NICOR Outlier Policy

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The Department of Health and HQIP have both issued guidance on the detection and management of outliers in comparing providers and individuals using batches of data collected over an appropriate defined period and in both outcome and process measures of performance.

These recommendations have been based on advice from an expert group of statisticians and a review of existing management protocols used by national clinical audits.

The definition of an outlier is based on setting a target for an indicator and then defining what level of variation from that target is acceptable, based on theories of statistical probability and/or clinical judgement. NICOR has partnered with the statistical team at UCL under Professor Rumana Omar to  develop this methodology further and this methodology has now been published – Outlier identification and monitoring of institutional or clinician performance: an overview of statistical methods and application to national audit data, Pavlou M et al. BMC Health Services Research (2023) 23:23.

The full manuscript is available as an open access paper that can be downloaded from this link:

Based on the definition the below-linked policy applies to the following clinical domains of the national cardiac audit programme (NCAP):

The policy applies to both positive and negative outliers. It will however be relevant to all appropriate analyses on datasets held by NICOR.

Risk models for the National Audit of Heart Failure and the Myocardial Ischaemia National Audit Project (MINAP) are in development and will enable outlier analyses.

This policy reflects the responsibilities of both NCAP (as a national clinical audit provider) and those of the provider organisations.

It will be applied to mortality outcomes and on agreed individual analyses of metrics that have a significant relationship with mortality outcomes.

Please see the link to our Outlier Policy.