NHS Digital Data Release Register - reformatted
Central Manchester University Hospitals NHS Foundation Trust
Project 1 — DARS-NIC-376374-F8D0M
Opt outs honoured: No - data flow is not identifiable
When: 2016/12 — 2019/01.
Repeats: One-Off, Ongoing
Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)
Categories: Anonymised - ICO code compliant
- Hospital Episode Statistics Critical Care
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Accident and Emergency
- Hospital Episode Statistics Outpatients
HES data has been used to inform reviews into the Trust’s quality of clinical coding and highlight areas of potential performance improvement, looking initially at hospital length of stay. Specifically HES was used for the following: • Analysis of HES data has revealed a significant shortfall in the coding of co-morbidities at the Trust (both regionally and compared to similar hospitals nationally). This finding has prompted a series of coding reviews aimed at capturing these conditions and resulted in more accurate patient records and diagnosis histories. The correct recording of long-terms conditions such as diabetes and asthma, with dementia another condition of particular local importance, enables patients to be assigned more appropriate pathways and treatment, ultimately leading to higher quality care. • HES data is an integral part of the Trust’s recently developed capacity planning model, which will be used on an annual basis for analysing bed requirements. The data from HES are used to provide the length of stay benchmarks used to identify service lines that are significantly different to comparable hospitals. These benchmarks highlight areas of potentially inappropriate or inefficient care, or areas that may be amenable to service redesign and new/better pathways. Whilst it takes time for the results of service change to be fully realised it is expected that focussing on the outlying areas identified through the benchmarking exercise will reduce average lengths of hospital stay, benefiting both the local health economy and patients. Ongoing analysis of HES will be used to track the Trust’s progress in reducing length of stay relative to peers in key areas.
As a large specialist organisation providing complex care to patients from a broad range of demographic backgrounds the Central Manchester University Hospitals NHS Foundation Trust (CMFT) strives to provide the best care possible for its patients. This entails understanding the complex co-morbidities of its patient population, through which it aims to establish a patient co-morbidity index for the Greater Manchester area. This data will be used for two projects of analytical work: Firstly, benchmarking the Trust against other Trusts to guide their clinical coding improvement strategy. The Business Analyst team will have direct access to HES data to create bespoke, specialty and Health Resource Group (HRG) specific reports. These reports, in their aggregate format, will be shared with other staff at the Trust. They will not be identifiable and small numbers will be suppressed in line with the HES analysis guide. Secondly, the HES data will be used to inform the Trust’s strategic development plans. The information will be analysed to determine areas (geographical by residence, GP practice, CCG etc.) where service provision could be enhanced (e.g. outreach or community clinics). This information will also be used to determine growing/declining service needs of the regional population. The full HES data set is required for this application. This is to allow for analysis across the UK, as the Trust is a national tertiary centre with national tertiary patient services. The Trust compares itself as a whole and individual services to Trusts and services across England. Analysis is at service, site, and HRG level that is not limited to the North West providers. Analysis is ongoing to understand and identify service and HRG level peers. The trust provides a full range of services and therefore requires the full HES dataset requested; other data minimisation efforts are not appropriate. The Trust’s aim is to constantly improve its position as a leading healthcare provider both locally and Nationwide. There are a wide range of patient services that are positioned nationally, for example, the Royal Manchester Children’s Hospital would not suitably compare to the Northwest cohort, whereas the 10 specialist Children’s Trusts across England stretch from Bristol to Newcastle. Similarly, the care that many patients receive at The Royal Eye Hospital is only comparable to that at Moorfields Eye Hospital in London, and the Paediatric Burns Service would compare its specialism to that at Chelsea and Westminster. Analysing the data across the whole country will help CMFT identify the best care outcomes delivered at these similar sites and, from this analysis, work to ensure their services meet their own high standards. Knowledge of output area (OA) and GRIDLINK fields (geographical reference fields) will allow the Business Analytics team to very accurately extrapolate geo-demographic changes occurring within the catchment areas Central Manchester Foundation Trust (CMFT) serves. The Trust will link their existing activity numbers at OA level, to the publically available ONS population prediction statistics. This will enable them to anticipate not only the scale of the demographic growth for demand on services, but also casemix of service needs within specific geographical boundaries. This will enable the Trust to proactively plan for the needs of patients before those needs occur. This way access to NHS services across all acute and specialist services will be improved. Another use of the OA data in HES would support the applicant’s analysis of the local patient population – the percentage of total patient activity which belongs to the Trust. In knowing this, CMFT will be able to investigate the reasons for variation in patient accessing CMFT, whether that be due to ease of transport to their site(s), patient experience or whether they simply don’t provide the services needed. In doing this at OA level, the applicant would be able to understand and plan service expansions (e.g. additional community clinics) which will improve public health and patient access to NHS services.
