Introducing the NCAS Diabetes Audit

1. Introducing the NCAS Diabetes Audit David Stones

2. National Clinical Audit Support Programme National Diabetes Audit

3. Introduction • Overview of the Programme • Current projects • The national diabetes audit • Objectives • Audit Questions • Overview of the Solution • Demonstration of web application • Where we are now and plans for early adopters • The future and the national programme • Questions

4. Programme Overview • Background of professional body & ministerial pressure for better clinical audit information • Programme initially commissioned by Department of Health. Now commissioned by CHI – moving to to CHAI • Objective: • 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 work • collaboration and partnership • undertake that which is best done centrally

5. Generic process • Identification and agreement on initial priorities • Develop and agree audit questions • Identify data items required • Undertake reconciliation with national dataset development • Specification and development of central IT infrastructure for collation, analysis and feedback • Provide support tools for collection at local level • Use data for national reporting

6. NCASP: Current Programme • Coronary Heart Disease (CHD) • Cancer • Diabetes

7. Coronary Heart Disease • AMI (MINAP) – operational for 2 years • 100% of sites contributing • Patient benefits: • Reduced time to effective thrombolytic treatment • Discharge on appropriate medication • Paediatric cardiac surgery and congenital heart disease • operational for 2 years • profession’s response to the Bristol inquiry • Angioplasty – in pilot stage • Adult cardiac surgery – in pilot stage

8. Cancer • Lung Cancer Data (LUCADA) • Early adopters in January • Data for Head and Neck Oncology (DAHNO) • Early adopters in January • Colorectal cancer audit • Support for existing audit

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

10. Audit Questions (Priority) • Is everyone with diabetes diagnosed and recorded on a GP Practice Diabetes Register? • Denominator is number of people predicted to have diabetes • Reporting level: GP practice, PCT, SHA, National • For 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 diabetes • Reporting level: PCT, SHA, National • Key source of information will be HES

11. 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 screening • denominator is number of people with diagnosed recorded diabetes within NHS organisation • Recording 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 140/80 • denominator number of people with diagnosed recorded diabetes within NHS organisation • Recording level: GP Practice, Hospital Trusts, PCT's, SHAs, National

12. Datasets • Information 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) • BMI • Systolic Blood Pressure • Diastolic blood pressure • HbA1c level • Creatinine Level • Microalbuminuria Level • Cholesterol Level • Eye Examination • Foot Examination • Smoking Status • Relevant 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

13. Data quality

14. Context diagram GP Practice Operational reports to PCT, SHA and National CHI SHAs PCTs Other Extract query Upload files View quality reports nhsnet NCASP Diabetes Central Infrastructure Open Exeter Audit Database Analysis and strategic reports DDIS PCTs Hospital Trust To third party for analysis

15. Timeline Data collection (happening now!) Data extraction from clinical systems Linkage and preparation of benchmark reports 31 Mar 04 Cut off 31 Aug 04 Report distribution 30 Nov 04

16. Security and Confidentiality • The 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 present • A patient information leaflet is available • explains what the audit is about and why the data is required • Patients, or parents of children with diabetes, may opt out of the audit

17. Demonstration

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

39. Other Reports • There are also specific sets of reports for Hospitals, Paediatric Units, PCTs, SHAs and national organisations • Reports and services available to users are determined by the logon of each user • Organisations above GP practices and Hospitals only see anonymised aggregated data • Final analysis and benchmark reports: • Not part of web application • Reports for the first year will be available by December 2004 • Details of analysis and publication methods yet to be finalised

40. Early Adopter Testing • Began Early Adopter Testing in February 2004 • PCTs: • Dacorum • Brent • (Salford) • Test feasibility and usability prior to rollout • Rollout from 1 April 2004 • Local preparation for rollout can begin now

41. 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 about 1 hour per year …… however data quality issues???? …… some system specific issues????

42. Miquest query/data quality Helen Atkinson and Dai Evans

43. The future

44. More information • www.nhsia.nhs.uk/ncasp • Background • File specifications for standard CSV upload (secondary care) • Miquest queries • Open Exeter Registration forms • General information leaflets • Patient information leaflets • Quick start leaflets • Guidance for Caldicott Guardians • diabetes@nhsia.nhs.uk

45. National Clinical Audit Support Programme Diabetes Project