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What’s new in Q new tools for commissioning & early diagnosis

What’s new in Q new tools for commissioning & early diagnosis. Professor Julia Hippisley-Cox EMIS NUG, Warwick 2011. Acknowledgements. Contributing practices EMIS NUG (Chris, Charlie + others) EMIS (Sean, David, Andy, Shaun+ others) University of Nottingham QResearch Advisory Board

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What’s new in Q new tools for commissioning & early diagnosis

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  1. What’s new in Qnew tools for commissioning & early diagnosis Professor Julia Hippisley-Cox EMIS NUG, Warwick 2011

  2. Acknowledgements • Contributing practices • EMIS NUG (Chris, Charlie + others) • EMIS (Sean, David, Andy, Shaun+ others) • University of Nottingham • QResearch Advisory Board • ClinRisk (software) • Co-authors/researchers

  3. Overview • QFeedback • QData Linkage Project • Risk stratification tools for commissioning • QCancer – assess risk of existing cancer • Questions/Discussion/Suggestions

  4. See the invitation in your delegate bag ideally all practices to contribute to both QResearch & QSurveillance Email julia.hippisley-cox@nottingham.ac.uk Get switched on

  5. QFeedback

  6. QFeedback: update • Interactive tool based on QSurveillance • Allows practices to view own data compared • PCT, SHA, UK • Similar practices • Graphs, Maps, Export data to excel • Deployed to 3,400 EMIS LV in early 2011 • Uptake 2885 practices in 1st 6 months • Final of E Heath innovation awards

  7. QFeedback in LV

  8. QFeedback dashboard

  9. Example maps

  10. QResearch Data Linkage Project

  11. QResearch Data Linkage Project • QResearch database already linked to • deprivation data • cause of death data • Very useful for research • better definition & capture of outcomes • Health inequality analysis • Improved performance of QRISK and similar scores

  12. QResearch Linkage Project Data source Content Inpatient, outpatient, A&E, maternity Cancer type, grade stage Heart attack type and treatment • Hospital Episode Statistics • Cancer registry • MINAP ‘Myocardial Infarction National Audit Project’

  13. New approach pseudonymisation • Need approach which doesn’t extract identifiable data but still allows linkage • Legal, ethical and NIGB approvals • Secure, Scalable • Reliable, Affordable • Generates ID which are Unique to Project • Applied within the heart of the clinical system • Minimise disclosure

  14. Pseudonymisation: method • Scrambles NHS number BEFORE extraction from clinical system • Takes NHS number + project specific encrypted ‘salt code’ • One way hashing algorithm (SHA2-256) • Cant be reversed engineered • Applied twice in to separate locations before data leaves EMIS • Apply identical software to external dataset • Allows two pseudonymised datasets to be linked

  15. QScores – risk prediction tools

  16. QScores – family of Risk prediction tools • Population level • Risk stratification • Identification of rank ordered list of patients for recall or reassurance • Individual assessment • Who is most at risk of preventable disease? • Who is likely to benefit from interventions? • What is the balance of risks and benefits for my patient? • Enable informed consent and shared decisions

  17. Criteria for chosing clinical outcomes • Major cause morbidity & mortality • Represents real clinical need • Related intervention which can be targeted • Related to national priorities (ideally) • Necessary data in clinical record • All then available as Open Source software

  18. Population risk stratification for PCTs/CG • Possible to apply all algorithms at PCT level • view the risk profile of population, • estimate the likely burden of disease • model the costs and benefits of interventions at different thresholds of risk • set local targets • determine search strategies which the practice or community staff can use for call/recall • evaluate outcomes & reset priorities.

  19. Risk Stratification: questions • QRISK & QDScore now being used at PCT level for recall • How useful has QRISK been for PCTs/practices • Useful to do this for other existing QScores? • Suggestions for new outcomes which would be useful • at PCT level? • at patient level?

  20. Risk of Hospital Admission • Requests from PCTs/CG to develop new tool identify patients • At risk of hospital admission • At risk of re-admission • Problems with PARR ++ and the Combined Tool • Never properly validated • Difficult to implement • Not been updated

  21. QAdmission (QA) Scoreshall we do it? • Utility • To identify patients high risk (re) admission • Intervention • Virtual wards • Community matrons • Implementation • Needs to be simpler to implement • Integrated into any clinical system • Regularly updated coefficients

  22. QCancer Tools to help earlier diagnosis www.qcancer.org Username: nuguser Password: ATouchOfSpice

  23. Cancer: The problem of diagnosis • Some cancers diagnosed very late when curative Rx not possible • Symptoms very common in general practice • Single symptoms not very specific • Earlier diagnosis improves options & outcome • NICE guidelines • Complicated • Miss patients & false positive • No indication of risk of patient having cancer

  24. Key predictive symptoms & factors • Loss weight/appetite • Rectal bleeding • Haematemesis • Dysphagia • Haemoptysis • Haematuria • PMB • Abdominal pain • Constipation/diarrhoea • Cough • Age, sex, ethnicity • deprivation • Smoking • Alcohol • Family history • Chronic diseases • Prior cancers • Anaemia (Hb<11)

  25. Six common cancers so far • Lung cancer • Colorectal cancer • Gastro-oesophageal cancer • Pancreatic cancer • Ovarian cancer • Renal cancer

  26. New approach needed • Need information based on patients record • combines symptoms + patient characteristics (age, sex, deprivation, PMH, FH) • Absolute risk of different type of cancer • Needs to be available WITHIN the consultation to guide management • Also as batch processing to identify patients with alarm symptoms/high risk but no investigations or outcome BEFORE or AFTER consultation

  27. QCancer methods • Used 2/3 sample of QResearch database • Identified all patients with new onset alarm symptoms in last 10 years • Followed up over 2 yr for diagnoses of cancer • Developed set of models which incorporates symptoms and profile to give risk calculation • Tested performance of models on rest of QResearch database & THIN database (INPS) • External validation by Oxford academics • Publication due Winter 2011/12

  28. Using QCancer in practicesdemo • www.qcancer.org • Either use as standalone or integrated • Template to help better recording positive and negative symptoms triggered by code for alarm symptom? • system calculates background risk before consultation and alerts to high risk of undiagnosed alarm symptoms? • Run in batch mode to pick up those with high risk and/or undiagnosed alarm symptoms

  29. Discussion/questions • QFeedback • QLinkage project/pseudonymiation • Risk stratification tools • QAdmission Score – shall we do it • QCancer tools • Suggestions for future work.

  30. Questions on pseudonymisation • Pseudonymisation needed for QResearch • Do we need it for other purposes in clinical system? • Eg generating list of patients for recruitment to studies • Any more examples? • Any questions?

  31. See the invitation in your delegate bag Get switched on

  32. General application

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