“It is about the delivery of evidence based care. The data that Clarity produces is really interesting, particularly regarding the reduction of mortality for orthopaedic surgery. Using this service we go through a shared decision making process and complete patient reported outcome measures, looking at the length of stay and recovery, which I feel is another really positive element of the programme.”
Advancing Quality is the flagship programme of AQuA. It aims to improve standards of healthcare provided in NHS hospitals across the North West of England and reduce variation. Focusing on several clinical areas which affect many patients in the region – heart attack, heart bypass surgery, heart failure, hip and knee replacement surgery, pneumonia, stroke, dementia and first episode psychosis – Advancing Quality works with clinicians to provide NHS trusts with a set of quality standards which define and measure good clinical practice. We started providing a Quality Improvement Service for Advancing Quality (AQ) and their participating trusts in January 2009. This service initially focussed on adult patients with pneumonia, hip and knee surgery, heart failure and acute myocardial infarction. As time has progressed and improvements have been made this service has evolved and now covers COPD, dementia, sepsis, stroke, coronary artery bypass grafting and first episode psychosis. The programme was begun by AQ in order that each measure of clinical quality is delivered to every patient to ensure that they receive the highest standard of care in hospital. Quality improvement, patient safety, evidence based medicine and clinical governance are now in common usage in modern medicine. National audits of clinical care in specific disease areas have been criticised for being slow, unresponsive to change and having variable data quality. In the past four years Advancing Quality and Clarity have been engaged in a project to address some of these concerns and to provide high quality data on evidence based measures. The initial concept was to improve the outcomes relating to secondary care in specific disease areas in the North West of England. In the past five years this has been used as a mechanism to demonstrate achievements as part of the national CQUIN achievements. The Clarity Informatics quality improvement service (QIS) is a whole system review of a clinical topic. This process comprises the following steps. We take the best current evidence to improve clinical outcomes. We consult with clinical leaders and arrive at series of measurable questions or indicators. We use pseudonymised information from SUS provided by trusts. This information is augmented by clinical data accessed by our web-based software tool. We collate this information in order generate reports which are then disseminated to clinicians to inform the process of improving quality of care. Trusts, clinicians and coders are provided with regular reports which allow them to review progress in each clinical topic being measured. The data is available as soon as it is processed and uploaded to our system. There are also reports which are visible on the website to assess progress. Overall trust performance reports are produced monthly. In addition there are regular clinical collaborative conferences in each of the clinical areas listed above where benchmarking data is available for all trusts and clinicians to discuss and review. Using our quality improvement service Clarity can demonstrate tangible benefits both in terms of lives saved, length of in-patient stay and cost reductions. This has been independently evaluated by the Universities of Manchester and Nottingham.  In patients suffering from Acute Myocardial Infarction adherence to the quality measures is associated with a 3.7% reduction in directly age standardised mortality rate in these patients. In Heart Failure patients’ good clinical evidence demonstrates a positive outcome benefit for patients prescribed ACEI/ARB medications. This research evidence is replicated in this analysis with a 5.5% reduction in the crude readmission rate for patients who pass this measure against those who fail. In Hip and Knee replacement surgery patients’ re-admissions overall have reduced over the period of this programme from an age standardised 9.1% in 2008 to 5.1% in 2012. In patients suffering from stroke we can demonstrate here is a statistically significant reduction in mortality of 3.3% between those patients measured to have received aspirin and those who failed to have this prescription. In pneumonia care there has been a 2.9% reduction in age standardised mortality in pneumonia over the lifetime of our programme. This is in line with the findings from the Manchester University study published in November 2012.
 Reduced Mortality with Hospital Pay for Performance in England available fromhttp://www.nejm.org/doi/full/10.1056/NEJMsa1114951  The cost-effectiveness of using financial incentives to improve provider qualityhttp://onlinelibrary.wiley.com/doi/10.1002/hec.2978/full