NHS Digital Data Release Register - reformatted
Oxford University Hospitals NHS Trust
Project 1 — DARS-NIC-07787-Z1W1X
Opt outs honoured: N
Sensitive: Non Sensitive
When: 2016/04 (or before) — 2018/02.
Legal basis: Section 42(4) of the Statistics and Registration Service Act (2007) as amended by section 287 of the Health and Social Care Act (2012), Health and Social Care Act 2012
Categories: Anonymised - ICO code compliant
- Hospital Episode Statistics Admitted Patient Care
To identify whether there is any evidence from existing electronic health record data to support the key prescriber concern that early antibiotic review leading to reduced antimicrobial usage will cause greater rates of treatment failure/mortality. The Antibiotic Reduction & Konservation (ARK) programme’s overarching aim is to reduce the incidence of serious infections caused by antibiotic-resistant bacteria in the future, through substantially and safely reducing antibiotic use in hospitals now. The programme has three specific research questions (i) how can antibiotic prescription ‘review & revise’ strategies be implemented optimally to reduce antibiotic use safely within hospitals? (ii) can a feasible inexpensive package of interventions that increase prescriber compliance with ‘review & revise’, and patient acceptability of shorter antibiotic therapy durations driven by ‘review & revise’ be built? (iii) are ‘review & revise’ strategies cost-effective across a range of scenarios reflecting plausible associations between antibiotic use now and future resistance leading to loss of antibiotic options? The goal of reducing total antibiotic burden in acute/general medical inpatients by at least 15% will be addressed through 6 work-packages. WP1-WP3 will provide underpinning data for design and piloting in WP4 of a ‘review & revise’ intervention package for inpatients/carers and healthcare professionals. WP5 will evaluate its effectiveness and safety, and WP6 will conduct health-economic evaluations. This request for data is for observational analysis as part of WP2.
This analysis would inform the development of a behavioural intervention to reduce antibiotic usage in acute/general medical inpatients. If the behaviour intervention reduces antibiotic use without changing patient outcomes, then it would be immediately ready for NHS deployment. It would be freely available to the NHS (under the terms of the contract with NIHR). Providing that the results do not suggest that substantial harm could result from reducing antibiotic use (in which case the whole Programme Grant will be reviewed by the funders and the Programme Steering Committee), the results will be used, together with other published studies, to inform the development of a ‘review &revise’ behavioural intervention package for inpatients/carers and healthcare professionals aimed at reducing antibiotic usage. This behavioural intervention will then be tested in a large cluster-randomised stepped-wedge trial during years 3-5 of the Programme Grant.
The results of these analyses will be published in a peer-reviewed medical journal - no record-level data will be an output and any small numbers will be suppressed in line with the HES analysis guide. These analyses are comparing Trust-level outcome data with Trust-level antibiotic usage (see protocol for further details). Therefore, even though the Trust will make every attempt to adjust for case-mix and other factors that could influence outcomes and antibiotic usage, such adjustments may be imperfect, and any residual association does not necessarily imply causation. Interpretation of results from these analyses will explicitly highlight this. Standardly, such biases can occur in either direction, making it impossible to work out whether effects observed in observational studies are optimistic or conservative; hence, the need to rely on randomised controlled trials for unbiased inference regarding intervention effects. However, a priori, in this specific context of adults admitted to acute general/medical specialities, it is highly likely that any residual bias is primarily in one direction, namely that “less sick” individuals (at lower risk of the various clinical outcomes) have lower antibiotic exposure. Given this, not observing harm in these observational analyses is necessary to conclude that no harm would be associated with an intervention to reduce antibiotic use in this group of patients. If one observes evidence for harm from this observational analysis, after adjustment for as many confounders as possible, this would seriously undermine the rationale for the proposed trial within the larger Programme Grant, necessitating high-level review of the larger project. It is expected that a publication will be submitted to a medical journal within 1 year of receiving the data from HSCIC. The Trust will also disseminate findings through the patient and public engagement activities ongoing within ARK and the Oxford Biomedical Research Centre within which key team members also work. The Trust are requesting for the data to be retained for 18 months from the date of provision, to allow for queries during the publication process.
