National Clinical Audit Support ProgrammeNational Diabetes Audit

IntroductionOverview of the ProgrammeCurrent projectsThe national diabetes auditObjectivesAudit Questions Overview of the SolutionDemonstration of web applicationWhere we are now and plans for early adoptersThe future and the national programmeQuestions

Programme OverviewBackground of professional body & ministerial pressure for better clinical audit informationProgramme initially commissioned by Department of Health. Now commissioned by CHI moving to to CHAIObjective: provide comparative audit information to stakeholders routinely and facilitate data collection (primary aim: to support the front line in improving patient care)Approach:pragmatic support existing workcollaboration and partnershipundertake that which is best done centrally

Generic processIdentification and agreement on initial prioritiesDevelop and agree audit questions Identify data items requiredUndertake reconciliation with national dataset developmentSpecification and development of central IT infrastructure for collation, analysis and feedbackProvide support tools for collection at local levelUse data for national reporting

NCASP: Current Programme

Coronary Heart Disease (CHD)CancerDiabetes

Coronary Heart DiseaseAMI (MINAP) operational for 2 years100% of sites contributingPatient benefits:Reduced time to effective thrombolytic treatmentDischarge on appropriate medicationPaediatric cardiac surgery and congenital heart diseaseoperational for 2 yearsprofessions response to the Bristol inquiryAngioplasty in pilot stageAdult cardiac surgery in pilot stage

Cancer

Lung Cancer Data (LUCADA)Early adopters in January Data for Head and Neck Oncology (DAHNO)Early adopters in JanuaryColorectal cancer auditSupport for existing audit

Diabetes project objectivesTo establish a national system for routine data, collation, analysis and feedback of diabetes related dataTo cover all people (children and adults) with diabetes in England To use the approach developed for the QUIDS project as the foundation for the projectThe priority for the project during 2003/4 will be the identification of all people registered with diabetes

Audit Questions (Priority)Is everyone with diabetes diagnosed and recorded on a GP Practice Diabetes Register? Denominator is number of people predicted to have diabetesReporting level: GP practice, PCT, SHA, NationalFor people with diabetes what is the annual rate of specific complications and outcomes e.g. amputation, myocardial infarction, stroke, ketoacidosis, end stage renal failure and diabetic retinopathy?Denominator is number of people recorded with diabetesReporting level: PCT, SHA, NationalKey source of information will be HES

Audit Questions (Optional)What is the annual rate of carrying out the key processes of diabetes care amongst people with registered diabetes?Includes blood pressure, HbA1c, lipid profile, urine albumen creatinine ratio, other measures of urinary micro protein, foot examination, retinal screeningdenominator is number of people with diagnosed recorded diabetes within NHS organisationRecording level: GP Practice, Hospital Trusts, PCT's, SHAs, National.What proportion of people with registered diabetes achieve treatment targets? Includes HbA1c less than 7%, less than 8%, less than 9%; total cholesterol less than 5; blood pressure less than 140/80denominator number of people with diagnosed recorded diabetes within NHS organisationRecording level: GP Practice, Hospital Trusts, PCT's, SHAs, National

DatasetsInformation to be collected is based on the Summary Core Dataset submitted to ISB in March 2003:NHS number (Essential)Year of Birth (Essential)*Ward code of usual address (Essential)*Sex (Essential)*Death date*Year of diagnosis (Essential)Type of Diabetes (Essential)BMISystolic Blood PressureDiastolic blood pressureHbA1c levelCreatinine LevelMicroalbuminuria LevelCholesterol LevelEye ExaminationFoot ExaminationSmoking StatusRelevant conditions and complications (Essential from HES linkage)

Additional items (not in approved dataset)GP Practice Code (Essential)*Data Supplier Code (Essential)

* Indicates item could be provided through linkage to Open Exeter

Data quality

Context diagramAudit DatabaseGP Practice

nhsnetHospital TrustDDISPCTsNCASP Diabetes Central InfrastructureAnalysis and strategic reportsUpload filesView quality reportsExtract queryTo third party for analysisCHISHAsPCTsOtherOperational reports to PCT, SHA and NationalOpen Exeter

TimelineData collection(happening now!)31 Mar 04Data extraction from clinical systemsCut off31 Aug 04Linkage and preparation of benchmark reportsReport distribution30 Nov 04

Security and ConfidentialityThe current NCASP audits have been approved under Section 60 of the Health and Social Care Act to collect the required patient identifiable information Written consent from patients to collect the information is not required at presentA patient information leaflet is availableexplains what the audit is about and why the data is required Patients, or parents of children with diabetes, may opt out of the audit

Demonstration

Further Patient details are availble by clicking on the NHS number.

Other ReportsThere are also specific sets of reports for Hospitals, Paediatric Units, PCTs, SHAs and national organisationsReports and services available to users are determined by the logon of each userOrganisations above GP practices and Hospitals only see anonymised aggregated dataFinal analysis and benchmark reports:Not part of web applicationReports for the first year will be available by December 2004Details of analysis and publication methods yet to be finalised

Early Adopter TestingBegan Early Adopter Testing in February 2004PCTs:DacorumBrent(Salford)Test feasibility and usability prior to rolloutRollout from 1 April 2004Local preparation for rollout can begin now

A burden on practices and PCTs?Organise logon to the Open Exeter System (20 minutes)Run the Miquest Query (20 minutes)Load the query and view the reports the following day (20 minutes)

Once you understand what you are doing the time per practice is about1 hour per year

however data quality issues???? some system specific issues????

Miquest query/data quality

Helen Atkinson and Dai Evans

The future

More informationwww.nhsia.nhs.uk/ncaspBackgroundFile specifications for standard CSV upload (secondary care)Miquest queriesOpen Exeter Registration formsGeneral information leafletsPatient information leafletsQuick start leafletsGuidance for Caldicott Guardiansdiabetes@nhsia.nhs.uk

National Clinical Audit Support ProgrammeDiabetes Project

Example from early adoptersPIAG require movement to NHS number as sole patient identifier.Logged on a s a GP practiceGMS contract and population managerDivided NWCS-2 OBS between NASP and LSPWidened the scope to SUSForged strong links with NPfIT and now using this to influence the wider Secondary Uses Service (SUS) of which NWCS-2 will a partSUS is vital to future of NASKept to timescales to replace before end of current McKesson contract (June 05)