Clinical Excellence DivisionPatient Safety and Quality Improvement Service
Variable Life Adjustment Display (VLAD)
The VLAD methodology was introduced to Queensland Health to aid the monitoring of quality of services provided. It provides an easily understood graphical overview of clinical outcomes over time and plots the cumulative difference between expected and actual outcomes. Selected private hospitals are also provided with VLADs for certain indicators.
The data that is used to construct the VLAD is sourced from the corporately submitted patient data set. This data is updated monthly, and as such, the VLAD technique allows timely detection of potential problems or improved performance. The VLAD technique includes a mechanism for signaling when further investigation of performance is warranted. Hospital staff can then investigate performance using The Pyramid Model of Investigation. This structured investigation approach assists staff to identify reasons for variations in clinical outcomes.
VLADs are a type of statistical process control chart. The VLAD incorporates a logistic regression model to predict the likelihood of the outcome for each patient. The VLAD then plots the difference between predicted and actual outcome. Upper and lower control limits are used to enable flagging when the cumulative outcome varies from state average at pre-defined levels.
- How control limits are worked out (PDF, 22KB)
VLAD Information System
VLAD CM, a joint venture between Opus 5K and Patient Safety Unit, facilitates the dissemination, monitoring, investigation and reporting of VLADs across Queensland.
Patient Safety Health Service Directive & Guidelines
- Patient Safety Health Service Directive
- Patient Safety Guideline for Variable Life Adjusted and Other National Patient Safety Indicators
The VLAD clinical indicators were developed in association with clinical expert groups and undergo ongoing review to ensure relevance. A number of medical, mental health, obstetrics and gynaecology and surgical indicators are monitored.
- Latest VLAD Indicator Definitions (PDF, 494KB)
Ongoing indicator review is an iterative process of statistical and clinical debate and discussion. Each indicator is rigorously evaluated for clinical significance, definition clarity and responsive potential. Following completion of an indicator suite review the VLAD Indicator Review Working Group release a Statement of Activity that includes the results of the review.
- Report on the Obstetrics Indicator Review Summary of Activity February 2014 (PDF, 331KB)
- Report on the Orthopaedic VLAD Indicator Review Summary of Activity November 2012 (PDF, 381KB)
- Report on the Acute Myocardial Infarction VLAD Indicator Review Summary of Activity November 2012 (PDF, 395KB)
- Report on the Stroke VLAD Indicator Review: Summary of Activities - August 2012 (PDF, 258KB)
- Laparoscopic Cholecystectomy Indicator Review - February 2012 (to be released 27 June 2012) (PDF, 397KB)
- Heart Failure Indicator Review - February 2012 (to be released 27 June 2012) (PDF, 343KB)
- Paediatric Tonsillectomy and Adeniodectomy Indicator Review - October 2010 (PDF, 189KB)
- Maternity Indicator Review - Oct 2009 (PDF, 194KB)
The Clinical Monitoring Team is interested in working collaboratively to update and revise clinical indicators to ensure they remain clinically relevant. All feedback will be discussed at subsequent indicator reviews.
- Coory M, Duckett S, Sketcher-Baker K, 'Using control charts to monitor quality of hospital care with administrative data', International Journal for Quality in Health Care 2007:1-9
- Duckett SJ, Coory M and Sketcher-Baker, K (2007) Identifying variations in quality of care in Queensland Hospitals, Medical Journal of Australia, (187) p 571-5
- Lezzoni L, 1997, 'Assessing quality using administrative data', Annals Internal Medicine, vol 127, pp 666-674.
- Mohammed M A, Rathbone A, Myers P, Patel D, Onions H, Stevens A, 2004, 'An investigation into general practitioners associated with high patient mortality flagged up through the Shipman inquiry: retrospective analysis of routine data', British Medical Journal, vol 328, pp 1474-7.
- Sherlaw-Johnson, C (2005) 'A method for detecting runs of good and bad clinical outcomes on variable life-adjusted display (VLAD) charts' Health Care Management Science (8) 61-5.
- Woodall W, 2006, 'The use of control charts in health-care and public-health surveillance', Journal of Quality Technology, vol 38, pp 89-104