Introduction

The Quality Improvement Programme at ISD Scotland leads, supports and contributes to a wide range of projects designed to promote improvements in the quality of care provided to patients in Scotland.

Stoma Care Audit
Clinical Nurse Specialists (CNSs) approached NHS Quality Improvement Scotland to ask for help in carrying out a short audit following the introduction of a new community pharmacy contract on 1st April 2006. This new contract involved a change in the reimbursement arrangements to stoma suppliers as documented in NHS HDL (2004) 54. CNSs lost their sponsorship from stoma suppliers and are now fully funded by the NHS. NHS QIS commissioned the Information Services Division to carry out an audit with an aim to ascertain the impact of the new stoma contract on the quality of the service provided to patients. This report summarises the findings from the audit 

Scottish Arthroplasty Project (SAP) 
The aim of the Scottish Arthroplasty Project (SAP) is to encourage continual improvement in the quality of care provided to joint replacement surgery (arthroplasty) patients. This is currently achieved through the auditing of routinely collected SMR01 national data in Scotland.

Clinical Indicators 
In Europe, Scotland has led the way in the production and public release of clinical indicators.  Since 1993 a report has been produced annually, presenting data on a range of health and healthcare issues.  The main purpose of producing these indicators is to supply information that local NHS clinicians and managers can use to improve the quality of patient care.

Since 2003, an increasing number of previously published indicators have been updated on the internet. The 'web indicators' are updated every six months and it is planned over time to increase the number of indicators that are available on the web. These indicators can be accessed via theClinical Indicators support team website (CIST).

eSCRIPS - Electronic Scottish Consultant Review of Inpatient Statistics
The web based electronic package eSCRIPS gives hospital consultants in NHSScotland secure access over the NHSnet to nationally recorded information about their inpatient and daycase workload and provides local and national comparative information.

Surgical Profiles 
NHS Quality Improvement Scotland (NHS QIS) and the Information Services Division (ISD), together with a clinically led group, have developed a report called a surgical profile. The profile presents a suite of clinical indicators about the surgical care provided by an NHS Board, and is a tool designed to help the NHS Board monitor and continuously improve the quality, safety and effectiveness of surgical care.

SPICE 
At the end February 2006, a project looking at Scottish Programme for Improving Clinical Effectiveness in Primary Care (SPICE) data was established. SPICE has been developed by health care professionals to assist General Practices in the provision of effective care and to encourage quality improvement in the primary care setting. It offers practices a voluntary scheme under which they can submit data on their clinical effectiveness and receive feedback on their performance relative to other participating practices. A bi-annual return launched in March 2000, to date 24 sets of criteria have been developed which take account of up-to-date evidence base coupled with the quality indicators of the nGMS Contract.

The Clinical Governance Programme has been funded by NHSQIS to carry out 4 sub-projects using this data:

• Before and after analysis of nGMS contract.
• Improved presentation of feedback.
• Measures of change.
• Treatment of deprived individuals in affluent and deprived practices.

Results of these projects will be used to

• - improve methods for appropriate presentation of data.
• - show whether the nGMS contract has improved quality generally or distorted priorities away from other conditions.
• - identify data requirements for the routine application of ?value added? measures.
• - provide evidence to inform policy of anticipatory primary care in deprived areas.