It sounds a pretty daft idea. How would you take account of the
shifting age distribution of the patients on a GP practice list over
time as they register and de-register? let alone shifts in all the other
characteristics which we know affects mortality. A simple count of
deaths per practice with which dead people were registered, would be
obviously much simpler - and could probably act as an equally effective
warning signal. Even so, the informaiton on de-registration because of
deaths is, currently, at least 6 months old and - as far as I know -
noone actually collates the data in that form (i.e. by practice of
registration) and I'm not certain it's possible as deaths can be
certified by 'anyone' (well not quite).
The comparison of death rates from surgery - which is what of course
Confidential Enquiries do all the time - is at least referring to one
identifiable intervention, taking place at an identifiable institution,
even if we know that we 'ought' to take into account hundreds of
complicating factors. GPs - on the whole (with, e.g., Shipman an
exception) - do not intervene in the same way.
[log in to unmask] wrote:
>
> It looks as if one of the first new 'National Statistics' might be measures
> of performance of General Practioners!
>
> In the aftermath of the conviction for murder of Dr Shipman, one of the
> promises made by Alan Milburn the Minister of Health is to involve the ONS
> in monitoring the performance of GPs.
>
> I suppose it would be relatively easy to calculate the average expectation
> of life of patients of a particular doctor. The data needed is simply date
> of birth and date of death for all deaths. Is is not likely that, even
> though Shipman's victims were elderly, such calculations made on the basis
> of the deaths of his patients would have shown that something strange was
> going on?
>
> Standardised mortality rates for individual doctors, and individual
> practices, could also be calculated, but that would require data on the age
> distribution of all patients.
>
> This kind of monitoring is has some precedents in the US. New York State
> publishes statistics for the mortality rate for coronary artery bypass
> surgery for individual surgeons every year. See
> <http://www.health.state.ny.us>.
>
> Ray Thomas, Social Sciences, Open University
> Tel: 01908 679081 Fax 01908 550401
> Email: [log in to unmask]
> 35 Passmore, Milton Keynes MK6 3DY
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