Transcript Slide 1

Local Improvement following National Clinical Audit
The View from a National Clinical Audit Provider –
the Health & Social Care Information Centre
National Clinical Audits
• Majority funded by Department of Health
• Supported by Professional bodies
• Commissioned by the Healthcare Quality Improvement Partnership
(previously by Healthcare Commission) and other organisations eg
Special/National Commissioning Groups
• Partnership – IC, Royal Colleges, Professional bodies
• Measure the quality of care received by patients in England and Wales
(and Scotland, Northern Ireland etc)
• Maturity of the audit
– Reports start with data quality and move to reporting clinical performance
• Use of clinical audit outputs
– Quality Accounts, CQC, national initiatives eg NAEDI (early detection of
cancer), research requests, service reviews, transparency agenda,
national training initiatives, NHS Choices, revalidation, NHS Outcomes
Framework, commissioning services
Clinical Audit Support Unit
Clinical Audit Support Unit
– Diabetes
– Kidney care
– Heart / Cardiovascular disease
– Hip fracture
– Cancer
– Dementia
– Minor Surgery
• All subject to competitive tender
• Single largest provider of national clinical audit
Current Reports
• Annual reports (paper and/or electronic) case
ascertainment and clinical outcomes at various levels –
national, trust (LHB), PCT, clinical network etc
• Interim reports – data quality, findings to date,
participation, case ascertainment – local and clinical
network level
• Outlier reports (Bowel & OG cancer & MBR) to make
local organisations aware of findings prior to publication
• Local Action Plans – follow up from annual report for
local organisations to reflect on findings locally and agree
action
Clinical Audit Support Unit – Annual
Reports
• Eligible trusts submit data
• Data Quality - national picture requires good participation,
case ascertainment and data completeness
• Analyse data, adjust for casemix, link to other national
datasets for enriched picture of patient care
• Publish audit outcomes in Annual Reports
• Best practice
• Outliers
• Recommendations for service improvement
• Varied audience
– Public and Patient Summaries
Producing Reports (annual) – the
process
• The overriding aim of the reports is to provide
national comparative information to assess clinical
performance against agreed standards, both
nationally & locally
• We can only publish what is submitted
• Timeliness vs. usefulness
• Different reporting platforms – data collection
system, iView – transition to same platform across
all audits
• Who do we send the report to/ notify ?
Barriers to delivering local data
• Legal
– The data have to go to the people who are authorised
to see it – e.g. via single sign on
• Small numbers
– Cause two problems, potential disclosure of sensitive
information and meaningless data due to large random
fluctuation
• Balancing use with timeliness
– including enough to be useful but not so much that it
takes 12 months to publish them
How are organisations expected to
use the reports
• Annual report
– Discuss findings within the clinical team providing care
– Identify if local service is acceptable
– Agree action for change if needed (use of LAPs –
cancer audits)
– Re-audit locally or monitor with next annual report
• Outlier reports – check data entered & report back to
HSCIC / professional body
• Data quality / completeness reports
– Identify gaps in data & re-submit
National Bowel Cancer Audit - background
• The Audit is a collaboration between the Association of
Coloproctology of Great Britain and Northern Ireland and
the Health and Social Care Information Centre. The
Clinical Effectiveness Unit of the Royal College of
Surgeons are contracted to provide the analysis for the
annual reports (2010, 2011 and 2012)
• Collects prospective data on patients diagnosed with
bowel cancer
• Established to investigate whether the care received by
bowel cancer patients is consistent with recommended
practice and to identify areas where improvements can be
made
National Bowel Cancer Audit – How we
present audit outcomes
• Annual reports
• Potential outlier notification
– 30-day / 90-day post-operative mortality
– Permanent stoma rates
• Local action plans
– Recommendations from the AR
– Suggest actions for trusts / cancer networks to achieve
the recommendations
• On-line reports
– Network and trust specific results
National Bowel Cancer Audit – How we
target improvement in data quality
• Quarterly network reports
– Participation
– Case ascertainment
– Data completeness
• Data quality reports
– Data submission deadline
– Highlight gaps in data quality
• Data extraction
– Local picture
National Bowel Cancer Audit – impact of
feedback reports
• 2006 Annual Report
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Trust level outcomes anonymised
30% participation
56% case ascertainment
17% data completeness for risk adjustment
• 2012 Annual Report
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Outcomes reported on trust identifiable basis
100% participation
87% case ascertainment
80% data completeness for risk adjustment
• Possible to determine the survival status at 30-days and 90days of over 99.9% of patients who had major surgery
National Bowel Cancer Audit –
improvements in data quality improve
clinical outcomes reported
– Characteristics of patients submitted to the Audit
– Management of patients
– Surgical and pathological outcomes of patients
undergoing major surgery
– Complications (return to theatre, failure to rescue,
emergency readmissions)
– Permanent stoma rates
– Emergency admissions
– Rates of laparoscopic surgery and its outcomes
– Length of stay
– Post operative mortality
Group Work
• Consider the current reports you receive:
– What is good about them
– What is bad about them
– What could be done differently
– What would you like to see that isn’t there