Performance assessmentA performance assessment framework is a

collation of statistics across a district or within a hospital and is far removed from the practice of an individual practitioner

Areas of performance monitoringHealth improvementHealth outcomes of health careFair access Effective delivery appropriate careEfficiency Patient /carer experience

Health improvementThis reflects the general aim of the health

service to improve the health of the population

Many factors beyond the health service influence the health of populations

Examples of health improvement indicatorsStandardized all-cause mortality ratio

(stratified by age)Cancer registration ratesDeaths from malignant neoplasmsDeaths from all circulatory diseases <75Deaths from suicideStandardized mortality rate from accidents

Health outcomes of healthcareThis measures the success of NHS in

reducing risk factors and level of disease, impairment and premature death and improvement in QoL for patients

Examples of health outcome indicators• Emergency admission in patients over 75 Y• Emergency psychiatric readmission• Infant mortality• 5 year survival rates (for cancers)• Avoidable mortality• Hospital deaths after surgery or heart attacks• Complications of treatments/ 28 day

emergency readmission rate

Fair access This measures the fairness of service

provision in relation to need, geography, socio-economic status, age, sex and ethnicity

ExamplesInpatient waiting lists to reflect variations in

the supply and demand for servicesRegistration of adults and children with

dentistsEarly detection of cancerDisease prevention(% of children immunized

in a district

Effective delivery of appropriate careThis is a measure of the extent to which local

services are clinically effective, appropriate to local health needs, timely and in line with evidence based standards

Examples Discharge from hospital within 65D after

emergency admission for stroke and 28D after fractured neck femur

Inappropriately used surgerySurgery rates- age standardized elective

rates for CABG total hip or knee replacement, cataract replacement

Early detection of cancer

Efficiency This measures the extent to which the NHS

provides efficient services, including cost per unit of care or outcome

Examples Case mix adjusted length of stayUnit cost of maternity serviceUnit cost of specialist mental health servicePercentage of generic prescribing

Patient/ carer experienceThe perception of responsiveness to

individual needs and preferencesThe continuity of service provisionPatient involvementGood information and choiceWaiting and accessibility

Clinical indicators“health outcome” and “health improvement”

indicators are influenced by many more factors than simply clinical care

It will be useful to gauge the quality of local health services

Examples of clinical indicators• Deaths in hospital within 30 days of surgery:

emergency and non emergency admission• Deaths in hospital within 30 days of emergency

admission with a hip fracture for patients 65Y and over

• Deaths in hospital within 30 days of emergency admission with a heart attack in patients with 50Y and over

• Emergency readmission to hospital within 28 day of discharge from hospital

• Discharge to usual place of residence within 56D of emergency admission from there with a stroke for patients aged 50 and over

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