UKRR – HES linkage

James FotheringhamSheffield Kidney Institute

Why do this at all?

2002 2003 2004 2005 2006 2007 2008 20090

10

20

30

40

50

60

70

80

90

100

49.362 66.4

52.160.1

5446.8 44.4

Year of data collection

Perc

enta

ge D

ata

Com

plet

enes

s fo

r Com

orbi

dity

USRDS

Period prevalent dialysis patients age 20 & older. At the end of 1998 a new ICD-9-CM code was added for infections due to internal devices in peritoneal dialysis patients; data prior to this date are omitted. Infections in this category include those related to vascular access devices or peritoneal dialysis catheters. Dialysis patients, 2005, used as reference cohort. Rates adjusted for gender, race, & primary diagnosis.

Potential avenues it opens up

• Hospitalisation• Procedures• Location• Diagnosis• Superior position to USRDS in that we can

describe events preRRT in < 65 year olds– Centre attributable outcomes

Linkage & Dataset & Fields

21,268 Incident RRT Patients

2002 - 2006

Hospitalisations, Procedures & Outpatient

Episodes1998 to Date

Cause of Death & Location

HES

ANONYMISED

Comprehensive timelineDEATH

FRACTURE

PARATHYROIDECTOMY

START

OF RRT

AVF

FORMATION

MI

DIABETES

HESHospital Episode Statistics

CaPhosPTHHb

CHANGE IN

MODALITY

TENCKHOFF

INSERTION

L741X411

M809B142

E119I21

0 1 2 3 4

CABG X3

K423

-1-2 YEARS

DHSMR / SHMI-D

95%

95%99.8%

99.8%

0 100 200 300 400 500 600 700 800 900 1000

Expected Number of Deaths

0.00

0.25

0.50

0.75

1.00

1.25

1.50

Sta

ndar

dise

d M

orta

lity

Rat

io

Transplant Centre

On Site Renal Services

Visiting Renal Cover> 95% CI> 99.8% CI

Length of Stay & Frequency of Admission

Location of Admission

Better adjusted incident survival & practice characteristics influence it

HES I21 - Myocardial Infarction

HES E10 - Diabetes

HES I71 - Peripheral Vasc. Dis.

HES I50 – Cong. Cardiac FailureNoneCOPDMIPVDDMCCF

Underpinning all this

• Comorbidity adjustment• Insights into individual units own practice with

relation to hospitalisation and how this differs from national practice

• Begin understanding if HES offers the answers to missing data

• Intuitive way of displaying centre specific data• Demonstrating the utility of HES-linkage

Recognised pitfalls

• Undercoding and inaccuracies– Early focus will be describing robust endpoints

• Hospitalisation Location• 30 Day Mortality• Length of stay

– Learn what the data can allow us to do

Progress to date

• Funding and authorisations are in place• HRSS has the HES data• UKRR will shortly be sending their data• Combined dataset should arrive early August

Thank you