Case-mix adjusted outcomes in patients admitted to acute/general medicine will be compared with Trust-level antibiotic usage data from the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), in an observational ecological (Trust-level) analysis. Hospital-level data will be used as a proxy for consumption in acute/general medicine as speciality-level data is not yet available in ESPAUR. Four outcomes will be considered: • Mortality by 14 and 30 days after admission (in and out of hospital) (binary indicator) • Admission to intensive care unit or high-dependency unit within this admission (identified from number of days of high-dependency/augmented care within each spell) • Length of stay of the admission spell, both to actual discharge date and date medically ready for discharge • Re-admission (non-elective) within 30 days of discharge (regardless of re-admission speciality) Antibiotic use will be considered at the level of each Trust in terms of defined daily doses (DDDs: a World Health Organisation system for standardising antibiotic usage), overall and by drug class, per quarter, per year and over the 5 year study period. Broad spectrum will be defined as: co-amoxiclav; meropenem; second (eg cefuroxime), third (e.g. ceftriaxone ceftazidime) or fourth (e.g. cefepime) generation cephalosporins; quinolones; piperacillin/tazobactam. The following potential confounders will be adjusted for age at admission (years); gender; ethnicity; index of multiple deprivation (IMD) score; Clinical Classifications Software (CCS) group of primary diagnosis code; Charlson co-morbidity score (calculated from secondary diagnosis codes associated with the first consultant episode within each spell, or the second consultant episode if the first is A&E); immunosuppression (calculated from the secondary diagnosis codes); intended management (admitted overnight, not admitted overnight, etc.); patient classification (actual management: admitted overnight, not admitted overnight etc.); admission day of the week, day of the year; calendar year; admission method; admission source; number of admissions (excluding as day case) in the previous year. The null hypothesis is that there is no association between Trust-level antibiotic usage and outcomes in patients admitted to acute/general medicine. The analysis will be conducted by medical statisticians only. Any individual using the data for such analysis will be either employed by the Trust or by the University of Oxford, with an honorary contract with the Trust in place. The data will be stored and processed on an NHS server housed within the Oxford University Hospitals NHS Trust (OUH), within the NHS N3 firewall. A database manager/software engineer will process the data onto the NHS server. No third parties will store, process or access record-level data.
Project 2 — DARS-NIC-148156-N8FNR
Opt outs honoured: N
Sensitive: Sensitive, and Non Sensitive
When: 2016/04 (or before) — 2017/11.
Legal basis: Informed Patient consent to permit the receipt, processing and release of data by the HSCIC
- MRIS - Cause of Death Report
- MRIS - Cohort Event Notification Report
- MRIS - Bespoke
- MRIS - Scottish NHS / Registration
- MRIS - Flagging Current Status Report
The data supplied by the NHS IC to John Radcliffe Infirmary will be used only for the approved Medical Research Project in MR174.
Project 3 — DARS-NIC-47368-F1C2M
Opt outs honoured: N
Sensitive: Non Sensitive
When: 2016/12 — 2017/05.
Legal basis: Health and Social Care Act 2012
Categories: Anonymised - ICO code compliant
- Hospital Episode Statistics Accident and Emergency
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Critical Care
- Hospital Episode Statistics Outpatients
Oxford University Hospitals (OUH) NHS Foundation Trust hosts the Oxford Academic Health Science Network (AHSN). The Oxford AHSN was licensed for 5 years by NHS England in 2013. It covers a population of 3.3 million living in Berkshire, Buckinghamshire, Milton Keynes, Oxfordshire and Bedfordshire. The Oxford AHSN is focused on collaboration to reduce unwarranted variation across the geographical region. The wider AHSN network includes a number of partner organisations which includes all NHS Acute and Community and Mental Health Trusts, CCGs and Universities across the region. The AHSN exists to achieve the following four objectives (each of which is underpinned by a supporting Programme): o Focus on the needs of patients and local populations – support and work in partnership with commissioners and public health bodies to identify and address unmet health and social care needs, whilst promoting health equality and best practice (Best Care Programme). o Speed up adoption of innovation into practice to improve clinical outcomes and patient experience – support the identification and more rapid uptake and spread of research evidence and innovation at pace and scale to improve patient care and local population health (Clinical Innovation Adoption Programme). o Build a culture of partnership and collaboration – promote inclusivity, partnership and collaboration to consider and address local, regional and national priorities (Patient Safety Collaborative). o Create wealth through co-development, testing, evaluation and early adoption and spread of new products and services (Wealth Creation Programme). OUH NHS Foundation Trust requires Hospital Episodes Statistics (HES) data for use in the Best Care Programme, Clinical Innovation Adoption Programme, and Patient Safety Collaborative Programme. Data will only be used in support of these three programmes, and specifically not for the Wealth Creation Programme. Within each Programme there are projects undertaken focusing on different areas of health in the region. Each project has a network lead (in common across theme) who coordinates and identifies what areas will be investigated or what hypotheses will be tested within a project. Examples of current themes include but are not limited to the following conditions: o Respiratory o Sepsis o Pressure Ulcers o Acute Kidney Injury (AKI) o Intraoperative