The introduction of revalidation in the UK has changed the way doctors are regulated. Doctors need to demonstrate that they are keeping up to date and participating in activities that evaluate the quality of their work.
The project presented in this report:
- Assesses whether routinely collected administrative data could be used as part of the evaluation of gynaecologists’ practice
- Compares measures of activity and outcome derived from administrative data with measures derived from data in two specialist societies’ clinical databases
The source of administrative data used by the project was the Hospital Episode Statistics (HES) database, which captures information on all admissions to English NHS trusts.
The project had two major components:
- A literature review of studies that used HES data to assess the performance of inpatient gynaecological practice in the English NHS
- An analysis of performance measures derived from HES data and the clinical databases maintained by the British Society of Urogynaecology (BSUG) and the British Society of Gynaecological Endoscopy (BSGE)
The comparison of the HES database with the clinical databases demonstrated that:
- The HES database can be used to study the treatments and outcomes of women with incontinence or recto-vaginal endometriosis
- HES can only be used to produce generic performance indicators (e.g. readmission, return to theatre and length of stay)
- The clinical databases contain more detailed data on the nature and severity of the women’s symptoms, the underlying clinical condition, the clinical procedures, and the outcomes; however, their low case ascertainment and level of missing data, especially with respect to outcomes, are a current concern
These results are not unexpected. The ICD-10 and OPCS4 coding systems used in HES lack clinical detail and also do not allow the coding of more recently introduced procedures. On the other hand, the clinical databases are designed by clinical experts who aimed to collect detailed information about the patients they treat and the outcomes they achieve. However, participation in the clinical databases is currently voluntary, which explains the problems with case ascertainment and data completeness.