Transcript National Prostate Cancer Audit Prospective audit development Julie Nossiter, Project Manager Clinical Effectiveness Unit – Royal College of Surgeons of England www.npca.org.uk [email protected] Introduction • Prospective audit.

National Prostate Cancer Audit
Prospective audit development
Julie Nossiter, Project Manager
Clinical Effectiveness Unit – Royal College of Surgeons of England
www.npca.org.uk
[email protected]
Introduction
• Prospective audit designed to address two key concerns:
• The management of men with low-risk disease
– Are patients being over-treated that could be appropriately managed
by active surveillance?
• Use of multimodality therapy* for men with high-risk localised
or locally advanced prostate cancer
– Are these patients being under-treated?
*hormones and external beam radiotherapy; surgery followed by adjuvant or early salvage radiotherapy
www.npca.org.uk
[email protected]
Prospective audit
• Data collection started on the 1st April 2014 in England:
– Characteristics of all newly diagnosed men, how their cancer was
detected & the referral pathway
– Crucial steps in the diagnostic & staging process
– The planning of initial treatment & initial treatments given
• NPCA will also systematically measure the functional impact
of radical therapies on patients’ lives (PROMs/PREMs)
– 18 months’ after diagnosis
• Provide key information on current practice and outcomes:
– Early complications, longer term survival & quality of life
– Compared with NICE Quality Standards
– Generate QPIs
www.npca.org.uk
[email protected]
Design of the NPCA MDS: key principles
• All men with newly diagnosed prostate cancer
• Data on their diagnosis, staging and initial treatment should
be collected during the initial phase of management and
available at meetings of the MDT
– ‘All patients with a new diagnosis of PC should be discussed at a MDT
meeting’ NICE 2002
• The burden of data collection on staff and patients should be
kept to a minimum
• The audit data items should be available soon after they are
generated in clinical practice
www.npca.org.uk
[email protected]
A new generation of national cancer audit
• Key characteristics of NPCA prospective audit:
– based on Cancer Outcomes and Services dataset (COSD) items as
much as possible
– National Cancer Registration Service (NCRS) is data collection partner
• Developed ‘minimum dataset (MDS)’
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Project team in consultation with stakeholders
Utilised COSD items, BAUS & created NEW items where appropriate
50 data items in total (now 49 – 2xCOSD items removed)
only 20 new data items (now 21)
www.npca.org.uk
[email protected]
MDS implementation: England
• NPCA contact database developed & updated
– Communication with trust teams about the audit
• NPCA Prospective Audit Information Package
– Detailed data set specification
– Data dictionary & guidance document
– Summary handout & FAQ
• MDT system suppliers
– 50% of trusts use Somerset, 25% InfoFlex, 25% ‘Other’
– Worked with Somerset and Infoflex to implement within systems
• NCRS regional offices
– Coordination of CG approval & distribution of NPCA Information
Package (also available @ www.npca.org.uk)
– Help-desk function for trusts
– Accept test extracts as local IT teams upgrade MDT systems
www.npca.org.uk
[email protected]
Collection & submission of data: England
• Mechanism for collection & submission of data for the NPCA mirrors COSD
• Frequency of data submission is monthly by designated dates post
diagnosis/treatment, e.g:
• November 2014 data by 6th January 2015
• December 2014 data by 5th February 2015
• NPCA data is subsequently exported from MDT software systems and
submitted to local NCRS offices along with routine COSD submission
• It was anticipated that it may take a few months to fully implement
appropriate mechanisms for data collection & to align with COSD
submission schedule
• Possible to plug data gaps at a later submission
• Participation has increased month on month
• Update from Regina, NCRS including launch of monthly Quality Reports (data
completeness)
www.npca.org.uk
[email protected]
Schematic of NPCA data collation
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Collection & submission of data: Wales
• Included in NHS Wales National Clinical Audit and Outcome
Review plan
– Participation is mandated
• Mechanism for data collection & submission is currently being
developed
• NHS Wales Information Service are developing software
updates to the national Canisc system
– Mapping NPCA dataset
• NPCA has received confirmation that the data collection
process in Wales will start in April 2015
– NPCA will work with colleagues in Wales during implementation of the
MDS & dissemination of the necessary guidance
www.npca.org.uk
[email protected]
NPCA Prospective Audit MDS
• MDS 1. all newly diagnosed men with PC during MDT meeting
(s) to discuss initial phase of treatment
– more detail and data item change in the following slides
• MDS 2. all men with PC who have undergone radical
prostatectomy
– Paul will explore in more detail and explain data item changes
• MDS 3. all men with PC for whom external beam
radiotherapy or brachytherapy +/- androgen deprivation
therapy are planned
– Ajay will explain rationale behind collection of planned items and
propose mechanism for data collection
www.npca.org.uk
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MDS 1: introduction
• 9 routinely collected mandated COSD items: patient identity &
demographic details; NHS Trust/MDT/Consultant
• Collect clinical data on the patient, their cancer and their
initial treatment plan (summary handout in delegate pack)
– 20 clinical items in total : 11 in COSD, 9 new items including 2 in
RCPath
www.npca.org.uk
[email protected]
MDS 1: Case-mix adjustment
• NPCA will take account of differences in mix of patients
between providers
– Age & ethnicity, socioeconomic status, overall physical condition,
comorbidity and pre-existing urinary symptoms
www.npca.org.uk
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MDS 1: Source of referral
• Approx. 25% patients first diagnosed with cancer after an
emergency hospital admission
– Early detection is an important determinant of treatment outcome
• NPCA will determine variation in the way PC is diagnosed
– Geographical variation, relationship with disease stage at
presentation, treatment allocation and ultimately outcomes
www.npca.org.uk
[email protected]
MDS 1: Risk Stratification
• NPCA will collect information on a patient’s definitive
diagnosis of PC
– Biopsy type, biopsy histology, D’Amico risk stratification
www.npca.org.uk
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MDS 1:Multiparametric MRI
• NPCA will determine whether men undergo mpMRI before
prostate biopsy as an initial step in the diagnostic pathway
www.npca.org.uk
[email protected]
MDS 1: Patient pathways
• NPCA will determine the patient pathway following diagnosis
– type/s of clinical specialist men are seen by and in what setting
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MDS 1 data item change: Planned treatments
• ‘Planned prostate cancer treatment’ was captured during
MDT prior to discussion with patient
– ‘back mapped’ to COSD item ‘Planned treatments’
– ‘all options’ captured = limited utility
• NPCA will collect: Planned Prostate Cancer Treatment agreed
with the Patient
– Treatment plan agreed with the patient – only one plan (may be a
combination of radiotherapy and hormones)
www.npca.org.uk
[email protected]
Thank You
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