The National Bowel Cancer Audit: the risks and benefits of moving to open reporting of clinical outcomes.
BACKGROUND
The government's proposals to openly report clinical outcomes poses challenges to the National Bowel Cancer Audit now funded by the UK department of health.


OBJECTIVE
To identify the benefits and risks of open reporting and to propose ways the risks might be minimized.


METHODS
A review of the literature on clinical audit and the consequences of open reporting.


RESULTS
There are significant potential benefits of a national audit of bowel cancer including protecting patients from sub-standard care, providing clinicians with externally validated evidence of their performance, outcome data for clinical governance and evidence that increases in government expenditure are achieving improvements in survival from bowel cancer. These benefits will only be achieved if the audit captures most of the cases of bowel cancer in the UK, the data collected is complete and accurate, the results are risk adjusted and these are presented to the public in a way that is fair, clear and understandable. Involvement of clinicians who have confidence in the results of the audit and who actively compare their own results against a national standard is essential. It is suggested that a staged move to open reporting should minimise the risk of falsely identifying an outlying unit.


CONCLUSIONS
The fundamental aim of the National Bowel Cancer Audit is the pursuit of excellence by identification and adoption of best practice. This could achieve a continuous improvement in the care of all patients with bowel cancer in the UK. The ACPGBI suggests a safer way of transition to open reporting to avoid at least some of its pitfalls.
Thompson
M R
MR
Department of Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK. karen.flashman@porthosp.nhs.uk
Tekkis
P P
PP
Stamatakis
J
J
Smith
J J
JJ
Wood
L F
LF
von Hildebrand
M
M
Poloniecki
J D
JD
D054869:Clinical Audit / Q000379:methods*; D006801:Humans; D007414:Intestinal Neoplasms / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000331:legislation & jurisprudence / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D018570:Risk Assessment; D006113:United Kingdom