NHS Digital Data Release Register - reformatted
Regional Drug & Therapeutic Centre
Project 1 — DARS-NIC-135277-R8M3G
Opt outs honoured: No - data flow is not identifiable (Does not include the flow of confidential data)
Sensitive: Non Sensitive
When: 2017/09 — 2020/07.
Repeats: Ongoing, System access, System Access
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 Admitted Patient Care
- Hospital Episode Statistics Accident and Emergency
- Hospital Episode Statistics Outpatients
- Hospital Episode Statistics Critical Care
Prescribing is the most common patient-level intervention in the NHS, and covers all sectors of care: primary, hospital, public and community health. It is the second highest area of spending in the NHS, after staffing costs (NHS Digital). The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the Newcastle Upon Tyne Foundation Trust (NUTH) extracts and analyses prescribing data to identify trends and variation, and to support medicines optimization. These are presented in reports at regional and CCG level in relation to particular conditions, such as diabetes. Scatter charts incorporating the HES data are included within these reports, and are used to present the outcomes that may be attributed in some part to prescribing patterns within an area. In particular, the reports are useful for CCGs to benchmark against others, identifying where they, for example, have an unusual or high prescribing pattern for a particular condition, which could have a higher than average cost. They can then use this information to investigate further, consider practice in other CCGs, and make changes accordingly, with a view to being more cost effective. Reducing unwarranted variation and increasing value through medicines optimisation is a crucial element of NHS RightCare’s innovation work (further information can be found on the NHS RightCare website). RDTC prescribing reports were developed in response to requests from CCGs (and this work is funded by the CCGs) so that variation in prescribing between CCGs could be illustrated, so that they can benchmark their performance against their peers regionally and nationally. Identifying variation at this level prompts CCGs to investigate the causes of variation locally. They can then identify better performing CCGs and make contact with them to share best practice, which can be implemented locally with an aim to improve prescribing and outcomes in their area. The RDTC produces a series of reports and publications for their stakeholders across the North of England, utilizing EPACT data, Quality Outcomes Framework (QOF) data and for a small number of their charts Hospital Episodes Statistics (HES) data. The RDTC requires HES data for use in the therapeutic prescribing reports, in the attached example the scatter chart illustrates that the CCGs sitting in the bottom left quadrat are demonstrating lower prescribing costs in diabetes realising lower hospital admissions whereas the CCGs sitting in the top right quadrat are demonstrating higher admissions with higher prescribing costs. It would be of benefit for the latter CCGs to communicate with those better performing CCGs to understand steps that can be taken to improve their prescribing and outcome position. The RDTC is hosted by the Newcastle Upon Tyne Foundation Trust (the data controller), however data processing is undertaken by the prescribing reports team within the RDTC. The reports are produced only for RDTC stakeholders as listed: Newcastle Gateshead CCG North Cumbria CCG North Tyneside CCG Northumberland CCG South Tyneside CCG Sunderland CCG Darlington CCG Durham Dales, Easington and Sedgefield CCG Hartlepool and Stockton CCG North Durham CCG South Tees CCG Bolton CCG Bury CCG Heywood, Middleton and Rochdale CCG Manchester CCG Oldham CCG Salford CCG Stockport CCG Tameside and Glossop CCG Trafford CCG Wigan Borough CCG East Riding of Yorkshire CCG Hambleton, Richmondshire and Whitby CCG Harrogate and Rural District CCG Hull CCG North East Lincolnshire CCG North Lincolnshire CCG Scarborough and Ryedale CCG Vale of York CCG Rotherham CCG Airedale, Wharfedale and Craven CCG Bradford City CCG Bradford Districts CCG Leeds North CCG Leeds South and East CCG Leeds West CCG North of England Commissioning Support Service Greater Manchester Shared Service Yorkshire Shared Service HES data is currently only supplied to these users within the form of scatter charts presented at either an area team level or CCG level. This work was instigated in response to stakeholder requests that it would be of value to include information highlighting whether prescribing patterns could influence episodes of hospital admissions. This data is only presented at CCG level, and is only extracted for processing at CCG level. The aim of this work is to highlight variation in prescribing between CCGs, more specifically the use of HES data within these reports aims to highlight possible variation in hospitals admissions due to prescribing practice. It maybe that the data suggests that higher prescribing costs within a therapeutic area by CCG A do not lead to reduced hospital admissions compared to CCG B who is prescribing at a lower cost. National data is specifically required in order to enable benchmarking of CCGs. RDTC were previously granted access to HES data in October 2013 and have been incorporating the data into their reports since October 2014 via the data depot system and the HDIS system. They have had no access to HES data since July 2016 in any form (i.e. HDIS or an extract), hence the request for a new DSA. The reports are updated quarterly, the following data is required for inclusion in the therapeutic reports: Diabetes report • Diabetes hospital admissions (ICD-10 codes E10-E14) per diabetes patients within each CCG compared against spend on diabetic drugs per diabetic patients or QOF target DM007. • Severe hypoglycaemia hospital admissions (ICD-10 codes E160-162) per diabetic patients compared against insulin Determir, Glargine and Degludec as a percentage of all long/inter insulin analogues. Respiratory report • Chronic Obstructive Pulmonary Disease (COPD) hospital admissions (ICD-10 codes J40-J44) per COPD patients compared against spend on LAMA inhalers. • COPD and asthma hospital admissions (ICD-10 codes J40-J45) per COPD and asthma patients compared against spend on bronchodilators and corticosteroids. Cardiovascular report • Stroke hospital admissions (ICD-10 codes I60-I69) with a secondary diagnosis for Atrial Fibrillation (ICD-10 codes I48) per stroke patients compared against defined daily doses (DDDs) per stroke patients. Bone Metabolism report • Hip fracture hospital admissions (ICD-10 codes S720-S722) per bisphosphonate STARPU compared against spend on bisphosphonate drugs per bisphosphonate STARPU. The applicant requires this data from NHS Digital, as it is the only avenue available to them.
