Maximising the value of clinical registry information through integration with a health service clinical governance framework: a case study

Abstract

This initiative sought to identify unit participation in clinical registries within a large metropolitan health service and to develop approaches to integration of registry reporting within the organisational clinical governance framework to maximise potential quality improvement benefits. The initiative, led by the Medical Services Department at Alfred Health, initially involved identifying health service participation in clinical registries via a range of mechanisms, including one-on-one meetings with clinical registry investigators. In conjunction with the Clinical Governance Unit, tools to summarise and track clinical registry information at Alfred Health over time were developed and piloted. Alfred Health identified 69 clinical registries in which its units participated. These were heterogeneous in terms of clinical area and purpose, as well as the nature and frequency of reporting. Engagement with clinicians led to the establishment of a registry interest group, a calendar of clinical quality registry reports, and a guideline and reporting template and dashboard. Clinician engagement and medical leadership were critical to the development of this initiative. The reporting tool and dashboard have had initial success, with long-term success ultimately being measured by the routine incorporation of registry outcomes into clinical governance reporting over time. What is known about the topic?Health service clinical governance systems require the collection, analysis and ongoing monitoring of clinical performance and quality improvement information. These data may be from internally derived clinical indicators or from external datasets, such as clinical registries. However, although clinical registries have traditionally provided information at the unit level, mechanisms to systematically incorporate these clinical measures into health service clinical governance systems have been lacking. What does this paper add?This paper provides a case study of the steps taken by one large health service to identify, engage clinicians and incorporate disease-specific clinical registry indicators into its organisational clinical governance framework. It highlights the complexity of the task through the time taken to identify, translate and summarise key clinical information into a format suitable for organisational committee reporting. What are the implications for practitioners?This paper highlights to health service managers the importance of initial and ongoing engagement of clinicians in the development of a shared approach to organisational use of clinical registry data. It outlines potential steps that can be taken within a health service to engage clinicians in sharing registry information, and processes that can assist in systematically incorporating registry information into actionable organisational-level reporting as part of clinical governance.

Which strategies support the effective use of clinical practice guidelines and clinical quality registry data to inform health service delivery? A systematic review

“…Four studies [ 7 , 13 , 19 , 27 ] were assessed using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS, Version 1.0) tool, a valid and reliable critical appraisal instrument applicable to healthcare quality improvement (QI) interventions [ 40 ]. It comprises 16 criteria, with responses of either “met” or “not met” [ 40 ] (see Additional file 4 ).…”

“…It comprises 16 criteria, with responses of either “met” or “not met” [ 40 ] (see Additional file 4 ). Of these four studies, the overall quality was very high: one met 15 of the 16 criteria [ 19 ], two met 14 [ 13 , 27 ] and one met 13 of the 16 criteria [ 7 ].…”

“…The 15 CQR articles included the following: four beforeand-after studies [26][27][28]36]; four survey studies [24,29,31,34]; four case studies [7,25,32,35]; and three interview studies [30,33,37]. Again, the lack of rigorous study design limited the confidence in findings from these studies and their generalisability.…”

“…CQRs function to inform, monitor and report on the implementation of QI measures, aiming to reduce variation and extend best practice care to as many patients as possible, delivering more equitable outcomes [ 7 ]. Registries that collect data without benchmarking it against best practice (either through CPGs or high-quality clinical settings) will not have the knowledge to learn from the data and improve quality outcomes.…”

Using Digital Technologies in Response to the COVID-19 Pandemic in Portugal

“…The value of real-world data analysis is evident for planning, intervention and validation of strategy. This continuous collection of information in real time allows the development of research, supporting timely decision-making and promoting the drafting of updated rules and guidelines, whose implemented strategies enhance good practices [ 3 ]. Nevertheless, as data volume increases, so does its complexity which requires computational power and advanced analytical tools.…”