In my very limited experience of this sort of thing, I think the idea is
to use the figures as a stimulus for reviewing practice. It is therefore
not just a question of "How many do I (or my colleagues) request?", but
"Why do I request them?", "What are the evidence-based guidelines for
requesting this test?", "How does my practice compare with the
guidelines", etc. A common example would be use of lumbar spine x-rays,
which seem to be commonly over-used.
Hope this helps.
Richard Hancock
Clinical Audit
Burton Hospitals NHS Trust.
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In message <005901bee832$8daebb00$0426883e@default>, Chris Burton
<[log in to unmask]> writes
>I know this is slightly off the mainstream of EBHC but nevertheless the same
>principles of being aware of the meaning of things expressed as numbers and
>asking the right questions apply.
>
>Producing statistics of physician (or group or unit or whatever) performance
>seems to be one of the great growth industries in medicine. Graphs of
>performance in just about anything seem to be produced - usually with
>something that looks at first glance like a normal distribution (and almost
>never with any statistical addenda). But I would like to know whether we can
>use them sensibly as anything other than pictures. In particular when I am
>one of the subjects of the analysis how do I interpret my own performance?
>
>I don't recall seeing this discussed in mainstream (UK based) journals so
>probably either its a stupid question or there's no easy answer. I have some
>ideas but I'm not a statistician.
>
>So let's try a few scenarios:
>1. Local radiology dept feedback usage stats for a procedure (say plain
>lumbar spine) to 30 primary care practices. They circulate a bar chart of
>number of requests /1000 registered patients and put a few values on the y
>axis. I know which bar is my practice (and I know how many patients I have)
>but I don't know who any other bar is (although I know the approximate total
>number of patients of all the practices). There is no mean supplied although
>the median is easy to see and because the distribution is fairly symmetrical
>the mean is probably about the same. My practice is the second lowest user,
>I want to know if I am behaving differently from most of my colleagues or
>whether it is just a random thing. My practice population is somewhere near
>the median of the distribution so it's not a very small sampling effect.
>
>2. The above radiologists didn't limit it to plain L spine, but added in
>abdo ultrasound, and barium enema. I'm the lowest user of abdo ultrasounds
>but in the middle of the pack for ba enema. Do I pool them or analyse
>separately?
>
>There are a few more but perhaps I'll see if anyone bites on this first.
>
>Chris
>Dr Chris Burton
>GP, Sanquhar, Dumfriesshire
>Member of WestNet, the West of Scotland Primary Care Research Network
>http://medicine21.com/heartGP
>
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