Is mortality a good indicator of the clinical quality of National Health Service hospitals? A cross-sectional study of outlier trusts for mortality indices using quality dashboards

OBJECTIVES This study assessed whether the 14 National Health Service (NHS) acute trusts reviewed by Sir Bruce Keogh in July 2013 were performance outliers on the Acute Trust Quality Dashboard (ATQD) and examined whether high mortality indices results are associated with increased numbers of quality risk alerts and alarms. DESIGN The proportion of dashboard indicators rated amber or red in the Keogh Review trust group was compared with that for all trusts. Quality performance at primary care level was assessed for lead Clinical Commissioning Groups (CCG) of Keogh Review trusts through the national General Practice High Level Indicators. SETTING England. PARTICIPANTS The study examined the performance of all acute NHS trusts in England and the performance of the lead CCGs for all acute NHS trusts included in the Keogh Review. MAIN OUTCOME MEASURE The primary outcome was the proportion of alerts and alarms identified in the summer 2013 ATQD. RESULTS The mean proportion of indicators scored as alert or alarm across all trusts was 14.1% (13.5-14.7%). For Keogh Review trusts, the mean was 14.5% (12.6-16.4%). There was no significant difference between Keogh Review trusts and all acute trusts in numbers of alerts or alarms or for lead CCG quality performance. CONCLUSION This study finds no evidence to suggest the trusts reviewed by Sir Bruce Keogh in spring 2013 were outliers for overall quality of care as defined by the ATQD. The use of mortality indices alone to identify potential quality outliers in secondary care may not be sufficient.