PROMs) are a very important measure of satisfaction – or the lack of it – but there is not the data coverage to support publication for patients yet.
For each of these measures, the EBA says that consultants should have access to the information attributed to their practice in the PHIN portal and have the opportunity to audit and review as appropriate.
Transparency and trust
It may be possible to publish more information for patients in the future.
For now, PHIN hopes that the approach set out in the EBA will reassure consultants that this will be done only when the data is of sufficient quality, the clinical methods are available and the information can be meaningfully used and understood in context.
Publication on the PHIN portal meanwhile will allow hospitals and consultants to address any potential issues identified by the information, without inadvertently causing harm through misinterpretation of data or a lack of context.
We will continue to support consultants and other stakeholders to achieve the ambitions of the CMA Order, improve patient understanding and choice and make information transparent, accurate and meaningful.
Jonathan Finney (right) is member services director at the Private Healthcare Information Network
