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					           VOLUME TWO: PART B




                         Appendix II:

     List of performance measures from indicator
                      programs




a.   CONQUEST


b.   National Library of Healthcare Indicators


c.   Cleveland Health Quality Choice Program


d.   Australian Council on Healthcare Standards


e.   National Health Service (UK)
                                               Appendix II a

                                              CONQUEST 1.0


     Computerized needs-oriented quality measurement evaluation
                              system

Table 1 Listing of clinical indicators in CONQUEST

      Organisation                                                                   Set   Excl.   Reason

1     Ambulatory Care Medical Audit Demonstration Project (ACMAD)
                      Adult                                                         29    29      Ambulatory care
                      Paediatric                                                    26    26      Ambulatory care
2     Department of Health Care Policy faculty Harvard Medical school: Avoidable     12    12      Ambulatory care
      Hospitalisations (AVHO)
3     American Medical Review Research Centre (CCQE)
                      Benign prostatic hypertrophy                                  23    23      Ambulatory care
                      Post-operative pain                                           27
                      Urinary incontinence                                          24    24      Ambulatory care
4     Beth Israel Hospital Boston: Complications screening program                   27    3       3 Infection
5     A Project to Develop and Evaluate methods to Promote Ambulatory Care Quality
      (DEMPAQ)
                      DEMPAQ - claims                                               56    56      Ambulatory care
                      DEMPAQ - records                                              224   224     Ambulatory care
6     Health Care Financing Administration (HCFA)
                      Acute myocardial infarction                                   11
                      Mortality                                                     17    2       1 CABG
                                                                                                   1 Infection
                     Generic Screens - Home care                                    26    26      Ambulatory care
                     Generic Screens - Inpatient                                                  1 ICU
                                                                                                   1 Infection
                                                                                                   7 Discharge
                                                                                                   planning
                     Generic Screens - Psychiatry                                   19    19      Mental health
                     Generic Screens - Skilled Nursing Facility                     13    13      Ambulatory care
7     Heathcare Cost and Utilisation Project (HCUP-3)
                     Outcomes                                                       16    3       3 Infection
                     Utilisation                                                    9     9       Utilisation
                     Access                                                         8     8       Access
8     National Committee for Quality Assurance
                     HEDIS - Administrative                                         11    6       4 Preventive care
                                                                                                   1 Paediatric
                                                                                                   1 Mental health
                     HEDIS - Records                                                7     6       4 Preventive care
                                                                                                   1 Paediatric
                                                                                                   1 Mental health
                     HEDIS - Hybrid                                                 7     6       4 Preventive care
                                                                                                   1 Paediatric
                                                                                                   1 Mental health
9     Joint Commission on Accreditation of Heathcare Organisations (JCAHO)
                    Cardiology                                                      7     2       Cardiac surgery
                    Infection control                                               3     3       Infection
                    Medication use                                                  8
                    Oncology                                                        5
                    Perioperative                                                   5
                    Prenatal                                                        5
                    Trauma                                                          9     9       Trauma
10    Marylands Hospital Association Quality Improvement Project                     15    6       5 Ambulatory care
                                                                                                   1 Infection



                                                             2
                    In-hospital mortality                                                 3      2 Infection
                                                                                                  2 ICU