By presenting the HES data provided within RDTC therapeutic reports, stakeholders have been able to identify and prioritise key areas for development. For example, in Greater Manchester the illustration that CV outcomes in diabetes population were out with that of the rest of the region has driven the accelerated development of a pathway to tackle this issue, resulting in changes to the agents listed within the formulary to provide those agents with known cardiovascular benefit to be placed over previously used therapies. Without this data this population may not have been highlighted as needing more appropriate therapy, the provision of this data has directed the necessary resource to support this work ahead of other topics.
By highlighting to medicines optimisation teams any potential relationship between prescribing patterns and hospital admissions organisations can work to identify ways to optimize prescribing, enabling the most cost effective use of medicines across the health economy. Identifying better outcomes to the patient population by a change in prescribing pattern e.g. identifying that lower prescribing rates of high dose inhaled corticosteroids (ICS) does not result in increased hospital admissions for an exacerbation of COPD , may support prescribers to reduce high dose ICS prescribing which is of health benefit to the patient. High dose ICS are associated with an increased risk of systemic side effects, including adrenal suppression and growth retardation in children (NICE Academic detailing aid, July 2012). One of the applicant's stakeholder regions has implemented a new treatment pathway across its health economy to address the following issues: • Multitude of different inhalers and inhaler types • Probable overprescribing of inhaled corticosteroids • Variation between CCGs in admission rates and spend on respiratory drugs The outputs being measured are: • Any change in corticosteroid prescribing • Any change in exacerbations of COPD • Any change in COPD referral or admission rates. Using the RDTC respiratory report the group are able to watch for any change in trends of ICS prescribing and also any change in hospital admissions for COPD exacerbations. If a correlation is identified then the team can investigate further using their local data. The benefit of using CCG reports enables the stakeholder to benchmark their progress against other CCGs, where the health economy is working on one footprint such as in Greater Manchester this enables the medicines management group to consider the whole health economy whilst being able to instigate variation at CCG level within that health economy.
The following outputs will be produced: Therapeutic prescribing reports will be provided to stakeholder CCGs on a quarterly basis via the secure area of the RDTC website which stakeholders can access via password protection. The pdf summary report document is also emailed to stakeholders to alert them to the fact that a new therapeutic report is available from the website. The RDTC twitter account also alerts stakeholders that a new report has been added to the website via a statement such as “the latest RDTC cardiovascular report is now available to stakeholders on the RDTC website”. All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide. Published outputs will not identify individual general practices. CCG medicines optimisation teams use the information within the report to benchmark their prescribing against their neighbouring CCGs and their comparator CCGs. The hospital admissions data enable CCGs to identify whether their prescribing practice is leading to improved outcomes for patients via a reduction in hospital admission for that condition. CCG medicines optimisation teams can also look to those CCGs where there appear to be "better" outcomes and seek to replicate this success. For example identifying that lower prescribing rates of high dose inhaled corticosteroids (ICS) does not result in increased hospital admissions for an exacerbation of COPD, may support prescribers to reduce high dose ICS prescribing which is of health benefit to the patient. High dose ICS are associated with an increased risk of systemic side effects, including adrenal suppression and growth retardation in children (NICE Academic detailing aid, July 2012). CCGs across GM has implemented a new treatment pathway across its health economy to address the following issues: • Multitude of different inhalers and inhaler types • Probable overprescribing of inhaled corticosteroids • Variation between CCGs in admission rates and spend on respiratory drugs. The outputs being measured are: • Any change in corticosteroid prescribing • Any change in exacerbations of COPD • Any change in COPD referral or admission rates. Using the RDTC respiratory report the group are able to watch for any change in trends of ICS prescribing and also any change in hospital admissions for COPD exacerbations. If a correlation is identified then the team can investigate further using their local data. The benefit of using CCG reports enables the stakeholder to benchmark their progress against other CCGs, where the health economy is working on one footprint such as in Greater Manchester this enables the medicines management group to consider the whole health economy whilst being able to instigate variation at CCG level within that health economy.
