Quality data: The PRIMIS Comparative Analysis Service for Coronary Heart Disease

3rd April 2001Birmingham

PRIMISFirst National Conference

3rd April 2001Birmingham

PRIMISFirst National Conference

Quality data:

The PRIMIS Comparative Analysis Service for Coronary

Heart Disease

Dr Pete HorsfieldPRIMIS Clinical DirectorMs Shirley McLean

PRIMIS Facilitator, South Hams & West Devon PCT

3rd April 2001Birmingham

PRIMISFirst National Conference

Outline of Session

• Overview of Comparative Analysis Service (CAS) – Pete Horsfield

• Outline of CAS for CHD – Pete Horsfield

• User perspective of CAS for CHD – Shirley McLean

• Discussion

3rd April 2001Birmingham

PRIMISFirst National Conference

Overview of CAS (1)• PRIMIS

– Support and Training• Information Management• Data Quality

– Data Quality Analysis• Standard Query Set• All schemes (within scheme only)

– Comparative Analysis Service• Added-value service• Clinically focused• Voluntary• Selective (data quality filters)• Out-of-scheme, practice level

3rd April 2001Birmingham

PRIMISFirst National Conference

Overview of CAS (2)• Methods

– Selection of topics• Clinical Advisory Group• User Representative Group• PRIMIS Team

– Development of queries• National standards

– NSFs– Recognised guidelines

• Clinical Advisory Group• Iterative process

3rd April 2001Birmingham

PRIMISFirst National Conference

CAS for CHD

• First CAS query set– Pilot model for future work– Approaching end of first cycle of iteration– Run in 14 schemes ( 150 practices)

• Pragmatic approach– Loosely based on immediate priorities of NSF– Anticipate core information needs– Reflect what is achievable now– Platform on which to build

3rd April 2001Birmingham

PRIMISFirst National Conference

The PRIMIS Comparative Analysis Service for Coronary

Heart Disease

Dr Pete HorsfieldPRIMIS Clinical Director

3rd April 2001Birmingham

PRIMISFirst National Conference

PRIMISFirst National Conference

Information from General Practice

Coronary Heart Disease Shirley McLean

Clinical Information Co-ordinatorSouth Hams & West Devon PCT

3rd April 2001Birmingham

3rd April 2001Birmingham

PRIMISFirst National Conference

South Hams & West DevonClinical Data Project

Started Aug 200018 practices in total16 participating2 due to start in

July

av. 75% patient records on computer

100% by April 2002

Query sets used• DQ Data Quality• CHDB Basic LevelSystems in Use• Microtest x 8• EMIS x 4• Meditel System5 x 3• Vision x 3

3rd April 2001Birmingham

PRIMISFirst National Conference

September• Approval from Clinical Governance Leads

October / November• Read Code training

December• New version of MIQUEST received for use with CHD

NSF Queries• Test sites, one for each system• MIQUEST Interpreter failure• Deadline extended (thanks Lynne!)

3rd April 2001Birmingham

PRIMISFirst National Conference

January• PCT CHD NSF Launch Day held• Summary list of Read codes• Data sent to the Comparative Analysis Service

February• Feedback received; gross errors at one practice fixed

by supplier; data resubmitted

March• Feedback received & reported to Clinical Governance• Practices visits arranged

3rd April 2001Birmingham

PRIMISFirst National Conference

Beneficial Outcomes• Motivation to enter data on the computer• Coding lessons learnt• System failures identified & fixed• Corrupt data identified & fixed• Under-recording of Diagnoses, Smoking

Status, Alcohol, BMIs identified• New templates enabling improved data

collection• Validation of ‘Registers’ supported &

encouraged

3rd April 2001Birmingham

PRIMISFirst National Conference

Hints & Tips

• Select Test sites• Check the raw data• Allocate PRIMIS Unique

Identifiers in batches by supplier• Provide free training, preferably

on-site• Suppliers can help!

3rd April 2001Birmingham

PRIMISFirst National Conference

Known Problems with Results

• Un-coded drug data• Unreliable incidence data• A true picture of Clinical Practice is masked by

clinical system / data quality issues, e.g.Apparent under-recording:– Not all patient records on the computer /

codes not entered at all– Alternative Read codes used

• No guarantee that NSF information requirements will be fully met in the form required by HAs

3rd April 2001Birmingham

PRIMISFirst National Conference

Wish List• Rush output in NSF age ranges, <35, 35-74,

>74• To be included in queries:

G73% PVD

5853. Echocardiogram792.. / 773. Coronary Artery Operations771. Angioplasty8HTK. Referral to stop-smoking clinic

137L. Current non-smoker (where date ceased = ?)

• Rush files to include a record of the Read codes and terms used for each chart

3rd April 2001Birmingham

PRIMISFirst National Conference

Future Plans

• Provide feedback & agree action plans with practices

• Get written consent from each practice before identifying & publishing the results

• Report to the Executive• CHD Intermediate & Advanced queries• More Read Code training• Repeat query cycle & map trends

PRIMISFirst National Conference

Information from General Practice

Coronary Heart Disease Shirley McLean

Clinical Information Co-ordinatorSouth Hams & West Devon PCT

3rd April 2001Birmingham

3rd April 2001Birmingham

PRIMISFirst National Conference

3rd April 2001Birmingham

PRIMISFirst National Conference

Discussion Topics

• Strengths• Weaknesses• Training / support implications• Suggestions for improvement• Data Quality criteria• Clarification of rationale

3rd April 2001Birmingham

PRIMISFirst National Conference