Table 2 Listing of clinical indicators in CONQUEST continued

     Organisation                                                                Set   Ex      Reason
                                                                                       c
11   New York State Department of Health : CABG                                  1     1       Cardiac Surgery
12   Managed Health Care Association - Outcomes Mangement System
                   American Group Practice Association: Outcomes Management     47    47      Ambulatory care
                    System                                                                     5 Hip replacement
                                                                                               5 Cataract
                                                                                               25 Diabetes
                                                                                               12 Back pain
                    MCHA                                                        24    24      Ambulatory care
                                                                                               11 Asthma
                                                                                               13 Angina
                     Depression                                                 11    11      Ambulatory care
                     Panic Disorder                                             13    13      Ambulatory care
13   Pacific Business Group on Health (PBGH)                                     33    33      Ambulatory care
14   Patient Reports of System Performance (PROSPER)                             60    60      Ambulatory care
15   Centre for Quality of Care Research and Education
                     QCaRE Core                                                 4     4       Ambulatory care
                     QCaRE Diabetes mellitus - claims                           12    12      Ambulatory care
                     QCaRE Diabetes mellitus - records                          24    24      Ambulatory care
                     QCaRE Ischaemic Heart Disease - claims                     2     2       Ambulatory care
                     QCaRE Ischaemic Heart Disease - records                    16    16      Ambulatory care
16   RAND Corporation
                     Appropriateness of CABG/PTCA                               21    21      Appropriateness
                     Cataract
                     Depressed elderly                                          20    20      Mental health
                     Depression, outcome                                        2     2       Mental health
                     Depression, process                                        6     6       Mental health
                     Prenatal care                                              45    38      38 Ambulatory care
                     Pressure ulcers                                            11    11
                     Prospective payment system                                 29    29
17   United Health Care Report                                                   9     9       7 Preventive care
                                                                                               1 Paediatric
                                                                                               1 Ambulatory care
18   University of Wisconsin Centre for Health Systems Research and Analysis :   30    30      Nursing home
     Nursing Home Measures
19   Veterans Administration
                    External Peer Review Program - Medical                      18    2       2 Pressure ulcers
                    External Peer Review Program - Surgical                     13    10      8 Cardiac surgery
                                                                                               1 discharge planning
                                                                                               TURP
                                                                                               1 appropriateness
                                                                                               TURP
                    QUIC                                                        27    9       4 Waiting time
                                                                                               1 Infection
                                                                                               1 Mental health
                                                                                               3 Ambulatory care
                    Risk-adjusted readmission rate                              9




                                                           3
Exclusion of Indicator Sets from CONQUEST
The following indicator sets were excluded from further review based on the specifications of the tender

brief. These indicator sets should be considered by the relevant working groups in the future.


    1.   Ambulatory Care Medical Audit Demonstration Project


         This set contains performance criteria for ambulatory or office based practice. There are two

         sets of measures one set for: ADULTs which includes criteria for the follow up of a low

         haematocrit, follow up of high glucose levels, performance of cancer screening and monitoring

         of digoxin therapy; another for PAEDIATRICS.


    2.   Department of Health Care Policy faculty Harvard Medical School: Avoidable

         Hospitalisations


         This set monitors access and quality of care by determining avoidable hospitalisation rates. For

         example admission for rupture appendix or immunizable conditions. These reflect the quality

         of care in the ambulatory care setting.


    3.   American Medical Review Research Centre (CCQE)


         This set was developed from relevant practice guidelines to measure quality and utilisation

         patterns for groups of providers. The measures contain criteria for the screening, patient

         counselling and treatment. Two sets of measures were excluded:


         Benign prostatic hypertrophy


         Urinary incontinence


    4.   A Project to Develop and Evaluate methods to Promote Ambulatory Care Quality


         This set was developed to assess the quality of care delivered to Medicare patients in the

         primary care physicians offices. Two sets of measures are available one evaluates care based

         on the medical record the other evaluates care based on Medicare claims data.


    5.   Health Care Financing Administration: Home Health Agency


         This set was developed to judge the quality of care in home health agency care.




                                                    4
6.   Health Care Financing Administration: Psychiatry


     This set was developed to evaluate aspects of psychiatric care.


7.   Health Care Financing Administration: Skilled Nursing Facility (SNF)


     This set was developed to evaluate aspects of care in skilled nursing facilities.


8.   Joint Commission on Accreditation of Heathcare Organisations : Infection Control


     This set measures adverse patient outcomes in infection control.


9.   New York State Department of Health: CABG


     This set was developed by the New York State Department of Health to measure and improve

     outcomes of care for patients undergoing coronary artery bypass graft surgery.


10. Managed Health Care Association - Outcomes Management System


     This set was developed at the department of Psychiatry of the University of Arkansas for

     Medical Sciences. This contains performance measures for panic disorders and depression.


11. Pacific Business Group on Health


     This set was developed by the Pacific Business Group on Health. This contains performance

     measures for satisfaction with health plans and reported adherence to preventive care

     guidelines.


12. Patient Reports of System Performance PROSPER


     This set was developed at the Centre for Quality of Care Research and Education. It uses a

     self-administered patient questionnaire to collect data on patient- provider communications.