Data is extracted from HDIS aggregated at CCG level. Record-level data cannot be downloaded and, in line with the HES Analysis Guide suppression rules, small numbers will be suppressed and/or aggregated, and will not include any description of a cell size below 6. Data is saved within a restricted drive as per the Protocol - RDTC Management of Hospital Episode Statistics (HES) data. The original downloads are password protected. All downloads are recorded in the extraction log including: • date and purpose of extraction. • the name and location of the extraction. • the report the extraction will be included in. • a review date for deletion. Data is imported into a specific database which only holds hospital data aggregates the data to LAT, Region and North of England level. The data then flows via linked tables into databases for each therapeutic area and after processing for weighting with the data’s denominator. The data is then linked to a further database which holds all scatter plot data. Data is copied from this database into a spreadsheet for all scatterplot data and finally copied into the therapeutic report spreadsheet. The reports are made available to stakeholders via the centres website which is password protected. A PDF of the reports dashboard summary is emailed to all stakeholders. Data is only handled as per the protocol and data flow maps. Data will only be accessed by individuals within the prescribing reports team of the prescribing support unit at the RDTC who have authorisation from NHS Digital to access the data for the purpose(s) described, all of whom are substantive employees of the RDTC. Only one team member currently has the authority and thus the log in details to access HDIS system, and will be the only user. HES data will be plotted against EPACT prescribing data and displayed as scatter charts. It will only be presented at CCG and Area Team level. The data will not be linked with any record level data. There will be no requirement nor attempt to reidentify individuals from the data. The data will not be made available to any third parties other than those specified except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide. Access is being requested to admitted patient care data as this will provide the Trust with the data required to produce the scatter charts detailed above. They only require data for the current financial year, national data is required in order that The Trust will filter this to only include the exact CCGs they require as not all CCGs nationally fit the top 10 most similar CCGs, for example Central London (Westminster) CCG does not feature in the top 10 similar CCGs of any of the applicant's stakeholders so the data could be filtered out. Data will be filtered by the applicant for specific conditions using ICD-10 codes within the diagnosis fields. For example diabetes admissions counts will be identified using the E10 to E14 diagnosis codes. Processing of HES Accident and Emergency, Outpatient and Critical Care data is not permitted under this agreement. All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract i.e.: employees, agents and contractors of the Data Recipient who may have access to that data). this agreement. The following conditions apply to HDIS access: 1) Access to HDIS will be restricted to approved users agreed with the NHS Digital in a controlled manner. Only users who have undergone Information Governance training as required by IG Toolkit v14 may be permitted to access HDIS. 2) Initially, 1 user licences are approved and this will be managed under change control. The charges outlined in the agreement may therefore vary over the agreement period. 3) An annual review of the system use will be completed as part of the audit process. 4) The NHS Digital will monitor use of the HDIS system as part of ongoing access and any excessive use will be reviewed and access could be withdrawn with data destruction notices issued if that occurs. 5) Users are only permitted to download tabulated data (which may contain small numbers) from the system. Downloading of record-level data or record level linkage is not permitted under this agreement. 6) Where any record level data may have been downloaded previously from HDIS, such data must be securely destroyed and certificate of data destruction provided to NHS Digital within 2 months of this agreement. 7) Where downloaded aggregated data contains small numbers, such data must be securely destroyed at the end of the data sharing agreement, and a certificate of data destruction supplied to NHS Digital. 8) Where downloaded aggregated data is suppressed in line with the HES analysis guide, such data may be retained beyond the period of this agreement. 9) All outputs shared by the licensee must have small numbers suppressed in line with the HES analysis guide.