NHS Digital Data Release Register - reformatted
National Institute for Cardiovascular Outcomes Research
Project 1 — DARS-NIC-42272-S9J3L
Opt outs honoured: N
Sensitive: Non Sensitive
When: 2016/09 — 2016/11.
Legal basis: Health and Social Care Act 2012
- Hospital Episode Statistics Admitted Patient Care
The National Heart Failure Audit is a national clinical audit which monitors the care and treatment of hospitalised heart failure patients in England and Wales and collects data on patients with an unscheduled admission to hospital in England and Wales who are discharged with a primary diagnosis of heart failure. It was established in 2007 and has now collected over 200,000 records of heart failure-coded hospital episodes. The audit aims to capture data on clinical indicators which have a proven link to improved outcomes for heart failure patients, and to encourage the increased use of clinically recommended diagnostic tools, disease modifying treatments and referral pathways. The audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and feeds back on this to NHS England and the Care Quality Commission. The data supplied by NHS Digital (formerly known as Health and Social Care Information Centre) will be used to produce ‘participation’ tables for audit purposes, to determine whether hospitals are fully participating in the audit. Aggregate HES data at Trust level will be compared to the number of records submitted to the audit by each Trust and Health Board, to measure case ascertainment. For the purpose of the heart failure national report NICOR cannot allow for any small numbers to be suppressed, because otherwise when comparing HES figures with the number of records that hospitals have submitted to the audit, NICOR’S numbers will be inaccurate. If 300 cells are suppressed, that is up to 1500 admissions excluded from the total, which is quite a significant amount. The data is required for a national clinical audit so the data needs to be as accurate as possible. Over 200 hospitals in England and Wales are assessed against the data NICOR publish in reports in Quality Accounts and by the CQC.
The audit aims to drive up the quality of the diagnosis, treatment and management of heart failure by collecting, analysing and disseminating data, measuring improvements in participation in the National Heart Failure Audit; eventually to improve mortality and morbidity outcomes for heart failure patients. Audit data is used in a number of ways to drive improvement in heart failure services and patient outcomes. Primarily, data is fed back to individual hospitals to report on their clinical practice and outcomes over time. The audit provides participation rates, and hospital level data to organisations such as the Care Quality Commission’s Quality and Risk Profiles, the NHS Choices website and data.gov.uk. In addition to this, the audit produces an annual report, which is publically available: an archive of National Heart Failure Audit Reports can be found on the Annual reports webpage. There are future plans to provide anonymised National Heart Failure Audit data, by hospital, to Cardiac Networks and Clinical Commissioning Groups. Audit data is also used for research purposes, to investigate further the causes, treatment and management of heart failure. More information about the research use of National Heart Failure Audit and NICOR data can be found on the Research section the NICOR website: - http://www.ucl.ac.uk/nicor/audits/heartfailure/research
Past Outputs NICOR UCL published the National Heart Failure Audit Report 2013/14 on the 20 October 2015. The seventh annual report for the National Heart Failure Audit presents findings and recommendations based on patients with an unscheduled admission to hospital, who were discharged or died with a primary diagnosis of heart failure between 1 April 2013 and 31 March 2014. The report covers all NHS Trusts in England and Health Boards in Wales that admit patients with acute heart failure. The report is aimed at all those involved in collecting data for the National Heart Failure Audit, including those involved in collecting data for the National Heart Failure Audit, as well as clinicians, hospital chief executives, managers, clinical governance leads commissioners, patient groups and many others. The report includes clinical findings at national and local levels and patient outcomes. Participation tables are produced and published every year in the report. Future outputs NICOR will use aggregate HES data with small numbers suppressed at Trust level to produce ‘participation tables’ in the National Heart Failure Audit Annual Report each year with publication to be confirmed. Participation tables are produced and published every year in the report. The publication will be distributed in hard copy to all Trust Chief Executives, and clinicians in the heart failure community, and also made publically available on the NICOR website. It will also be published by HQIP on its PARCAR (participation and case ascertainment) webpages.
Comparison of HES-recorded heart failure admissions with National Heart Failure Audit-recorded heart failure admissions to determine case ascertainment rate. HSCIC supply tabulated HES APC data for the year only specified in this agreement for ICD 10 codes for heart disease. Data is broken down at provider level. NICOR (UCL) will publish aggregated data with small number suppression within the National Heart Failure Audit Annual Report for the current financial year in hard copy to all Trust Chief Executives and clinicians in the heart failure community; also made publically available on NICOR website HQIP will publish aggregated data with small number suppression in-line with the HES analysis guide within the National Heart Failure Audit Annual Report for the current financial year; made publically available on PARCAR (participation and case ascertainment) webpages. For clarity, no record level data will be shared with any third party; all individuals with access to the record level data are employed by the data processor. No data will be transferred outside the EEA.
