Data sources to support Quality Improvement

Dr Bill Taylor and Dr Joanna Bircher, RCGP Clinical Leads for Quality Improvement

Why bother with data?

Data is crucial to Quality Improvement (QI) and has two defined, but different, roles. Firstly it can tell us what we need to improve, then, once we’ve started to make changes, it can tell us if our efforts are making a difference.

Using data to tell us what we need to improve

Externally collected data that lets us benchmark our performance against others can be very useful for this. Are we doing as well as the practice down the road at controlling our patients’ blood pressure? Is our hypertension prevalence in line with expected for our population, or are we missing opportunities to diagnose?

Much of the data collected about our practices and patients has been extracted from our practice software systems. Other data provides us with information about our patients that we could not collect from our own systems. For example you can find out your practice prevalence for long-term conditions to see how this compares with others. The College has collected and formed a list of where data sources exist and this is available here.

Benchmarking data comes with a ‘health warning’

Data about your practice can easily be misinterpreted and it often requires local knowledge to work out if what might initially look like lower performance might just reflect normal variation, or performance that reflects the challenges and lifestyles of your practice demographic. When benchmarking data is presented in order to compare practices it is important that appropriate statistical tools are used to identify true outliers before conclusions are drawn. 

Using data to see if we’re making a difference

“All improvements involve change not all changes are improvement”
  
QI projects need to include some kind of measurement to see if your improvements are resulting in better care for patients. This kind of data needs to be ‘real time’ and is best gathered at the practice level, rather than waiting for externally collected data to be published, as this usually incurs a significant time delay. If your project is to improve blood pressure control, then you might do a monthly measure of how many patients are ‘to target’. If your project is to improve detection of a long-term condition then you may want to create a graph of the practice prevalence of the condition against time to see if your interventions are helping to increase the detection rate.
 

However some data you collect could be subject to a pattern of variation that might make it difficult to tell if you have made improvements. If your project is to reduce the length of time patients spend waiting to be seen, then it would be normal for this to vary from day-to-day. If your data is likely to be variable, then you will need to develop an understanding of the normal variation so that you can see if your QI project has generated improvements. Run charts  are one way of presenting data to help differentiate between changes produced by chance (random variation) and special cause (non-random).

Displaying your Data

Visual displays of data can be very powerful when trying to engage colleagues with your improvements. When presenting data to colleagues to bring about change it needs to be presented in a format that allows easy analysis. A table filled with many results may not achieve this aim, but large colourful line graphs displayed in a prominent place can remind everyone of the project and keep people working towards the improvements. Read more about producing run charts and understanding variation in the RCGP Guide to QI for general practice.

Multitude of data sources

The Health Foundation  recently reviewed the data sources about GP practices to assess which indicators could be used to demonstrate high quality of care in England. This is reflected in our list of data sources and is true for all four nations. Their analysis of the usefulness of the indicators shows the challenge we face when making sense of data and is fascinating further reading.

Further sources

We are aware that our list may not be complete. If you are aware of other sources which have data that would be useful in quality improvement in general practice please email qualityimprovement@rcgp.org.uk

  1Batalden P and Davidoff F. 2007. What is “quality improvement” and how can it transform healthcare?,
Qual Saf Health Care, Feb; 16(1): 2–3.

  2Taylor B and Bircher J. 2015. Quality improvement for General Practice. [on line] London: Royal College of General Practitioners. Available here 

  3Dixon J, Spencelayh E, Howells A, Mandel A, Gille F. 2015. Indicators of quality of care in general practices in England. [on line] London: The Health Foundation Available at: http://www.health.org.uk/sites/default/files/IndicatorsOfQualityOfCareInGeneralPracticesInEngland.pdf

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