Clinical Quality Registries in Australia

Background

There has been considerable interest over the past few years in identifying and using health data to monitor  quality of care.  The National Health Information Management Principal Committee in its Strategic Plan for the  period 2007-08 to 2012-13 has set as one of its four priorities  to better use health information to improve the quality of the health system.  This was endorsed by the Australian Health Ministers' Advisory Council.   

There is a recognition that in order to use data to monitor quality of care appropriate data sources need to be identified. To this end, the Australian Institute for Health and Welfare, in partnership with the Australian Commission on Safety and Quality in Health Care, undertook an environmental scan of healthcare safety and quality data sources.  In 2009, the NHMRC Centre of Research Excellence in Patient Safety surveyed clinical registry custodians and reported on the attributes of registries.  A summary of the findings is available in the peer-reviewed Journal of Internal Medicine.

What is a clinical quality registry?

An Australian Clinical Quality Registry is a registry whose purpose is to improve the safety or quality of health care provided to patients. Australian Clinical Quality Registries build on data collected from events in daily health care and use this information to assess care provision and implement quality improvements where required.

Clinical registers are databases that systematically collect health-related information on individuals who are:

• treated with a particular surgical procedure, device or drug, e.g. joint replacement;
• diagnosed with a particular illness, e.g. stroke; or
• managed via a specific healthcare resource, e.g. treated in an intensive care unit.

Clinical quality registers are a particular subset of clinical registers. The purpose of a clinical quality register is to improve the safety or quality of health care provided to patients by collecting key clinical information from individual healthcare encounters which enable risk-adjusted outcomes to be used to drive quality improvement.

Figure 1. Clinical registers and clinical quality registers  

Clinical quality registers can provide the most suitable and accurate method of providing monitoring and benchmark data and, where applicable, offer the greatest potential to improve health care performance across institutions and providers. Clinical quality registers should be focused on conditions and procedures where outcomes are thought to vary and where improvements in quality have the greatest capacity to improve quality of life and/or reduce costs.

The system or organisation governing the register is known as the registry.

How should registries be established and maintained?

Draft Operating Principles and Technical Standards have been developed as a tool to assist groups wishing to establish a registry.  It is important that people thinking of establishing a clinical quality registry have a clear understanding of what is required in setting up and maintaining a registry.  They should clearly understand that registries are long-term databases. Unlike clinical trials, which recruit a select sub-group of patients for usually a short  pre-defined period of time, registries collect ongoing data on the entire eligible population.  

Identifying your registry as a clinical quality registry

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