13. Centre for Quality of Care Research and Education (QCare)


     This set was designed to evaluate care for elderly enrollees with specific chronic diseases,

     diabetes mellitus and ischaemic heart disease. Medical records or administrative data are used

     to address issues of access to health care and compliance with screening tests and

     immunization and compliance with disease management.




                                                 5
14. RAND Appropriateness of PTCA and CABG


    This set was developed to judge the appropriateness of the decision to perform the procedures

    of percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery.


15. RAND Depressed Elderly


    This set was developed to distinguish between acceptable and clearly unacceptable quality of

    care for elderly depression patients.


16. RAND Depression Outcome Measures


    This set was developed to measure the number of depressive symptoms and number of

    functional limitations at follow-up for depression patients.


17. RAND Depression Process


    This set was developed to measure the detection of depressive disorders and the

    appropriateness of medication use and patient counselling.


18. University of Wisconsin Centre for Health Systems Research and Analysis


    This set was developed to judge the quality of care in Nursing Homes.




                                               6
                                            Appendix II b

                       National Library of Healthcare Indicators


National Library of Healthcare Indicators
Four broad areas of classification are included in the frame work of the NLHI for the performance

measures:


     1.   Clinical Performance


     2.   Administrative/Financial


     3.   Health status


     4.   Satisfaction


Healthcare indicators from the last three categories were excluded. The indicators listed as ‘clinical

performance measures’ were screened to remove performance measures already included as part of the

CONQUEST database.


Table 3National Library of Healthcare Indicators: Clinical performance measures

Classification             Condition                    ID Number    Developer                 Not included in
                                                                                               CONQUEST†

Clinical Performance       Appendicitis                 0117-00209   Sagamore Health Network   * * *
Clinical Performance and   Arthritis                    0124-00292   DEMPAQ
Health Status
                           Arthritis, Diabetes, Heart   0124-00313   DEMPAQ
                           Disease, High Blood
                           Pressure, Obstructive
                           Lung Disease
Clinical Performance       Asthma                       0105-00072   AHCPR
                                                        0105-00073   AHCPR
                                                        0121-00282   NCQA-HEDIS
                           Breast Cancer                0100-00020   JCAHO
                                                        0117-00213   Sagamore Health Network   * * *
                                                        0121-00280   NCQA-HEDIS
                                                        0125-00338   CRISP                     * * *
                           Breast Cancer,               0100-00018   JCAHO
                           Colorectal Cancer,           0100-00019   JCAHO
                           Lung Cancer
                           Breast Cancer,               0124-00316   DEMPAQ
                           Diagnostic Radiology
Clinical Performance and   Breast Cancer,               0124-00299   DEMPAQ
Health Status              Health Maintenance--         0124-00300   DEMPAQ
                           Adult
Clinical Performance       Cervical Cancer              0121-00281   NCQA-HEDIS
                           Colorectal Cancer            0100-00022   JCAHO




