The Medical journal of Australia
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Worldwide, current practice is to report hospital mortality using the hospital standardised mortality ratio (HSMR). An HSMR is generated by comparing an indirectly standardised expected mortality rate against a hospital's observed mortality rate. A hospital's HSMR can be compared with the overall outcomes for all hospitals in a population, or with peer hospitals. ⋯ There has been concern that HSMRs may be too variable over time for individual values to be interpretable. A study of HSMR outcomes in Australian hospitals confirmed earlier reports of the stability of the measure. Considerable progress has been made with developing Australian HSMRs for use as routine measures to improve the safety and quality of Australian hospital care.
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The National Antimicrobial Utilisation Surveillance Program (NAUSP) collects aggregate data from hospitals in all Australian states and provides reports of monthly hospital inpatient antimicrobial usage to contributing hospitals. These data provide an Australian peer-group benchmark; hospitals can compare their usage with similar hospitals and identify areas of antimicrobial use that require more in-depth analysis. ⋯ High use of particular classes of antimicrobials has triggered individual drug audits and been used to tailor interventions. Longitudinal antimicrobial usage data have been used by hospitals to measure the effects of antimicrobial stewardship strategies and provide feedback to prescribers.
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Although difficult to quantify, there is known widespread variation in the way that best available evidence is applied in clinical practice. The reasons for gaps between evidence and practice are complex, and efforts to improve uptake are unlikely to be successful if they are one-dimensional or focus on individual health professionals. This article provides contextual reference for articles in this Supplement in addressing how and why clinical variation exists, the importance of reducing it and strategies to drive a more streamlined approach to evidence-based care in Australian health care systems.
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The variable life-adjusted display is a graphical, statistical methodology used in Queensland to monitor patient outcomes of clinical indicators. The quality improvement cycle is a systematic approach employed by patient safety and quality programs worldwide to improve patient care. ⋯ Indicators with definitional issues that are not subject to the quality improvement cycle may initially prompt quality improvement opportunities, but are more likely to potentially lead to unnecessary chart and clinical reviews, which will disengage coders and clinicians. Queensland recently used the quality improvement cycle to refine the laparoscopic cholecystectomy complications of surgery indicator definition and several maternity definitions.