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Table 4 Out of hospital information

From: Increasing the options for reducing adverse events: Results from a modified Delphi technique

Proposals Effect [1 = v.high 6 = negative] mean (std dev) Implement (months) Impact (months) Total (years)
4.1 All Australians registered with Medicare should be offered the option of a smart card which contains the patient's full medical history, and/or the option of having their medical history kept on a centralized database. As an option, the card or database should have a 'secure' record of personal information which the patient wishes to keep confidential under normal conditions and which can be transferred from the patient to the doctor using a confidential PIN. All health care providers should have (subsidized) facilities for accessing information which is not confidential. 2.00 (.71) 47 9 4.7
4.2 Comparative risk adjusted mortality and adverse event rates should be on the provider website and freely available to the public. Providers should be allowed to comment on these data when the comment is informational and not marketing for the practice. The date by which this information must be posted should be determined by the volume of procedures and the elapsed time until the numbers allow the information to be statistically reliable. In the interim, process information should be provided. 3.06 (1.14) 43 52 7.9
4.3 The government should provide summary hospital data to Private Health Insurance Funds. Funds should be encouraged to use this data when contracting with hospitals. 3.27 (1.10) 33 50 6.9
4.4 Each State and Territory Health Department should routinely link discharge and re-admission data to determine the likelihood of an incident-related re-admission within a defined period. This provision should, subsequently, be extended to include data from the Health Insurance Commission and individual-level mortality statistics. Criteria should be developed to identify hospitals, hospital teams, and individual practitioners with an atypically high level of adverse events, to report on between-hospital variation, and to identify areas for improvement.a 2.78 (1.17) 40 30 5.8
4.5 As in parts of the United States and the United Kingdom, information should be available to the public, including on the internet, regarding risk-adjusted mortality and adverse event by cause for all public and private hospitals. Data should only be posted where the number of cases is sufficiently large that a statistically significant pattern could be expected to emerge. When case loads are below this threshold, this fact and other process information should be made available. Independent groups (such as consumer organisations) should be funded to interpret and disseminate this information. (This later step is needed or, as in some US states, there will be minimal impact of information.) 2.94 (1.14) 35 43 6.5
  1. a It should be noted that re-admission is not always related to an adverse event, and therefore is not a reliable indicator on its own.