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Clinical Excellence Division > Patient Safety and Quality Improvement Service

Clinical Excellence Division

Patient 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.

Technical details

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.

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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.

Related Resources

Patient Safety Health Service Directive & Guidelines

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VLAD 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.

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Indicator Review

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.

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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.

Related Resources

VLAD Publications


Last Updated: 26 February 2014
Last Reviewed: 08 August 2014

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