This study compared quality indicator performance between trusts identified through the Keogh Review for having high mortality rates and other acute trusts in England. The researchers found no evidence that Keogh Review trusts had poorer quality indicator results or more alerts/alarms according to the Acute Trust Quality Dashboard. This suggests mortality alone is not a good marker of clinical quality, and future quality monitoring should use an in-depth approach like the Keogh Review rather than just focusing on mortality indicators.

1. Mortality indicators and Acute Trust quality
Is mortality a good indicator of the clinical quality of NHS hospitals? A cross
sectional study of outlier trusts for mortality indices using quality dashboards
Ian Diley – Public Health Registrar, East of England
Dr Padmanabhan Badrinath – Consultant in Public Health Medicine, Suffolk County Council
Dr Sarah Annon – Foundation Doctor, East of England

3. Basildon
Blackpool
Buckinghamshire
Burton
Colchester
Dudley
East Lancashire
George Eliot
Medway
Northern Lincolnshire
North Cumbria
Sherwood
Tameside
United Lincolnshire

4. Objectives
• Are high mortality indices results associated with increased
numbers of quality alerts/alarms?
Design
• Comparison between Keogh Review trusts and all NHS acute
trusts: proportion of ATQD indicators rated amber or red
(alert/alarm)
Participants and Setting
• All NHS acute trusts in England
Main outcome measure
• Proportion of alerts and alarms identified in Summer 2013
ATQD

5. 100%
50%
Results
Ranked results for all acute trusts in England for the proportion of combined amber
and red, and green rated results in the Summer 2013 Acute Trust Quality Dashboard
0%
Better Worse
Proportion of alert/alarm results
Proportion of better than expected results
Proportion of as expected results
Keogh Review trust
NHS Acute trusts

6. Overall Red results Red or amber results Green results
Sum Proportion (95% CI) Sum Proportion (95% CI) Sum Proportion (95% CI)
Keogh Review trust indicators
n=1,278
139 10.9% (9.2% - 12.6%) 185 14.5% (12.6% - 16.4%) 269 21.1% (18.9% - 23.3%)
All acute trust indicators
n=11,838
1,213 10.3% (9.7% - 10.9%) 1,664 14.1% (13.5% - 14.7%) 2,635 22.3% (21.5% - 23.1%)

7. Overall Red results Red or amber results Green results
Sum Proportion (95% CI) Sum Proportion (95% CI) Sum Proportion (95% CI)
Keogh Review trust indicators
n=1,278
139 10.9% (9.2% - 12.6%) 185 14.5% (12.6% - 16.4%) 269 21.1% (18.9% - 23.3%)
All acute trust indicators
n=11,838
1,213 10.3% (9.7% - 10.9%) 1,664 14.1% (13.5% - 14.7%) 2,635 22.3% (21.5% - 23.1%)
Domain 1 Red results Red or amber results Green results
Sum Proportion (95% CI) Sum Proportion (95% CI) Sum Proportion (95% CI)
Keogh Review trust indicators
n=209
23 11.0% (0%-23.8%) 30 14.4% (9.7%-19.1%) 18 8.6% (0%-21.5%)
All acute trust indicators
n=1,934
80 4.1% (1.9%-8.5%) 133 6.9% (5.7%-8.1%) 249 12.9% (8.7%-17.0%)
Domain 3
Keogh Review trust indicators
n=385
11 2.9% (0%-12.7%) 23 6.0% (3.6%-8.4%) 54 14.0% (4.8%-23.2%)
All acute trust indicators
n=3,498
197 5.6% (2.4%-8.9%) 340 9.7% (8.7%-10.7%) 472 13.5% (10.4%-16.6%)
Domain 1 – Preventing people from dying prematurely;
Domain 3 – Helping people to recover from episodes of ill health or following injury

8. Conclusions
No evidence that Keogh
Review trusts were quality
outliers (as defined by ATQD)

9. Conclusions
No evidence that Keogh
Review trusts were quality
outliers (as defined by ATQD)
i.e. no association between
persistent excess mortality rates
and poor performance on the
ATQD

10. Conclusions
No evidence that Keogh
Review trusts were quality
outliers (as defined by ATQD)
Primary/community care no
poorer in Keogh Review trust
localities
i.e. no association between
persistent excess mortality rates
and poor performance on the
ATQD

11. Conclusions
No evidence that Keogh
Review trusts were quality
outliers (as defined by ATQD)
Primary/community care no
poorer in Keogh Review trust
localities
Mortality indicators alone are
not good markers of care
quality
i.e. no association between
persistent excess mortality rates
and poor performance on the
ATQD

12. Conclusions
No evidence that Keogh
Review trusts were quality
outliers (as defined by ATQD)
Primary/community care no
poorer in Keogh Review trust
localities
Mortality indicators alone are
not good markers of care
quality
Future quality monitoring
systems should follow depth
used in Keogh method
i.e. no association between
persistent excess mortality rates
and poor performance on the
ATQD
Any questions?
iandiley@nhs.net