Fluid Management) o Heart Failure o Maternity o Falls o Children’s diseases (including asthma; viral induced wheeze; fever and sepsis; sepsis in newborns; gastroenteritis, GI tract infection; bronchitis, and pneumonia) o Catheter Associated Urinary Tract Infection (CAUTI) o Stroke o Medicines optimisation o Imaging The network lead may be employed by one of the partner organisations of the AHSN, but neither the Programme, members of the wider network, nor network lead have access to record level data – only aggregate data with small numbers suppressed in line with the HES analysis guide. The objectives of the three Programmes for which the data will be used are directly in support of improving health care and benefiting health care users. Projects to be undertaken will be for the purposes of Health and Research only and no record level data will be accessed by any partner organisation(s) (commercial or otherwise) of the OUH NHS Foundation Trust. The network Leads liaise with the Clinical Engagement Lead (who works in the Informatics Team at OUH NHS Trust) over their requirements. It is the Clinical Engagement Lead who considers what aggregate data requirements may be required for the project, and in turn supports the project’s request for analysis from the AHSN Informatics Team. Only the AHSN Informatics Team access the pseudonymised HES data to perform analyses and produce outputs to be supplied for use within the specific project. A Data Request document will be written and submitted to the AHSN Informatics Team for triage. The AHSN Informatics Team would then consider the request based on the criteria outlined below and, if the request is approved, the AHSN Informatics Team will schedule the work. No individual outside of the AHSN Informatics Team will be given access to the data other than in the form of outputs that are aggregated with small numbers suppressed in line with the HES Analysis Guide. As each project is undertaken for the purposes of Health and Research only, each aggregated data request is only for the purposes of that project. The AHSN Informatics Team comprises of employees of the OUH NHS Foundation Trust, and professionally is accountable through the OUH NHS Trust governance arrangements. No other individual will have access to the raw HES data. The process will work as follows: 1. Network Lead completes Data Request form and submits it to the AHSN Informatics Team via the Clinical Engagement Lead; 2. Data Request is reviewed by the AHSN Informatics Team giving consideration to the following assessment/approval criteria: a. The appropriateness of the volume and scope of data required to produce the requested output(s) in terms of scientific approach and proportionality of expected benefit to health and/or social care; b. The likely scientific value of the project and use of data; c. The appropriateness of the data being used for the purpose of the project (including consideration of the expected benefits to healthcare) d. The AHSN Informatics Team's capacity to deliver requested output(s) within the required timeframe; 4. With recommendations from the AHSN Informatics Team members, the final decision is made by the Head of Informatics. 5. If a favourable decision is taken, the work is then scheduled according to priority and capacity. The HES data will not be linked with any other data. The OUH NHS Foundation Trust expects to use the HES data in support of approximately 100 projects per year in support of the differing Programmes. For each project, the outputs will be tabulations containing only aggregated data with small numbers suppressed. Such anonymous data would be provided back to the project together with analytical commentary. Typically, projects will request further iterations of analyses to address follow up questions based on the initial findings. Typical data requests take around 4 days for one person to complete. The HES data will only be used for purposes relating to the provision of healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014. The following are examples of recent and current projects: 1) Asthma and COPD This project aims to identify, reduce and monitor variation across the AHSN in treatments for patients with asthma and/or chronic obstructive pulmonary disease (COPD). The AHSN Informatics Team will analyse a subset of HES data filtered to specific ICD codes indicating asthma, COPD, and upper and lower respiratory tract infection. The objective is to try to gain a better understanding of the care pathways and outcomes for asthma and COPD patients across the Oxford AHSN region. The project will help to demonstrate the variations across the region and the demographics of this patient group as well as their outcomes. It will test the hypothesis that variations exist due to differences in standards within hospitals. The ultimate aim is to reduce that variation by bringing substandard hospitals, via training and introduction of new processes, to an excellent standard. 2) Sepsis Using a list of diagnosis codes spanning seven disease areas selected by clinical leads, this project aims to analyse not only pathways related to patients with sepsis, but also to look at those cases that would be at risk of sepsis. Various analytical and modelling techniques were used to look at patient pathways across sepsis and serious infections. The provision of this analysis enabled an understanding of how sepsis and related serious infections within hospitals are diagnosed and coded, variation across the region, to inform the work of the project group and for the production of a paper. 3) Children’s Diseases Variation The AHSN informatics team worked with the Children’s Clinical Network to design a set of queries to extract CCG level data across common paediatric conditions using HES. The aim was to highlight the differences in admission rates, lengths of stay and source of admission between different CCGs within the region. The data provided enabled the network to compile a second report on Variation in Paediatric Care in the Oxford AHSN region.