                                                         7
Classification             Condition                  ID Number    Developer                 Not included in
                                                                                             CONQUEST†
Clinical Performance and   Depression                 0100-00043   JCAHO
Health Status                                         0100-00045   JCAHO
                                                      0100-00046   JCAHO
                                                      0100-00047   JCAHO
                                                      0100-00048   JCAHO
                                                      0100-00049   JCAHO
Clinical Performance       Depression                 0100-00044   JCAHO
                                                      0100-00050   JCAHO
                                                      0100-00051   JCAHO
                                                      0100-00052   JCAHO
                                                      0100-00053   JCAHO
                                                      0121-00228   NCQA-HEDIS
Clinical Performance and   Diabetes                   0100-00034   JCAHO
Health Status                                         0121-00226   NCQA-HEDIS
                                                      0124-00294   DEMPAQ
Clinical Performance       Diabetes                   0105-00081   AHCPR
                                                      0105-00082   AHCPR
                                                      0117-00212   Sagamore Health Network   * * *
                                                      0124-00317   DEMPAQ
Clinical Performance and   Diabetes, Heart Disease,   0109-00125   Humana Inc                * * *
Health Status              High Blood Pressure
Clinical Performance       Diabetes, Heart Disease,   0109-00129   Humana Inc                * * *
                           High Blood Pressure
                           Medication
                           Diagnostic Radiology       0124-00323   DEMPAQ
                           Diagnostic Radiology       0124-00296   DEMPAQ
                           Laboratory
                           Gallbladder Disease        0105-00066   AHCPR
Clinical Performance and   Health Maintenance--       0124-00297   DEMPAQ
Health Status              Adult
                           Health Maintenance--       0124-00298   DEMPAQ
                           Adult, High Blood
                           Pressure
                           Health Maintenance--       0109-00127   Humana Inc                * * *
                           Adult, Medication          0109-00128   Humana Inc                * * *
Clinical Performance       Health Maintenance--       0121-00278   NCQA - HEDIS
                           Child
                           Heart Disease              0100-00003   JCAHO
                                                      0100-00004   JCAHO
                                                      0100-00011   JCAHO
                                                      0100-00013   JCAHO
                                                      0100-00014   JCAHO
                                                      0105-00067   AHCPR
                                                      0121-00279   NCQA - HEDIS
                                                      0124-00324   DEMPAQ
                                                      0125-00335   CRISP                     * * *
Clinical Performance and   Heart Disease              0124-00291   DEMPAQ
Health Status                                         0124-00295   DEMPAQ
Clinical Performance       Heart Disease,             0100-00012   JCAHO
                           Medication
                           Heart Disease, Mortality   0100-00017   JCAHO
                                                      0105-00069   AHCPR
                           Heart Disease, Mortality   0100-00015   JCAHO
                           (Surgical)                 0100-00016   JCAHO
Clinical Performance and   High Blood Pressure        0124-00290   DEMPAQ
Health Status




                                                       8
Classification             Condition                  ID Number    Developer                 Not included in
                                                                                             CONQUEST†
Clinical Performance       High BloodPressure         0124-00307   DEMPAQ
                           Hysterectomy               0105-00063   AHCPR
                           Infection                  0100-00042   JCAHO
                                                      0100-00056   JCAHO
                                                      0117-00216   Sagamore Health Network   * * *
                           Laboratory                 0100-00032   JCAHO
                                                      0124-00315   DEMPAQ
                                                      0124-00318   DEMPAQ
                                                      0124-00319   DEMPAQ
                                                      0124-00320   DEMPAQ
                                                      0124-00321   DEMPAQ
                                                      0124-00322   DEMPAQ
                                                      0124-00325   DEMPAQ
                           Laboratory, Medication     0100-00035   JCAHO
                                                      0100-00036   JCAHO
                                                      0100-00037   JCAHO
                                                      0100-00038   JCAHO
                           Lower Back Pain            0117-00211   Sagamore Health Network   * * *
                           Lung Cancer                0100-00021   JCAHO
Clinical Performance       Medication                 0100-00033   JCAHO
                                                      0100-00039   JCAHO
                                                      0100-00054   JCAHO
                                                      0100-00055   JCAHO
                                                      0100-00057   JCAHO
                                                      0100-00058   JCAHO
                                                      0100-00059   JCAHO
                           Mental Health--Suicide     0117-00221   Sagamore Health Network   * * *
                           Mortality                  0100-00005   JCAHO
                                                      0100-00031   JCAHO
                                                      0105-00083   AHCPR
                                                      0105-00084   AHCPR
                                                      0105-00088   AHCPR
Clinical Performance and   Obstructive Lung Disease   0124-00293   DEMPAQ
Health Status
Clinical Performance       Pneumonia                  0105-00074   AHCPR
                           Pneumonia, Site            0100-00041   JCAHO
                           Infection
                           Pregnancy/Maternal Care    0100-00006   JCAHO
                                                      0100-00007   JCAHO
                                                      0100-00008   JCAHO
                                                      0100-00009   JCAHO
                                                      0100-00010   JCAHO
                                                      0105-00077   AHCPR
                                                      0121-00227   NCQA - HEDIS
                                                      0121-00288   NCQA - HEDIS
                           Pregnancy/Maternal         0105-00086   AHCPR
                           Care, Mortality
                           Procedure Complications    0100-00001   JCAHO
                                                      0100-00002   JCAHO
                                                      0117-00223   Sagamore Health Network   * * *
                           Surgical Site Infection    0100-00040   JCAHO
                                                      0105-00091   AHCPR
                                                      0105-00105   AHCPR
                                                      0105-00106   AHCPR
                                                      0105-00107   AHCPR
                           Trauma                     0100-00023   JCAHO
                                                      0100-00024   JCAHO
                                                      0100-00025   JCAHO
                                                      0100-00026   JCAHO
                                                      0100-00027   JCAHO
                                                      0100-00028   JCAHO
                                                      0100-00029   JCAHO
                           Trauma, Mortality          0100-00030   JCAHO




