National arrangements for clinical quality registries

Clinical quality registries are organisations that monitor the quality (appropriateness and effectiveness) of health care, within specific clinical domains, by routinely collecting, analysing and reporting health-related information.

Role of clinical quality registries

Clinical quality registries are a specific type of clinical registry. They:

  • Use the data they collect to identify benchmarks and variation in clinical outcomes
  • Feed this information back to clinicians to inform clinical practice and decision making.

This clinical outcome feedback loop shown in the graphic is the defining feature of clinical quality registries.

improving-clinical-practice-diagram

Registries may provide reports to jurisdictions, healthcare providers, funders, clinical colleges and researchers.

Clinical quality registries are therefore a fundamental part of continuous quality improvement in their role of:

  • Improving patient outcomes
  • Improving compliance with evidence-based guidelines and standards,
  • Informing the development of new guidelines and standards.

A framework for Australian clinical quality registries

The Commission developed the framework for Australian clinical quality registries to facilitate efficiencies in the development of national clinical quality registry infrastructure and to promote best practice design, development, operation and security. The framework was endorsed by Health Ministers in 2014 and contains:

  • Strategic principles
  • National health information arrangements
  • A national infrastructure model
  • Operating principles
  • Technical guidelines
  • Prioritisation criteria.

Use of the framework

Application of the framework to clinical quality registries provides assurances that registry data, and the systems that hold those data, have satisfied minimum security, technical and operating standards.

The framework was developed in collaboration with states, territories and expert registry groups, and involved public consultation and piloting. The reports that summarise the testing and validation of the draft operating principles and technical guidelines for clinical quality registries provide insights into the application of the framework and may be useful to registries under development.

Work is required to develop a view on the national policy context for clinical quality registries. The Commission is undertaking a program of work in order to achieve this, using the Framework as an overarching guide.

Economic evaluation of clinical quality registries

The Commission engaged Monash University and Health Outcomes Australia to evaluate the economic impact of five Australian clinical quality registries. Using a conservative methodology the evaluation study showed that Australian clinical quality registries have delivered significant value for money, when correctly implemented and sufficiently mature.

Each of the five clinical quality registries included in the study:

  • Had an influence on clinical practice
  • Improved the value of healthcare delivery at relatively low cost.

Evaluation results

Substantial benefits were measured, including:

  • Greater survival for patients
  • Improvements in quality of life after treatment
  • Avoided costs of treatment or hospital stay.

The study found that:

  • Benefit to cost ratios ranged from 2:1 to 7:1 – meaning that for every dollar spent, the return on that investment ranged from $2 to as much as $7.
  • The return on investment could range from $4 if national coverage were achieved by all five clinical quality registries
  • Not every clinical quality registry will be cost-effective. Problems such as low coverage, inadequate reporting and inadequate collection of information about patient outcomes will limit the effect of clinical quality registries, and their value to the health system.

Evaluation resources

Prioritised list of clinical domains project

This project aimed to implement and document a process applying the prioritisation criteria (and other elements) in the framework, to create a prioritised list of clinical domains for potential development of national clinical quality registries.

The process used and combined the available data with the collective judgement of experts. Key steps included:

  • Shortlisting to identify a manageable list of diseases, conditions and interventions based on cost to the health system, burden of disease and stakeholder priorities
  • Identifying prioritisation criteria in the Framework that are essential to the successful functioning of a clinical quality registry (threshold criteria)
  • Applying threshold criteria to remove diseases, conditions and interventions that are not suitable for clinical quality registry development
  • Grouping remaining diseases, conditions and interventions into clinical domains
  • Prioritising clinical domains against the remaining prioritisation criteria.

Future work

The Commission is continuing to progress the program of work required to develop a view on the national policy context for national clinical quality registries. This will include:

  • Updating the Framework to clarify governance arrangements
  • Developing a standard for clinical quality registries (using the Framework as the basis).