General Practice Research Database and its linkages

1. General Practice Research Database and its linkages Tjeerd-Pieter van Staa, Head of Research Tjeerd.vanstaa@gprd.com

2. Anon. Research Database Current Data Flows to and in Primary Care Nurses Receptionists GPs Other HPs Treatments Immunisations Health Clinics BP Administration Encounters Symptoms Diagnosis Tests Treatments Referrals Treatments DEATH PRIMARY CARE Discharge summary ICD, Date Emergency care QC Hospital Day Case Mother baby link Hospital Clinics General Hospital In BED

3. Linkage methodology GP surgery Trusted Third Party NHS#, DOB, PC, Sex + GPRD ANON ID NHS Registry File Linkage data File All GP Stored data Anon ID HES data Anon ID

4. What linkages are underway or completed • Hospital Episode Statistics (done) • Hospital prescribing (pending) • Cancer registries (done) • Myocardial Infarction MINAP (done) • ONS Mortality (done) • ALSPAC (done) • Air pollution (done) • National Bone and Joint Registry (pending) • Socio Economic Status small area (done)

5. Reflections on linkages • Data • Data collection methods vary • Data dictionaries vary • Data format changes – sometimes regular • Data complexity • Differing time periods of data collections; unclear start and end of collection

6. HES data Yr end Hospital data- patient journey Spell in 2007 (days) Spell in 08 (days) Episode (days) Episode (days) Episode (days) General Ward Intensive Care Emergency Room Transfer to Transfer from to Transfer from to From where Disease codes Disease codes ICD Disease codes Procedural codes Procedural codes Procedural codes OPCS4

7. HES-HOSPITAL data fields • customer_hes_link neodur mydob dob_cfl ethnos hesid sex admidate adm_cfl admimeth admisorc firstreg disdate dis_cfl disdest dismeth bedyear spelbgin epiend epistart speldur spelend epidur epiorder epie_cfl epis_cfl epistat epitype provspno wardstrt diag_01 diag_02 diag_03 diag_04 diag_05 diag_06 diag_07 diag_08 diag_09 diag_10 diag_11 diag_12 diag_13 diag_14 diag3 diag4 cause cause4 cause3 opertn_01 opertn_02 opertn_03 opertn_04 opertn_05 opertn_06 opertn_07 opertn_08 opertn_09 opertn_10 opertn_11 opertn_12 oper3 opdate_01 opdate_02 opdate_03 opdate_04 opdate_05 opdate_06 opdate_07 opdate_08 opdate_09 opdate_10 opdate_11 opdate_12 operstat posopdur preopdur classpat intmanig mainspef tretspef pconsult preggmp preferer referorg acploc_1 acploc_2 acploc_3 acploc_4 acploc_5 acploc_6 acploc_7 acploc_8 acploc_9 acpdqind_1 acpdqind_2 acpdqind_3 acpdqind_4 acpdqind_5 acpdqind_6 acpdqind_7 acpdqind_8 acpdqind_9 acpdisp_1 acpdisp_2 acpdisp_3 acpdisp_4 acpdisp_5 acpdisp_6 acpdisp_7 acpdisp_8 acpdisp_9 acpend_1 acpend_2 acpend_3 acpend_4 acpend_5 acpend_6 acpend_7 acpend_8 acpend_9 acpplan_1 acpplan_2 acpplan_3 acpplan_4 acpplan_5 acpplan_6 acpplan_7 acpplan_8 acpplan_9 acpn_1 acpn_2 acpn_3 acpn_4 acpn_5 acpn_6 acpn_7 acpn_8 acpn_9 acpout_1 acpout_2 acpout_3 acpout_4 acpout_5 acpout_6 acpout_7 acpout_8 acpout_9 acpsour_1 acpsour_2 acpsour_3 acpsour_4 acpsour_5 acpsour_6 acpsour_7 acpsour_8 acpsour_9 acpspef_1 acpspef_2 acpspef_3 acpspef_4 acpspef_5 acpspef_6 acpspef_7 acpspef_8 acpspef_9 acpstar_1 acpstar_2 acpstar_3 acpstar_4 acpstar_5 acpstar_6 acpstar_7 acpstar_8 acpstar_9 depdays_1 depdays_2 depdays_3 depdays_4 depdays_5 depdays_6 depdays_7 depdays_8 depdays_9 intdays_1 intdays_2 intdays_3 intdays_4 intdays_5 intdays_6 intdays_7 intdays_8 intdays_9 numacp orgsup_1 orgsup_2 orgsup_3 orgsup_4 orgsup_5 orgsup_6 orgsup_7 orgsup_8 orgsup_9 delprean delposan antedur birordr_1 birordr_2 birordr_3 birordr_4 birordr_5 birordr_6 birordr_7 birordr_8 birordr_9 birweit_1 birweit_2 birweit_3 birweit_4 birweit_5 birweit_6 birweit_7 birweit_8 birweit_9 delchang delmeth_1 delmeth_2 delmeth_3 delmeth_4 delmeth_5 delmeth_6 delmeth_7 delmeth_8 delmeth_9 delplac_1 delplac_2 delplac_3 delplac_4 delplac_5 delplac_6 delplac_7 delplac_8 delplac_9 delinten anasdate anagest gestat_1 gestat_2 gestat_3 gestat_4 gestat_5 gestat_6 gestat_7 gestat_8 gestat_9 birstat_1 birstat_2 birstat_3 birstat_4 birstat_5 birstat_6 birstat_7 birstat_8 birstat_9 delonset matage numbaby numpreg postdur biresus_1 biresus_2 biresus_3 biresus_4 biresus_5 biresus_6 biresus_7 biresus_8 biresus_9 sexbaby_1 sexbaby_2 sexbaby_3 sexbaby_4 sexbaby_5 sexbaby_6 sexbaby_7 sexbaby_8 sexbaby_9 delstat_1 delstat_2 delstat_3 delstat_4 delstat_5 delstat_6 delstat_7 delstat_8 delstat_9 neocare wellbaby epikey 292 Columns of data >>>>>>>>>> See http://www.hesonline.org.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=571 For explanation of fields

8. HES-HOSPITAL data 292 Columns of data >>>>>>>>>> See http://www.hesonline.org.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=571 For explanation of fields

9. Challenges of coding in one database, let alone multiple (Gulliford Plos One 2009)

10. Concordance linked datasets

11. Concordance linked datasets

12. Reflections on linkages • Issues of data ownership and working practices • Confidentiality issues (linking with dataset with e.g. detailed location data => one line per patient records) • Complex results (with multiple definitions for outcomes covering different times and patients often confuse) • Gold standard versus independent replication?

13. Air pollution – GPRD R Atkinson St Georges