                                                       9
Classification                Condition                  ID Number      Developer                   Not included in
                                                                                                    CONQUEST†
Clinical Performance and      Arthritis                  0107-00117     Health Outcomes Institute
Health Status                                            0107-00120     Health Outcomes Institute
                              Asthma                     0107-00113     Health Outcomes Institute
                              Asthma, Breast Cancer,     0125-00326     Consortium Research on
                              Heart Disease,                            Indicators of System
                              Pregnancy/Maternal Care                   Performance (CRISP)
                              Carpal Tunnel Syndrome     0107-00116     Health Outcomes Institute
                              Cataracts                  0107-00123     Health Outcomes Institute
                              Depression                 0107-00124     Health Outcomes Institute
                              Diabetes                   0107-00122     Health Outcomes Institute
                              Heart Disease              0107-00111     Health Outcomes Institute
                              Heart Disease,             0107-00110     Health Outcomes Institute
                              High BloodPressure
                              Hip Fracture               0107-00118     Health Outcomes Institute
                              Low Back Pain              0107-00121     Health Outcomes Institute
                              Obstructive Lung Disease   0107-00112     Health Outcomes Institute
Health Status and Clinical    Sinusitis                  0107-00114     Health Outcomes Institute
Performance
                              Stroke                     0107-00115     Health Outcomes Institute
                              Total Joint Replacement    0107-00119     Health Outcomes Institute
Administrative/Financial      Utilization,               0121-00253     NCQA-HEDIS
and Clinical Performance      Alcohol/Substance Abuse
                              Utilization, Asthma        0125-00336     CRISP                       * * *
                              Utilization, Depression    0121-00254     NCQA-HEDIS
                              Utilization, Laminectomy   0105-00064     AHCRP
                              Utilization,               0121-00283     NCQA-HEDIS
                              Pregnancy/Maternal Care    0121-00284     NCQA-HEDIS
                                                         0121-00285     NCQA-HEDIS
Administrative/Financial       Utilization,              0121-00286     NCQA-HEDIS
                               Pregnancy/Maternal Care
Administrative/Financial       Utilization,                0105-00065   AHCPR
and Clinical Performance       ProstateDisease
                               Utilization, Trauma         0109-00130   Humana Inc                  * * *
† indicators not listed in cConquest are marked with * * *




                                                          10
Table 4 National Library of Healthcare Indicators: Measures for health status, satisfaction, administration and
finance

Classification             Condition                            ID Number
Health Status              Diabetes                             0116-00201
                           Overall Health                       0107-00108
                           Overall Health                       0123-00289
                                                                0125-00334
Satisfaction               Patient/Enrollee Satisfaction        0107-00109
                                                                0110-00131
                                                                0113-00186
                                                                0113-00189
                                                                0121-00275
                                                                0125-00333
                           Practitioner Satisfaction            0110-00132
Administrative/Financial   Financial Stability                  0121-00256
                                                                0121-00259
                                                                0121-00260
                                                                0121-00261
                                                                0121-00262
                                                                0121-00263
                                                                0121-00264
                                                                0121-00265
                                                                0121-00266
                                                                0121-00267
                                                                0121-00268
                                                                0121-00269
                                                                0121-00270
                                                                0121-00271
                                                                0125-00330
                                                                0125-00331
                                                                0125-00332
Administrative/Financial   System Description                   0121-00229
                                                                0121-00230
                                                                0121-00257
                                                                0121-00258
                                                                0121-00272
                                                                0121-00273
                                                                0121-00274
                                                                0126-00342
                           System Integration                   0126-00355
                           System Integration, Credentialing    0126-00365
                           System Integration                   0126-00367
                                                                0126-00368
                                                                0126-00369
                                                                0126-00370
                                                                0126-00376
                                                                0126-00377




