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Opportunity knocks: New Methodology for the National
Invasive Cancer AuditInvasive Cancer Audit Josie MurrayJosie Murray
ST4 Public HealthNHS Lothian
Presentation for the Committee of the FPH in ScotlandPresentation for the Committee of the FPH in Scotland 28th October 2016, Dunblane
ObjectivesObjectives
• Share from NHS Lothian NICA 2014 experience• Discuss added valueDiscuss added value• Highlight next steps for Lothian
BackgroundBackground
I 2015• In 2015, a new methodology for national invasive cervical cancerinvasive cervical cancer audit was introduced as part of the Scottish Cervical Screening ProgrammeNHS L hi i h fi• NHS Lothian is the first board in Scotland to use the new auditthe new audit methodology
MethodMethod• Th i i dit d h t l t d l ll d• The invasive cancer audit spreadsheet was completed locally and
submitted to NHS Information Services Division (ISD). Individual case and aggregate data output was requested and produced by ISDISD.
• An annual case review with all members of the multidisciplinary team was carried out, in conjunction with NHS Borders.Ti d dditi l j t ti lf t d b• Time per case and additional project time was self reported by individual audit participants.
• Costs were calculated by taking the payscale midpoint of all i l d i di i i d l i hi h iinvolved in audit activity and applying this to the time spent on audit.
• The audit was presented to the national screening coordinators f fgroup, and potential benefits and barriers for the audit were
discussed.
ResultsResults
These DataThese Data
Data useData use
1. Performance management2. Individual case review2. Individual case review3. Early identification of epidemiological trends
Invasive Cancers (n) in Lothian by age band for calendar year 2014
Age Band Number of Invasive Cancers
20‐24 2
25‐29 3
1530‐39 15
40‐49 15
50‐59 650 59
60‐64 1
65‐69 3
70+ 7
All Ages 52
AgeAgeNumber of Invasive Cancers
14
16
10
12
14
15 156
8
10
6 74
6
2 31
30
2
20‐24 25‐29 30‐39 40‐49 50‐59 60‐64 65‐69 70+Age Group
HistologyHistology100%
80%
90%
60%
70%
h diff i d
40%
50%
Other ‐ Undifferentiated
Adenosquamous
Adenocarcinoma
30%
40%
Squamous
10%
20%
0%20‐24 25‐29 30‐39 40‐49 50‐59 60‐64 65‐69 70+
Age Group
DeprivationDeprivation%
100%
80%
90%
60%
70%
5=least deprived
40%
50% 4
3
2
20%
30%
2
1=most deprived
10%
20%
0%Routine smear Non‐routine Symptomatic Incidental
Presentation
Stage by Screening AttendanceStage by Screening Attendance40
35
25
30
20 2 or Greater
1B
10
15 1A
5
0Adequate Inadequate
Screening Attendance
Stage by TreatmentStage by Treatment25
20
15
102 or Greater
B
5A
0LETZ/ Cone
bxHystx Hystx &
ChemoXRTRad. Hystx Rad Hystx &
ChemoXRTXRT only ChemoXRT Chemo only Pall. Care
T t tTreatment
Before you fall asleepBefore you fall asleep…
CostsCosts
• Cost per case approximately £160• Total cost of audit including annual meeting =Total cost of audit including annual meeting £8,250Ti i 0 64 d• Time per case is 0.64 days per case
• Total time of audit including annual meeting = g g33.53 days
Role Banding Salary Hourly Rate Time (mins/case) Time (hours/year) Total time (hours) * Total time (hours) ** Cost for 2014 **Call Recall
Band 5 £24,304 12.31 20 4 21.33 23.33 287.23£ Band 3 £18,468 9.19 30 26 52 54 496.26£
77.33 ‐£ Cytology
Band 8b £49,968 25.55 77 0 66.73 68.73 1,756.14£ Band 7 £35 891 18 36 30 0 26 477 36£Band 7 £35,891 18.36 30 0 26 477.36£ Band 5 £24,304 12.31 25 0 21.67 266.72£
116.4 ‐£ Colposcopy
CONS 1 £97,787 58.21 0 42 42 44 2,561.24£ CONS 2 £97,787 58.21 45 0 15 17 989.57£
61 ‐£ Histopathology
CONS £97,787 58.21 17.5 0 15.17 17.17 999.27£ 17.17 ‐£
Public HealthCONS £97,787 58.21 5 0 4.33 6.33 368.66£
6.33 ‐£ TOTAL 0 0 0 249 5 72 264 23 278 23 8 202 45£TOTAL 0 0 0 249.5 72 264.23 278.23 8,202.45£
