Monitoring mortality in general practice in Grampian, Scotland

Primary healthcare teams' views on using mortality data to review clinical policies

BACKGROUND AND OBJECTIVE

A UK-wide scheme to monitor mortality in general practices has been recommended to improve safety. A monitoring scheme might also have a role in improving quality by informing clinical policies. This study investigated the views of primary care teams on the desirable characteristics of mortality data to help them review and plan their clinical policies.

SETTING

10 general practices in Leicestershire, UK.

METHODS

Development of a format for presentation of mortality data for primary care teams, presentations of the data to team meetings, and subsequent interviews of 16 general practitioners and nurses to identify issues about the improvement and use of the data for informing clinical policies.

RESULTS

The presentation was important in helping teams to understand the data. Comparisons should be between practices with similar patient populations, and information provided on deaths from diseases potentially amenable to prevention through clinical intervention. Practice teams used the data in reflecting on their own clinical care.

CONCLUSIONS

Presentation of data about mortality in practice populations can enable practices to reflect on their clinical policies. The proposed national scheme for monitoring mortality should provide data in a format that helps teams to improve the quality of care as well as improve patient safety.

Making use of mortality data to improve quality and safety in general practice: a review of current approaches

OBJECTIVE

To review studies of the use of mortality data in quality and safety improvement in general practice.

DESIGN

Narrative review.

METHODS

Search of Medline, Embase and CINAHL for articles reporting mortality monitoring or mortality reviews in general practice. The included articles were reported in English and of any study design, excluding case reports and comment pieces. Studies of palliative care and bereavement, and of primary care programmes in developing countries, were excluded.

RESULTS

229 articles were identified in the searches, 65 were identified as potentially relevant and 53 were included in the review. The studies addressed the impact of primary care provision on mortality rates, methods of monitoring mortality, and the role of audit and death registers in quality and safety improvement. General practitioners were interested in using mortality data but reported difficulties in obtaining complete information. There were no experimental studies of the impact of the use of mortality data, and little evidence of long-term systematic initiatives to use mortality data in quality and safety improvement in general practice.

CONCLUSIONS

Mortality data are not used systematically in general practice although general practitioners appear interested in the potential of this information in improving quality and safety. Improved systems to provide complete data are needed and experimental studies required to determine the effectiveness of use of the data to improve general practice care.

Mortality in general practice: Problems concerning deaths in institutions

Following the provision of all general practitioners in Grampian with data on their practice death rates, the experience of death rates at institutions in the region was examined. Nursing homes are more likely to be situated in less deprived areas and their age-specific death rates are generally higher than those experienced by residents from non-institutional settings. For residents in non-institutional settings in Grampian, higher death rates generally parallel increasing deprivation. This expected trend is reversed when describing the mortality experience of nursing home residents. One reason for this is the movement of elderly people to the locations of nursing homes in less deprived areas. Methodological issues are discussed and proposals are made to improve the analysis of mortality in this article.