                                                           11
Classification             Condition          ID Number
Administrative/Financial   Utilization        0105-00062
                                              0109-00126
                                              0117-00203
                                              0117-00204
                                              0121-00231
                                              0121-00232
                                              0121-00233
                                              0121-00234
                                              0121-00235
                                              0121-00236
                                              0121-00237
                                              0121-00238
                                              0121-00239
                                              0121-00240
                                              0121-00241
                                              0121-00242
                                              0121-00243
                                              0121-00244
                                              0121-00245
                                              0121-00246
                                              0121-00247
                                              0121-00248
                                              0121-00249
                                              0121-00250
                                              0121-00251
                                              0121-00252
                                              0121-00255
                                              0121-00276
                                              0121-00277
                                              0121-00287
                                              0125-00328
                                              0125-00329




                                         12
Exclusion of Indicator Sets from National Library of
Healthcare Indicators
The indicators classified under the following categories were excluded:


    1.   Administrative/Financial


         This set contains performance criteria for the organisational structure including financial

         management.


    2.   Health status


         This set addresses the functional well-being of specific populations.


    3.   Satisfaction


         This set addresses how well patient, purchaser and practitioner needs are met.


The clinical performance measures were reviewed to remove the indicators already contained in the

CONQUEST database see Table 5.




                                                    13
Table 5: Clinical indicators included in NLHI and not in CONQUEST

Classification    Condition         ID          Developer             Exclusion
                                    Number
Clinical          Appendicitis      0117-       Sagamore Health       Ambulatory care
Performance                         00209       Network
                  Breast Cancer     0117-       Sagamore Health       Preventive care
                                    00213       Network               Screening
                                    0125-       CRISP
                                    00338
Clinical          Diabetes          0117-       Sagamore Health       Ambulatory care
Performance                         00212       Network
Clinical          Diabetes, Heart   0109-       Humana Inc            Access to ambulatory care
Performance and   Disease, High     00125
Health Status     Blood Pressure
Clinical          Diabetes, Heart   0109-       Humana Inc            Ambulatory care: compliance
Performance       Disease, High     00129                             with medication
                  Blood Pressure
                  Medication
                  Health            0109-       Humana Inc            Vaccination
                  Maintenance--     00127       Humana Inc            Vaccination
                  Adult,            0109-
                  Medication        00128
Clinical          Heart Disease     0125-       CRISP                 included
Performance                         00335
                  Infection         0117-       Sagamore Health       Infection (DHS)
                                    00216       Network
                  Lower Back Pain   0117-       Sagamore Health       Ambulatory care
                                    00211       Network
                  Mental Health--   0117-       Sagamore Health       Mental Health (DHS)
                  Suicide           00221       Network
                  Procedure         0117-       Sagamore Health       included
                  Complications     00223       Network
                  Asthma, Breast    0125-       Consortium Research   Measurement of health status
                  Cancer, Heart     00326       on Indicators of      (non acute hospital)
                  Disease,                      System Performance
                  Pregnancy/Mater               (CRISP)
                  nal Care
                  Utilization,      0125-       CRISP                 ambulatory care
                  Asthma            00336
                  Utilization,      0109-       Humana Inc            Trauma (DHS)
                  Trauma            00130




                                                    14
                                          Appendix II c

                    Cleveland Health Quality Choice Program

Table 6 Cleveland Health Quality Choice Program Clinical Indicators

Clinical Indicator Group                                              Reason for exclusion
Intensive care mortality: risk adjusted models                        DHS Intensive care
General medicine and surgery mortality: Risk adjusted models
    acute myocardial infarction
    congestive heart failure
    coronary artery bypass graft surgery                             DHS cardiac surgery
    gastrointestinal hemorrhage
    lower bowel resection
    obstructive pulmonary disease
    pneumonia
    stroke
Length of Stay: Risk adjusted models                                  Measure cost and efficiency
    acute myocardial infarction
    coronary artery bypass graft surgery
    congestive heart failure
    gastrointestinal hemorrhage
    lower bowel resection
    obstructive pulmonary disease
    pneumonia
    stroke
    reduction of fracture
    vascular bypass or repair
Obstetrics
    Primary C-section
Patient satisfaction                                                  Patient staisfaction