Project 2 — DARS-NIC-359940-W1R7B
Opt outs honoured: Yes - patient objections upheld (Section 251, Section 251 NHS Act 2006)
Sensitive: Non Sensitive, and Sensitive
When: 2016/12 — 2019/12.
Repeats: Ongoing, One-Off
Legal basis: Section 251 approval is in place for the flow of identifiable data, 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, Health and Social Care Act 2012 – s261(7)
Categories: Identifiable, Anonymised - ICO code compliant
- MRIS - Members and Postings Report
- Hospital Episode Statistics Admitted Patient Care
- MRIS - Cause of Death Report
- MRIS - Scottish NHS / Registration
- MRIS - Flagging Current Status Report
- Office for National Statistics Mortality Data
- Bridge file: Hospital Episode Statistics to Mortality Data from the Office of National Statistics
- Civil Registration - Deaths
The processing is to enable NICOR to undertake its HQIP contracted audit work - reports and aggregate table reports at the unit or consultant level. Specifically to enable the delivery, by NICOR staff, of the National Cardiovascular Audit Programme the 6 audits • Myocardial Ischaemia National Audit (MINAP) • Adult Cardiac Surgery Audit • National Heart Failure Audit • Congenital Heart Disease Audit, • Cardiac Rhythm Management Audit • Adult Cardiac Interventions Audit as contracted between NICOR and HQIP. The data may also be used to enable the delivery of additional audit analysis, with the approval of HQIP and as requested by those being audited (NHS Units and associated Consultants).
The audit data is being used by the NHS to support Best Practice Tarrif - particularly for Heart Failure and MINAP - a quality improvement initiative to reward hospitals that provide a high standard of care. This year, NICOR have harmonised the six national clinical cardiovascular audits into a national cardiac audit programme with 6 separate domains. This means that NICOR are standardising the approach in terms of (methodology, data collection, data completeness and data quality) conducting the audits. This will be reported back to all key stakeholders, commissioners, trusts, patients and public and clinicians data in a relevant and meaningful way which will lead to improvements in the quality of care provided. NICOR are using the audit data for developing risk adjustment models for Heart Failure and MINAP - to ensure that the reports are reliable and are being interpreted accurately and meaningfully.
There are a number of expected benefits for example; 1. The ability to look at cardiovascular admissions which may be related to, and impacted on by, the medical management of a patient’s heart failure. This will provide a much more detailed and complex picture of readmissions, and help us to determine the full impact that good and poor management of specific cardiac conditions has on readmission rates and mortality outcomes. 2. The ability to utilise readmission for reasons other than, but connected to, major cardiac surgery as an outcome measure would be extremely beneficial in terms of assessing the long term effects on patients undergoing the various cardiac surgical procedures, and what effect different variables have on these outcomes. 3. Provide additional insight into outcomes (especially adverse reactions such as stroke) which we can then include these in our annual reports used to inform quality improvement work. Linkage to the full HES dataset would allow further exploration of the geographic, socio-economic and organisational data of patients more detail. This could lead to a better understanding of commissioning patterns within the UK. In addition, the HES dataset collects information on augmented care and the patient care pathway. 4. The ability to investigate cumulative missed opportunities for patient care and major cardiovascular and cerebrovascular events. 5. The ability to determine case ascertainment rates and underreporting of procedures and patient admissions. These types of outputs will be included in the various publications NICOR produces including annual and other public reports (in various formats) for the key stakeholders such as clinicians, trusts, commissioners and patients. The information in the reports will be useful for Quality Improvement purposes.
The outputs will be audit reports (in various formats) which will be published throughout 2016/17.
Processing by NHS Digital of the cardiovascular audit data is required with both HES and ONS Mortality data, as done previously. Both HES and ONS data will be linked systematically by NHS Digital to the patient records submitted by hospitals/units, for each of the 6 audits using a number of variables (NHS Number, ID Number, Surname, Forename, Date of Birth, Gender, Postcode). NICOR will provide these patient identifiers to NHS Digital for linkage purposes. NHS Digital return to NICOR the linked HES and ONS data (fields detailed elsewhere). Before the linked data is used NICOR remove all patient identifiable fields so that the final dataset will be pseudonymised before the audit work is undertaken. No variables which might identify individuals (PID) will ever be published, reported or shared with a third party. Such analysis will only contain aggregated small numbers suppressed data in line with the HES Analysis guide.