Information for clinical governance: analysis of routine hospital activity data in Wales

Variations in hospital admission rates have been extensively reported for many years, but this evidence has not had a wide impact on clinical practice. Understanding local reasons for high variation to improve quality of healthcare should be a focus of clinical governance. Our aim was to convert routine hospital activity data into information on a category of high-variation, discretionary, hospital admissions and provide a tool for analysis for clinical governors in Local Health Groups (LHG).

We undertook a cross-sectional analysis of hospital activity data for the 22 LHGs in Wales and 101 general practices in Gwent Health Authority. Hospital spells for 1998-1999 and 1999-2000 were classified into Healthcare Resource Groups (HRGs). Using the systematic component of variation we identified a category of high-variation admissions for which the only plausible explanation was medical discretion. Using scatter plots we compared the proportion of these discretionary admissions with the age-, sex- and deprivation-adjusted standardized admission ratio. (SAR) for each LHG and practice.

We found a two-fold variation in SARs between LHGs and a three-fold variation between practices. Mean discretionary activity was 55 per cent (range 50-59 per cent) of total activity for LHGs and 56 per cent (51-62 per cent) for practices. Greatest variation was found for elective admissions. The relation between discretionary admissions and the SAR was identified for each LHG and practice as the starting point for further investigation.

This method provides useful information to LHG clinical governors to contribute to the process of reducing medical practice variation, increasing equity, improving the quality of care and making more cost-effective use of resources.