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Clinical quality registries

Clinical quality registries are organisations which systematically monitor the quality (appropriateness and effectiveness) of health care, within specific clinical domains, by routinely collecting, analysing and reporting health-related information.

Clinical quality registries are a specific type of clinical registry. They use the data they collect to identify benchmarks and variation in clinical outcomes. They then feed this information back to clinicians to inform clinical practice and decision making. This clinical outcome feedback loop is the defining feature of clinical quality registries.

Improving clinical practice

Reports may also be provided to jurisdictions, healthcare providers, funders, clinical colleges and researchers. Clinical quality registries are therefore a fundamental part of continuous quality improvement – improving patient outcomes, improving compliance with evidence-based guidelines and standards, and informing the development of new guidelines and standards.

A framework for Australian clinical quality registries

The Commission developed the framework for Australian clinical quality registries to facilitate efficiencies in the development of national clinical quality registry infrastructure and to promote best practice design, development, operation and security. The framework was endorsed by health ministers in 2014 and contains:

  • strategic principles
  • national health information arrangements
  • a national infrastructure model
  • operating principles
  • technical guidelines
  • prioritisation criteria.

Application of the framework to clinical quality registries provides assurances that registry data, and the systems that hold those data, have satisfied minimum security, technical and operating standards.

The framework was developed in collaboration with states, territories and expert registry groups, and involved public consultation and piloting. The reports that summarise the testing and validation of the draft operating principles and technical guidelines for clinical quality registries provide insights into the application of the framework and may be useful to registries under development.

Work is required to develop a view on the national policy context for clinical quality registries. The Commission is undertaking a program of work in order to achieve this, using the Framework as an overarching guide.

Economic evaluation of clinical quality registries

The Commission engaged Monash University and Health Outcomes Australia to evaluate the economic impact of five Australian clinical quality registries. Using a conservative methodology the study showed that Australian clinical quality registries have delivered significant value for money, when correctly implemented and sufficiently mature. Each of the five clinical quality registries included in the study had an influence on clinical practice and improved the value of healthcare delivery at relatively low cost. Substantial benefits were measured, including greater survival for patients, improvements in quality of life after treatment and avoided costs of treatment or hospital stay.

Benefit to cost ratios ranged from 2:1 to 7:1 – meaning that for every dollar spent, the return on that investment ranged from $2 to as much as $7. The study suggested that the return on investment would range from $4 if national coverage were achieved by all five clinical quality registries. However, the study noted that not every clinical quality registry will be cost-effective. Problems such as low coverage, inadequate reporting and inadequate collection of information about patient outcomes will limit the effect of clinical quality registries, and their value to the health system.

Economic evaluation of clinical quality registries (PDF 2MB) (Word 2MB)

Economic evaluation of clinical quality registries – Appendix D – Support slides (PDF 1MB) (PPT 2MB)

Prioritised list of clinical domains

This project aimed to implement and document a process applying the prioritisation criteria (and other elements) in the framework, to create a prioritised list of clinical domains for potential development of national clinical quality registries.

The process used, combined the available data with the collective judgement of experts. Key steps included:

  • shortlisting to identify a manageable list of diseases, conditions and interventions based on cost to the health system, burden of disease and stakeholder priorities
  • identifying prioritisation criteria in the Framework that are essential to the successful functioning of a clinical quality registry (threshold criteria)
  • applying threshold criteria to remove diseases, conditions and interventions that are not suitable for clinical quality registry development
  • grouping remaining diseases, conditions and interventions into clinical domains
  • prioritising clinical domains against the remaining prioritisation criteria.

Prioritised list of clinical domains for clinical quality registry development (PDF 788KB) (Word 806KB)

Future work

The Commission is continuing to progress the program of work required to develop a view on the national policy context for national clinical quality registries. This will include:

  • updating the Framework to clarify governance arrangements
  • developing a standard for clinical quality registries (using the Framework as the basis).