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Quality data: The PRIMIS Comparative Analysis Service for Coronary Heart Disease

Quality data: The PRIMIS Comparative Analysis Service for Coronary Heart Disease. Dr Pete Horsfield PRIMIS Clinical Director Ms Shirley McLean PRIMIS Facilitator, South Hams & West Devon PCT. Outline of Session. Overview of Comparative Analysis Service (CAS) – Pete Horsfield

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Quality data: The PRIMIS Comparative Analysis Service for Coronary Heart Disease

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  1. Quality data:The PRIMIS Comparative Analysis Service for Coronary Heart Disease Dr Pete Horsfield PRIMIS Clinical Director Ms Shirley McLean PRIMIS Facilitator, South Hams & West Devon PCT

  2. Outline of Session • Overview of Comparative Analysis Service (CAS) – Pete Horsfield • Outline of CAS for CHD – Pete Horsfield • User perspective of CAS for CHD – Shirley McLean • Discussion

  3. Overview of CAS (1) • PRIMIS • Support and Training • Information Management • Data Quality • Data Quality Analysis • Standard Query Set • All schemes (within scheme only) • Comparative Analysis Service • Added-value service • Clinically focused • Voluntary • Selective (data quality filters) • Out-of-scheme, practice level

  4. Overview of CAS (2) • Methods • Selection of topics • Clinical Advisory Group • User Representative Group • PRIMIS Team • Development of queries • National standards • NSFs • Recognised guidelines • Clinical Advisory Group • Iterative process

  5. CAS for CHD • First CAS query set • Pilot model for future work • Approaching end of first cycle of iteration • Run in 14 schemes ( 150 practices) • Pragmatic approach • Loosely based on immediate priorities of NSF • Anticipate core information needs • Reflect what is achievable now • Platform on which to build

  6. The PRIMIS Comparative Analysis Service for Coronary Heart Disease Dr Pete Horsfield PRIMIS Clinical Director

  7. Information from General PracticeCoronary Heart Disease Shirley McLean Clinical Information Co-ordinator South Hams & West Devon PCT 3rd April 2001 Birmingham

  8. Started Aug 2000 18 practices in total 16 participating 2 due to start in July av. 75% patient records on computer 100% by April 2002 Query sets used DQ Data Quality CHDB Basic Level Systems in Use Microtest x 8 EMIS x 4 Meditel System5 x 3 Vision x 3 South Hams & West DevonClinical Data Project

  9. September • Approval from Clinical Governance Leads October / November • Read Code training December • New version of MIQUEST received for use with CHD NSF Queries • Test sites, one for each system • MIQUEST Interpreter failure • Deadline extended (thanks Lynne!)

  10. January • PCT CHD NSF Launch Day held • Summary list of Read codes • Data sent to the Comparative Analysis Service February • Feedback received; gross errors at one practice fixed by supplier; data resubmitted March • Feedback received & reported to Clinical Governance • Practices visits arranged

  11. Beneficial Outcomes • Motivation to enter data on the computer • Coding lessons learnt • System failures identified & fixed • Corrupt data identified & fixed • Under-recording of Diagnoses, Smoking Status, Alcohol, BMIs identified • New templates enabling improved data collection • Validation of ‘Registers’ supported & encouraged

  12. Hints & Tips • Select Test sites • Check the raw data • Allocate PRIMIS Unique Identifiers in batches by supplier • Provide free training, preferably on-site • Suppliers can help!

  13. Known Problems with Results • Un-coded drug data • Unreliable incidence data • A true picture of Clinical Practice is masked by clinical system / data quality issues, e.g. Apparent under-recording: • Not all patient records on the computer / codes not entered at all • Alternative Read codes used • No guarantee that NSF information requirements will be fully met in the form required by HAs

  14. Wish List • Rush output in NSF age ranges, <35, 35-74, >74 • To be included in queries: G73% PVD 5853. Echocardiogram 792.. / 773. Coronary Artery Operations 771. Angioplasty 8HTK. Referral to stop-smoking clinic 137L. Current non-smoker (where date ceased = ?) • Rush files to include a record of the Read codes and terms used for each chart

  15. Future Plans • Provide feedback & agree action plans with practices • Get written consent from each practice before identifying & publishing the results • Report to the Executive • CHD Intermediate & Advanced queries • More Read Code training • Repeat query cycle & map trends

  16. Information from General PracticeCoronary Heart Disease Shirley McLean Clinical Information Co-ordinator South Hams & West Devon PCT 3rd April 2001 Birmingham

  17. Discussion Topics • Strengths • Weaknesses • Training / support implications • Suggestions for improvement • Data Quality criteria • Clarification of rationale

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