                                                      15
                                         Appendix II d

                  Australian Council On Healthcare Standards


ACHS Clinical Indicator Areas and Topics 1999
An extensive list of clinical indicators are available from the ACHS for 1999. The requirements of the

project brief meant the following clinical indicator sections were excluded:


Clinical Indicator Group                                 No.   Excl    Reason for exclusion
Adverse Drug Reactions - Version 1
Anaesthetics Indicators - Version 2
Day Procedure Indicators - Version 2                     4     4       DHS
Dermatology Indicators - Version 1                       3     3       Outpatient based
Emergency Medicine Indicators - Version 2                3     3       DHS
Hospital-Wide Medical Indicators - Version 6             6     2
              Trauma                                                  Emergency medicine
              Hospital acquired infection                             Infection
Intensive Care Indicators - Version 1                    4     4       DHS
Internal Medicine Indicators - Version 3
              Cardiology
              Endocrinology
              Gastroenterology
              Geriatric medicine
              Nephrology
              Neurology
              Oncology
              Thoracic Medicine
Obstetrics & Gynaecology Indicators - Version 3
              Obstetrics indicators
              Gynaecology indicators
Ophthalmology and Excimer Laser Indicators - Version 1
Pathology Indicators - Version 1                         4     4       turn-around time for laboratory tests
Paediatric Indicators - Version 2                        2     2       DHS
Psychiatric Indicators - Version 2                       10    10      DHS
Radiation Oncology Indicators Version 1                  6     6       not a general hospital service
Radiology Indicators - Version 2                         2     1       turn-around time for reports
Rehabilitation Medicine Indicators - Version 2           4     4       non acute general hospital service
Surgery Indicators - Version 2
              Paediatric surgery                        3     3       DHS Paediatrics
              Urological surgery
              Orthopaedic surgery
              Plastic surgery
              Cardiothoracic surgery                    1     1       DHS Cardiac Surgery
              Neurosurgery
              General surgery
              Vascular surgery
              Otolaryngology surgery




                                                    16
                                                 Appendix II e

                          NHS National Performance Framework

Table 7 NHS National Performance Framework Clinical Indicators

         Indicator                                                                            N      Excl    Reason
I        Health Improvement                                                                   x      x       Non acute hospital
i & ii   Deaths from all causes                                                               2      2
iii      Cancer registrations - the summation of age and sex standardised rates for           7      7
         cancers:
II       Fair Access                                                                          x      x       Access
i        Surgery rates - a composite indicator of elective surgery rates                      4      4
ii       Conceptions below age 16 (rate, girls aged 13-15).                                   1      1
iii      People registered with an NHS dentist - percentage of population registered          1      1
iv       Early detection of cancer - a composite indicator,                                   2      2
v        District nurse contacts - a composite indicator looking at access to community       3      3
         services
III      Effective Delivery of Appropriate Healthcare
i        Disease prevention and health promotion - a composite indicator consisting of:       x      x
                          % of target population vaccinated                                                 Non-acute hospital
                          % of all orchidopexies below age 5                                                Paediatric
ii       Early detection of cancer - a composite indicator consisting of                      x      x
                          % of target population screened for breast cancer;                                Non-acute hospital
                          % of target population screened for cervical cancer.                              Non-acute hospital
iii      Inappropriately used surgery - a composite indicator consisting of age and sex       x      x
         standardised:
                          rates of D&Cs performed in women under 40                                         Appropriateness
                          surgical intervention rates for glue ear (grommet surgery).                       Paediatric
iv       Surgery rates - a composite indicator of elective surgery rates, consisting of age   x      x       Access and
         and sex standardised:                                                                               appropriateness
                          CABG and PTCA rates;
                          hip replacement rates (for those aged 65 and over);
                          knee replacement rates (for those aged 65 and over);
                          cataract replacement rates.
v        Acute care management - a composite indicator consisting of age and sex              x      x       Ambulatory care
         standardised admission rates for
                          severe ENT infection
                          kidney/urinary tract infection
                          heart failure
vi       Chronic care management - a composite indicator consisting of age and sex            x      x       Ambulatory care
         standardised admission rates for:
                          asthma;
                          diabetes;
                          epilepsy.
vii      Mental health in primary care - a composite indicator consisting of:                 x      x       Mental health
                          volume of benzodiazepines;
                          ratio of antidepressants to benzodiazepines prescribed.
viii     Cost effective prescribing a composite measure                                       4      4       Financial
ix       Discharge from hospital - a composite indicator consisting of
                          rate of discharge home within 56 days of emergency admission
                           from home with a stroke
                          rate of discharge home within 56 days of admission with a
                           fractured neck of femur

