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AAA benchmarking by Dr Foster: a cause for concern?

V A Pandey1, M I Kerle, M P Jenkins

  • 1Regional Vascular Unit, St Mary's Hospital, London, UK.

Annals of the Royal College of Surgeons of England
|May 31, 2007
PubMed
Summary
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Hospital performance data can be misleading. A study found Dr Foster

Area of Science:

  • Medical benchmarking
  • Health services research
  • Vascular surgery outcomes

Background:

  • Publicly available hospital performance data is crucial.
  • Dr Foster published an abdominal aortic aneurysm (AAA) repair league table in 2002.
  • The validity of this benchmarking data required investigation.

Purpose of the Study:

  • To validate the accuracy of data used in hospital performance benchmarking.
  • To assess the reliability of Dr Foster's abdominal aortic aneurysm (AAA) repair league table.

Main Methods:

  • Collected data on elective infra-renal AAA (IRAAA) repairs from three sources: Dr Foster database, hospital PAS system, and a vascular unit database.
  • Cross-referenced and analyzed data from Dr Foster and PAS against the unit's audit database.

Related Experiment Videos

  • Evaluated data accuracy, sensitivity, and specificity.

    • Main Results:

    • The Dr Foster database identified fewer IRAAA repairs (115) and included non-IRAAA deaths compared to the unit database (223 repairs).
    • Dr Foster's data had lower sensitivity (0.41) and specificity (0.86) than the PAS system (0.51 and 0.93).
    • The published Standardised Mortality Ratio (SMR) for the unit was 160, while the actual SMR was 67, indicating significant data discrepancies.

    Conclusions:

    • Published hospital league tables require robust and accurate data.
    • Current data used for benchmarking, exemplified by the Dr Foster AAA repair table, appears misleading.
    • Inaccurate data may cause undue patient anxiety regarding hospital performance.