All Pay has been calculated using the 2015/16 rates using the midpoint (and mid servicepay) of payscales* These timings do not include attendance at annual audit meetings as these are not additional activities** These timings include attendance at annual audit meetings These timings include attendance at annual audit meetings
NOTES1. Call recall have invested time per case as well as additional time to support audit activities during the year 2. Public health time has been substituted by investment in call recall administrative time3. Cytology comprises of different staff grades delivering different elements of time4. Colposcopy staff distribute the tasks of data entry, one consultant fills out data entry of Section A for all NHSL cases5. Histopathology reviewed 4 cases for section D4 of the audit in Lothian NICA 2014
Added valueAdded value
Added valueAdded value
• Ad hoc analysis• Helpful for significant event analysisHelpful for significant event analysis• Focus on pathology & detailed HPV analysis• Fail safe
Added valueAdded value
• Ad hoc analysis – investigation of exclusion• Helpful for significant event analysisHelpful for significant event analysis• Focus on pathology & detailed HPV analysis• Fail safe
NHS Lothian & Borders Number of exclusions by monthsNumber of exclusions by months
excluded30
25
20
SIMD
sions
155=least deprived
4
3
Quintier
ofexclus
102
1=most deprived
le
Num
be
0
5
00<3 3<6 6<12 12<24 24<36 36+
Months Excluded
NHS Lothian & Borders Number of exclusions per case
14
12
SIMD Quintile
8
10
5=least deprived
4
SIMD Quintile
63
2
f cases
2
4 1=most deprived
Num
ber of
01 2 3 4
N
Number of exclusions
Added valueAdded value
• Ad hoc analysis• Helpful for significant event analysisHelpful for significant event analysis• Focus on pathology & detailed HPV analysis• Fail safe
• Ad hoc analysis ‐Investigation of exclusion• Helpful for significant event analysisHelpful for significant event analysis
– Datix reviewW ld h b l b f d– Would have been lab focused
– “blame culture”– Clinicians upload into the appraisal
Swiss CheeseSwiss Cheese
Failed to attend
Smear taker did not
screening x3
Cytology could not
did not visualise the cervix
Recall failed due to change of
define whether cells high risk or
O i change of address
notOperation complicationsCancer death
Added valueAdded value
• Ad hoc analysis• Helpful for significant event analysisHelpful for significant event analysis• Focus on pathology & detailed HPV analysis• Fail safe
Pathology & HPV AnalysisPathology & HPV Analysis
• Investigate the underlying disease process
• Working with virologists to establish what the underlying HPV pathology might be– HPS– “aggressive cancer”
Added valueAdded value
• Ad hoc analysis• Helpful for significant event analysisHelpful for significant event analysis• Focus on pathology & detailed HPV analysis• Fail safe
– 10 years10 years– SCCRS introduction 2007
Next stepsNext steps
Bench Mark
Appropriate measureAppropriate measure
ObjectivesObjectives
• Share from NHS Lothian NICA 2014 experience• Discuss added valueDiscuss added value• Highlight next steps for Lothian
ConclusionConclusion
• The new methodology for invasive cervical cancer audit is useful for performance pmanagement, individual case review, early identification of epidemiological trendsidentification of epidemiological trends
• Although the new methodology requires time h b f f h land money, the benefits of data to help
eliminate cervical cancer are arguably worth the investment
Special ThanksSpecial Thanks
• Camille Busby‐Earle• Sue Mehew
• Sally Abbott• Julieann Brennan
• Chris Munro• Sue Payne
• Shelagh King• Fiona McQueen• Sue Payne
• Simone Thomson• Fiona McQueen• Alison Macleod
• John Quinn• Alistair Williams
• Douglas Clark
