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Prospective Analysis of Clinical Outcome: Influence on Surgical Professional Development

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Title: Slide 1 Author: Malcolm Underwood Last modified by: RAY Created Date: 2/28/2007 2:53:32 AM Document presentation format: On-screen Show Company – PowerPoint PPT presentation

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Title: Prospective Analysis of Clinical Outcome: Influence on Surgical Professional Development


1
Prospective Analysis of Clinical Outcome
Influence on Surgical Professional Development
  • Professor MJ Underwood
  • Division of Cardiothoracic Surgery,
  • Chinese University of Hong Kong,
  • Prince of Wales Hospital,
  • Hong Kong

2
Questions
  • What is Professional Development ?
  • How does it relate to Clinical Outcomes ?
  • How does it relate to a National Database?

3
Personal Viewpoint
  • UK System
  • Hong Kong Initiatives

4
Continuing Professional Development (CPD)
5
Continuing Professional Development (CPD)
6
  • Interrelates
  • Clinical
  • Managerial
  • Professional

PROVISION OF HIGH-QUALITY PATIENT CARE
7
  • Interrelates
  • Clinical
  • Managerial
  • Professional

PROVISION OF HIGH-QUALITY PATIENT CARE
8
General Medical Council Guidance - 2006
9
High Quality Patient Care Quality Assurance
Programme in Cardiac Surgery
  • AIM
  • Provide safest journey for the patient during
    their hospital stay with acceptable outcome
    defined by international standards.

10
Quality Assurance Components
11
ESSENTIAL Quality Assurance Components
  • Practical Factors
  • Local Data Collection
  • Internal/External Validation
  • National Data Collection
  • Internal/External Validation
  • Data Confidentiality/Safeguards
  • International Data Comparison
  • Calibration, Comparison
  • Personal/Surgical Factors
  • Commitment
  • Culture
  • Consistent

12
CPDHigh Quality CareQuality AssuranceData
Collection Data Analysis
  • How do we collect data ?
  • How do we analyze data ?

13
DATA COLLECTION Surgical Perspectives
  • Accurate
  • Validated
  • Internal/External
  • Available for Analysis
  • real-time for risk monitoring
  • Internationally Compatible
  • Security

14
Data Collection Summary
Validated
15
Influencing Events
  • 1994-96 Senior Registrar Bristol Royal Infirmary
  • 1997 Fontan Scholarship Brussels
  • 1999-2002 Consultant/Senior Lecturer Bristol
    Heart Institute

1995 External Review
1998 GMC Enquiry
2001 Public Enquiry
16
  • Senior Lecturer/Consultant (1999-On)
  • Audit Lead Cardiac Services
  • Clinical Governance Lead
  • R and D Quality Assurance Lead
  • Consolidating Data Collection and Reporting
  • Contribution to CEPOD
  • Public Presentation of Results
  • External Validation of BRI Data Collection
  • Development of Sub-Specialist Databases

17
Saturday 27 June 1998 BMJ All changed, changed
utterly British medicine will be transformed by
the Bristol case Richard smith, Editor
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
Continuous Professional Development
Institutional Reporting
22
(No Transcript)
23
Continuous Professional Development Individual
Reporting
24
Prospective Analysis of Clinical Outcome Where
are we in Hong Kong ?
  • Institution of Computerized Data Collection and
    Analysis System
  • Automated demographic data
  • Data Input at point of clinical care
  • Dedicated Database Manager
  • Accuracy, validation processes

25
Automated Demographics and Risk Calculation
26
Direct Comparison of Risk Scoring Systems Testing
  • Receiver Operating Characteristic (ROC) Curves
  • Area represents probability that risk predictor
    accurately discriminates between death and
    survival
  • Area of 1 Perfect
  • Closer to 1 better, Closer to 0.5 less accurate
  • Calibration Plots
  • Plot observed vs expected events in calibration
    plot
  • Chi-squared value used as measure of accuracy of
    matching

27
Risk-Scoring in the UK Population
28
Validation of Euroscore in Hong Kong
ROC Area 0.819 modified Euroscore
ROC Area 0.823 logistic Euroscore
29
Influence of Risk-Stratified Data Analysis on
Professional Development.
  • Monitor actual mortality and morbidity vs
    predicted
  • Essential for Quality Assurance Progamme
  • Compare with International Data

30
Comparison of Risk-Profiles East vs West !
  • But
  • Does risk-validation hold for sub-groups ?
  • Is there a need for population specific risk
    assessment

31
Hong Kong Cardiac Database Overview
32
A National Database Unique Practical Challenges
from a Surgeon
  • Differing data collection mechanisms
  • How merge ?
  • Accuracy and validity
  • What infrastructure ?
  • Security
  • Who sees the data ?
  • Data Analysis
  • Who analyses the data?
  • Presentation and Publication
  • Who ?

33
Hong Kong Cardiac Database Overview
Chinese Cardiac Surgical Database
34
Professional Development/Clinical
Outcome/National Database Summary
  • Inter-related
  • inseparable
  • Inevitable
  • consumer/provider driven
  • Irreversible
  • USA, UK, Europe

35
BMJ 2005330 (5 March)
Editor's choice Individual performance data
revelation and revolution Welcome to a new
world. Be brave. Kamran Abbasi, acting editor
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