CRAB Comparison
| Other monitoring systems | CRAB |
|---|---|
| Use national aggregate data sets (HES) derived from high level management information of limited quality. | Uses extensive clinical data, most of which clinicians harvest in the course of treating patients. |
| Insufficient or no drill down to patient level data. | Drill down to raw patient data enables outliers and causes to be identified with a robust evidence base. |
| Single outcome measures for mortality & morbidity. | Single outcome measures as other systems. |
| Poor risk adjustment: no effective allowance made for case-mix. Generic adjustments only for age, gender, diagnosis & status of trust. | Excellent risk adjustment ensures proper assessment of clinical quality as information reported is risk adjusted to remove all variables except the clinical team. For each individual patient, the risk of mortality and morbidity is calculated from physiological and operative factors. |
| Employ statistical modeling based on averages. This highlights outliers on a volume basis. | Uses mathematical modeling to provide accurate identification of unexpected outcomes on a case by case basis. Incorporates sophisticated exponential regression. |
| Snapshot analysis exaggerates small anomalies. | Presents trends as well as snapshots and provides spectrum analysis by displaying results grouped according to the risk of morbidity or mortality of individual cases. |
| Use benchmarking that is not robust. These systems simply provide comparisons of similar organisations (which will always have differences in patient case-mix), rather than like patient profiles. | CRAB is benchmarked against an international database of over 500,000 patients, enabling sensible assessment of any organisation or clinician. |
| The principal focus is on identifying negative performance results (mortality / readmission outliers). No indication of root cause is provided and client organisations are required to perform their own follow-up investigations, with significant time and resource costs. These investigations regularly indicate that negative performance results were to be expected given the complications of individual cases. | CRAB presents data as actual vs. expected, thus highlighting variance. Not only are problems identified but and successes and exceptional performance are highlighted and may be celebrated. CRAB’s drill down facilities enable reports to be analysed by providing access to raw patient data. Thus results may be interrogated quickly and easily to identify root cause and process, e.g. nature of complications, availability of facilities or referral patterns, rather than simply highlighting outlying clinicians. |
| Data are not owned by the clinical organisation, and may be published without their consent. | CRAB is installed onto the IT system within the clinical organisation. The title to the data remains with the clinical organisation. |
| Sold to management as a policing tool: clinicians are mistrustful & disenfranchised. | Sold to organisations through clinicians as part of Darzi Service Line Reporting. Fulfils requirements for appraisal & revalidation, as well as Board assurance and management objectives for quality & safety. |