         Indicator                                                                            Excl       Reason
IV       Efficiency
i        Day case rate.                                                                                  Day stay/ambulatory
                                                                                                         care
ii       Length of stay in hospital (casemix adjusted).
iii      Unit costs (HCHS).                                                                              Financial
iv       Generic prescribing (percentage measure).                                                       Financial
V        Patient/Carer Experience Of The NHS                                                  X
i        Patients who wait more than 2 hours for emergency admission (admitted                x



                                                               17
       through A&E).
ii     Patients with operations cancelled for non-medical reasons on the day of, or       x
       after, admission.
iii    Delayed discharge from hospital for people aged over 75 (per 1,000 75 year         x
       olds not in hospital).
iv     First outpatient appointments for which patient did not attend (percentage         x
       measure).
v      Outpatients seen within 13 weeks of GP referral (percentage measure).              x
vi     Inpatients admitted within 3 months of a decision to admit (percentage             x
       measure).
VI     Health Outcomes of NHS Care
i      Conceptions below age 16 (rate, girls aged 13-15).                                 X   Non-acute hospital
ii     Decayed, missing and filled teeth in five year olds.                               X   Dental
iii    Avoidable diseases - a composite indicator of avoidable diseases and                   Non-acute hospital
       impairments, consisting of age and sex standardised:
             notification rates for pertussis in children;                               X
             notification rates for measles;                                             X
             episode rates for fracture of proximal femur (in those aged 65 and over);   X
             notification rates for TB                                                   X
iv     Adverse events/complications of treatment - a composite indicator consisting of
       age standardised
             28 day emergency readmission rates
             rates of surgery for hernia recurrence
v      Emergency admissions to hospital for people aged over 75 (per 1,000 75 year        X
       olds).
vi     Emergency psychiatric readmission rate                                             X   Mental health
vii    Infant deaths - a composite indicator consisting of
                         stillbirth rates
                         infant mortality rates                                          x   Paediatrics
viii   Survival rates for breast and cervical cancer - a composite indicator of 5 year    X
       survival rates consisting of age and sex standardised
                         survival rates from breast cancer (ages 50-69);                 X
                         survival rates from cervical cancer (ages 15-74).               X
ix     Avoidable deaths a composite indicator of potentially avoidable deaths             X   Non-acute hospital
       consisting of (with age and sex standardisation where possible):
                         mortality from peptic ulcer (ages 25-74);
                         mortality rate from fracture of skull and intracranial injury
                          (ages 1+)
                         maternal mortality (ages 15-44);
                         mortality from tuberculosis (ages 5-64);
                         mortality from Hodgkin’s disease (ages 5-64);
                         mortality from chronic rheumatic heart disease (ages 5-44);
                         mortality from hypertensive and cerebrovascular disease (ages
                          35-64);
                         mortality from asthma (ages 5-44);
                         mortality from appendicitis, abdominal hernia, cholelithiasis
                          and cholecystitis (ages 5-64);
                         mortality from CHD in persons under 65
x      In-hospital premature deaths
                         30 day perioperative mortality rate
                         30 day mortality rate following myocardial infarction




                                                            18
Exclusion of Indicator Sets from NHS National Performance Framework
The indicators classified under the following categories were excluded:


    1.   Health Improvement


         This set contains performance criteria for whole health system in the country and does not

         specifically apply to acute general hospitals.


    2.   Fair Access


         This set addresses the ability of the patient access health services from the NHS. This aspect of

         health care was not included in the project brief.


    3.   Patient/Carer Experience Of The NHS


         This set addresses how well patient, purchaser and practitioner needs are met.


    4.   Patient/Carer Experience Of The NHS


         This set addresses how well the patient and their carer’s needs are met. This set is similar to

         patient satisfaction measures.


    5.   Health Outcomes of NHS Care



         This set addresses the health outcomes of NHS care. The set includes all aspects of the health

         system with many of the outcomes related ambulatory based health care.




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