The objectives of the Programmes are is work is to directly benefit health care through identifying best and inferior practice; standardising best practice to optimise care; improve the patient experience and patient outcomes and potentially delivering cost savings. Raising the standards at the hospitals with lower levels of performance or less effective practises will be of direct benefit to local residents and users. Any improvements identified within the Oxford AHSN region would be shared with other AHSNs across the country. There are national forums of AHSNs used for this type of success sharing. The intention is to request further HES extracts in the future to be used to help monitor the effectiveness of improvements and the success in reducing variation in order to maintain standards and support continuous improvement.
The primary outputs from the work undertaken by the Informatics Team at OUH NHS Foundation Trust, using the HES data will be written reports containing tables of (aggregated) data with small numbers suppressed in line with the HES Analysis Guide with a commentary on findings. The findings are typically presented to and discussed with the Network that requested the analysis and the reports are stored on a secure server within an N3 network with access restricted to named users only. Depending on the nature of individual projects, outputs may be used to give feedback to treatment centres across the Oxford region via reports and meetings. As an example of how the outputs might be used, the Asthma and COPD project (described above) would use the findings to feedback to treatment centres the findings in relation to variations in practice and best practice in the region and the network would then work with treatment centres to put in place specific processes aiming to reduce and to further monitor variation. The following are examples of achievements to date: Analytical output from the Sepsis project allowed the Patient Safety Collaborative to understand the diagnosis and coding of patients with sepsis and those at risk of sepsis. Findings from these data were used to produce a medical paper on the subject. This paper has been submitted to The Lancet Infectious Diseases and is currently in the process of evaluation. The idea would be that other AHSNs use the same methodology for their region, so this work could be used nationally. Data analysis used for the Children network led to the production of the “Variation in Paediatric Care in the Oxford AHSN region” report. This report highlights that for a number of reasons intended and unintended, there are local and regional variations in the way that paediatric healthcare is delivered.
The Oxford AHSN is hosted by Oxford University Hospitals NHS Foundation Trust. In practice this means that the Oxford AHSN is a department within the OUH, operating within all OUH policies and procedures for Information Governance, HR, Finance, Information Management & Technology, etc. All Oxford AHSN employees are substantively employed by OUH. OUH NHS Foundation Trust has multiple sites which include the Magdalen Centre North site. The Magdalen Centre North site is remotely connected to the OUH NHS Foundation Trust’s N3 network. All employees based at the Centre are substantive employees of the OUH NHS Foundation Trust subject to the same contractual obligations and security arrangements as other OUH NHS Foundation Trust sites. Within the OUH NHS Foundation Trust, are dedicated teams set up to support the Trust’s role in hosting the Oxford AHSN including the Oxford AHSN Informatics Team based at the Magdalen Centre North. The HSCIC will supply an extract of HES data as per the specification to the Informatics Team at the Magdalen Centre North. The data will be stored on a secure server physically based at the John Radcliffe Centre at the Oxford University Hospital NHS Trust. The data will be remotely accessed by members of the AHSN Informatics Team based at the Magdalen Centre North. Access will be restricted to authorised personnel all of whom will be substantive employees of the OUH NHS Trust and data will only be processed in that location. No data will be shared or transferred to other locations. Once a project has been approved by the Head of Informatics, the AHSN Informatics Team will extract a subset of relevant data from the HES extract tailored towards the specific requirements of the project. This will always be the minimum amount of data required for the analysis. The subset is stored on a secure OUH NHS Foundation Trust network server physically based at the John Radcliffe Centre at the Oxford University Hospital NHS Foundation Trust with restricted access to only authorised personnel working on the specific project. The AHSN Informatics Team will then undertake analysis of that bespoke extract according to the specific details of the project and will produce multiple tabulations containing only aggregated data with small numbers suppressed in line with the HES Analysis Guide. Typically data will be broken down by hospital or CCG; patient age and sex, and by primary and secondary diagnoses. When using outpatient data, the data will typically be broken down by diagnosis codes or clinics; numbers of outpatient patients seen in clinics; number of outpatient appointments, and GP practices. For A&E data, the data will be broken down by diagnostic codes; presentation codes; number of patients presenting; treatments or interventions in emergency departments; patient age; patient gender; number of patients admitted and number to each ward broken down by hospital and CCG and by GP practice. The AHSN Informatics Team assess the tabulated data performing analysis of the variations between the factors and provide a narrative of findings. Outputs in the form of written reports including tables with narrative commentary are delivered to the Network lead and used in line with the original objective of the project. Follow up questions may be raised and/or further analyses may be requested.