Improving the Trust’s clinical coding develops the accuracy, precision and detail afforded in those policies for the population they serve. The Trust will use clinical coding information to determine disease prevalence rates so as to inform national and local commissioning policy. Any proposed process or service changes are discussed with CMFT's commissioners through established contracting channels (annual contract negotiation process). Any findings derived from the use of the data is shared with commissioners (in aggregated form and small numbers suppressed in line with HES Analysis Guide) to support service changes and local discussions. An example of this would be in Rheumatology, where it was identified that the Trust was not coding a series of comorbidities due to the nursing notes not having the relevant section to record items such as vitamin deficiency or uvetitis. Through local discussions with commissioners based on evidence from the analysis, the local coding/recording policy has changed and as a result the estimated value change has been applied to the 16/17 and 17/18 contract. It also means the patient record accurately reflects the true condition of the patients. This is the direct driver behind one of the applicant’s current Commissioning for Quality and Innovation payments (CQUINS): consistent coding of dental procedures across regional providers. Being able to identify areas where certain procedures and conditions are not being fully captured will ultimately safeguard the patient for any future clinical contact whilst securing the appropriate funding to the practice. It is also a vital factor in maintaining the Trust’s specialist status, which secures the continued provision of specialist care to our patient population. Better understanding the service needs of the Trust’s local and regional population will inform the Trust’s strategic development plans: thus the proportion of activity seen in an appropriate setting, potentially closer to patients’ homes in the community will increase. For example, should a discovery be made that acute asthmatic conditions arriving at A&E or positive screenings/admissions for cancer tend to come from a small number of geographical clusters, the Trust would then be able to run patient education seminars in GP practices or community centres in those localities to raise awareness of asthma self-care or the importance of screening programmes. Both these benefits are key strategic objectives which will take a minimum of 3 years to fully realise. The analysis of the HES data set and coding review has identified a number of areas requiring further investigation and clinical input. An example area was paediatric rheumatology where CMFT have identified a process gap in the Juvenile idiopathic arthritis patient pathway. The Doctor sees the child and identifies the pathway, the child then visits the nurse several times over the next 3 months to receive joint injections to relieve pain. The child is well cared for but the nursing documentation that goes into the notes did not include a section to include comorbidities. CMFT are now in the process of reviewing the medical record following this investigation. Spinal surgery is an area where very poorly children are seen for highly specialist care. Due to the nature of this care not many centres have the skilled workforce to carry the procedures out. As a result a lot of underlying conditions are taken for granted and factors such as wheelchair and stoma status are not always recorded in the notes. This has been highlighted to them and processes are being changed. A&E cases are an area where patients are in for a short time and notes are not always fully completed. The peer data has raised a number of areas that CMFT have been able to focus on and ensure care is taken by the medics to complete key comorbidity recording.
Outputs of analysis are in the form of reports and dashboards, which highlight any pertinent issues relating to the quality of patient care, and provide recommendations regarding the implementation of specific measures to improve efficiency and effectiveness of care. Performance indicators for clinical coding breadth and depth will be created, benchmarking specific services within the Trust with others, within 12 months of access. The Performance indicators for clinical coding breath is still currently in development which will be supported by the continuation of the Agreement. This will be at an aggregate HRG and/or service level with small numbers not suppressed. The audience for these types of reports will be only ever be within the Trust, executive board members, senior directors and management. There will be specialty level reporting for the alerting specialties where multi-disciplinary clinical leads will work with the indicators to ensure recorded case mix appropriately reflects their service. National/regional ‘access’ dashboard will be created detailing the activity conducted across the country, with attention to the North West region, detailing types of services being accessed by which patient groups. This may involve time-lapse geospatial analysis and imaging for specific services and or geographical areas of focus. This will be within 24 months of data access. Data will only ever be presented in aggregate format with small numbers suppressed in line with the HES analysis guide. Reports and dashboards will only be shared within the trust to be viewed by clinicians, managers and informatics staff. No output will be published in journals. A coding review process is now in place, supported by the HES data sets. An example has been provided in the benefits section of this purpose.
On receiving the data the data was uploaded by the Informatics department database administrator (DBA) to a ‘HES’ database on a secure SQL server. The server is accessible only within the Trust and access is controlled by permissions linked to Trust user accounts. Permissions to view the HES database are only given to specific Trust employees. Permission requests are received and managed by the Head of Information & Analysis via email to ensure an audit trail of the request. Permissions are only given to a limited and select cohort of the Trusts Business Analysts, within the information department for the purposes set out in this application. The data will not be linked to any other patient identifiable datasets or any other non-identifiable data sets. Informatics specialists then write SQL queries to extract relevant information to their analyses and create new tables within the HES database with the results. Reports and dashboards can link to this data without revealing any of the raw data due to the permissions that have been set. The reports are formatted using a number of different business intelligence tools such as MS Excel and SQL Server Reporting Services (SSRS) reports; depending on the intended audience and the data being analysed. These reports and dashboards are then shared in the trust to help improve the effective delivery of healthcare and the patient experience. This will be in the form of reports, dashboards, and analysis and may be distributed through a number of channels including email, presentations, and papers. Audiences will range from senior management to operational teams. Data in the reports and dashboards will only ever be presented in aggregate format with small numbers suppressed in line with the HES analysis guide. Informatics specialists are based within the Trust’s Business Analytics team and are substantively employed by the Trust.