Investigating the use of hospital episode statistics data to measure variation in performance and quality in colorectal surgery

• Main Author: Burns, Elaine
• Other Authors: Faiz, Omar ; Aylin, Paul ; Darzi, Ara
• Published: Imperial College London 2013
• Subjects: 610
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.568025

This thesis provides a comprehensive overview of general and subspecialist colorectal surgery in England. It examines variation in provision and outcome of colorectal surgery in structure, process and outcome factors at the patient, consultant team and NHS Trust levels. Finally, this thesis examines the potential role of increasing surgical caseload to reduce any demonstrable variation and improve outcome. To address these questions, current issues in surgical quality as well as the coding accuracy reported in the published literature have been reviewed. Colorectal resection and the more specialised procedure of restorative proctocolectomy were examined from the Hospital Episode Statistics dataset. Novel outcome measures were derived using longitudinal analysis. Regression analysis was used to understand the predictors of process factors and outcome measures. I have defined new outcome measures and demonstrated considerable variation in these new measures and in more traditional accepted measures in both general and subspecialist colorectal surgery from routinely collected datasets. Routinely collected data offer an exciting potential data source for measuring performance and quality. If data accuracy can be assured, measures such as reoperation may be used alongside established measures of quality in a meaningful way to benchmarking performance of surgical providers. The methods described in this thesis can be applied to a broad range of surgical specialties. Though volume may have a role in determining outcome and reducing variation in subspecialist colorectal surgery, it is by no means the panacea to improve quality across all providers in general colorectal care. The impact of volume on outcome in more general colorectal surgery is less clear. Though centralisation is likely to have benefits, further evidence of the optimum way to implement such changes is needed rather than indiscriminately increasing volume across all providers for general colorectal surgical care.