NHS Digital Data Release Register - reformatted
University Hospitals Coventry And Warwickshire NHS Trust projects
- What factors lead to palliative care patients being admitted to acute hospitals; can we design services to improve their support at home?
- Project 2
30 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).
What factors lead to palliative care patients being admitted to acute hospitals; can we design services to improve their support at home? — DARS-NIC-113611-X2Y3H
Type of data: information not disclosed for TRE projects
Opt outs honoured: N, Anonymised - ICO Code Compliant (Does not include the flow of confidential data)
Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(2)(b)(ii)
Purposes: No (NHS Trust)
Sensitive: Non Sensitive, and Non-Sensitive
When:DSA runs 2019-09-01 — 2020-08-31 2018.03 — 2018.05.
Access method: One-Off
Data-controller type: UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST
Sublicensing allowed: No
- Hospital Episode Statistics Accident and Emergency
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Accident and Emergency (HES A and E)
- Hospital Episode Statistics Admitted Patient Care (HES APC)
As part of the commitment to supportive & palliative care research the West Midlands Clinical Research Network Supportive & Palliative Care Research team conducted a study to ascertain the most important research questions for hospices in the West Midlands. The study identified the question, ‘What factors lead to palliative care patients being admitted to acute hospitals; can we design services to improve their support at home?’ as a top priority for research. Searching the published literature outlined the disadvantages of Emergency Department (ED) attendance for palliative care patients and it has been argued that frequent ED attendance and subsequent admission could be considered as inadequate management of palliative care patients, reflecting on substandard end of life care. A recent systematic review of the literature concluded that there was insufficient evidence as to why palliative patients are presenting in the emergency department. With an understanding of why patients present to the ED it may be possible to design interventions to support patients with palliative needs at home.
Subsequently, the NIHR Clinical Research Network West Midlands provided funding for obtaining data on the first part of the question to quantify the issue and provide data for service redesign. Whilst this funding was awarded for 17/18, it has been confirmed by the UHCW NHS Trust that this has carried over to 18/19 i.e. to ensure that this importance research can be completed.
Aim: Phase I: To explore factors leading to palliative care patients being admitted to acute hospitals in the West Midlands area and nationally.
• To determine how many patient admissions were related to palliative care needs in the years 2013 – 2016 in the West Midlands region and nationally.
• To determine the reasons for admission of the subset of palliative care patients identified by the specialist palliative care code Z515.
• To explore outcomes for the palliative care patients such as treatment given, length of stay and survival
Therefore, the data required will be filtered to code Z515 (patients with specialist palliative care needs), and only consist of the specific fields required for the research (9% of possible APC fields, and 17% of possible A&E fields). Whilst these fields will allow the data to be filtered geographically, this will only contain the hospital code where the patient attended, and not the patient's home address.
Phase I will provide insights into the incidence of admission, reasons for admission and clinical outcomes of palliative care patients within the West Midlands and national trends. This study will lead to phase II.
Phase II: This phase will be a qualitative exploration of palliative care patients’ and carers’ perspectives on reasons for and experience of admission into an acute Trust. The protocol must be submitted for full ethical review and, as at April 2018, is already in progress.
The HES data requested will be used for phase 1 of the study only. Phase 1 constitutes quantitative analysis using the raw HES data, and Phase II constitutes qualitative analysis of patient and carer experiences. There will be no linkage of data within or between the phases, rather the use of both quantitative and qualitative analysis will provide a richer evidence base to inform the development of improved support services for palliative care patients.
The findings from Phase 1 and 2 will inform the development of appropriate interventions which will be tailored to meet the needs of the palliative patient population and the NHS.
The data will not be used for commercial purposes, it will not be provided in record level form to any third party and it will not be used for direct marketing or shared in its original form with any third party other than staff at UHCW NHS Trust and a statistician at the University of Warwick. Processing of the HES data will take place at the University Hospitals Coventry and Warwick NHS Trust only.
The Data Controller has a responsibility to ensure they have in place appropriate contractual arrangements with the Data Processor(s).
a) General Benefits
Utilising HES data will provide more accurate information on the numbers and needs of palliative care patients going through Accident and Emergency Departments. Once these data are known, services will be designed to support patients in their home and hence strive to reduce anxiety and distress in patients with palliative care needs including end of life, as well as achieve the goal of preferred place of death. The redesigned pathways will lead to reduced admissions at acute trusts and consequently reduce pressure on emergency departments as most admissions occur via this route.
The research question, ‘what factors lead to palliative care patients being admitted to acute hospitals; can services be designed to improve their support at home?’ has not been asked before in the UK. This is new information requested and will be of direct benefit to the palliative care health sector as the information on the numbers and reasons for admissions to hospital (under Z515 code) elicited, will enable the palliative care teams to service redesign with the ultimate aim of reducing admissions to the acute sector (not always the optimal location for patients with palliative care needs).
UHCW, a large teaching Trust, had 120 inpatient admissions in one month under the Z515 code. It is estimated that at least 50% of these admissions could be successfully dealt with, with new approaches (intended service redesign). The potential benefit to the patients’ quality of life is huge if the service design stemming from the outputs is replicated in the hundreds of Type 1 A&E units in the UK.
b) Specific potential benefits dependent on results and directly related to the outputs:
i) Palliative care patients with all conditions admitted ‘appropriately’ for medical reasons (a list will be compiled from results of HES data search) - to have speedy referral to an acute palliative care team (similar to acute oncology service) to minimise any waiting in A&E
ii) if sufficient patients are found to be admitted for End of Life care with complex symptoms from HES data search, a joint post will be set up between the local hospice and the hospital to facilitate symptomatic care rapidly by the hospice inpatient or outreach team
iii) if patients are found to be admitted as they are not coping at home due to a lack of an informal carer, then an ‘accelerated service referral’ service could be set up to the specialist palliative care outreach on-call team and social workers
iv) Once numbers and reasons for admission for patients will palliative care needs are known, a virtual and triage palliative care service with a patient portal for patients to use at home instead of coming into A&E will be set up. Feedback to the patients where appropriate (immediate feedback to the patient for ‘severe’ needs). This is prevention of admissions for the group of patients identified by the HES data search who would be better served staying at home with specialist palliative care input.
Service redesign is expected to be in place by mid-December 2018, carried out by the wider palliative care team, approved by University Hospitals Coventry and Warwickshire UHCW Trust Executive and rolling out firstly to other interested Trusts in West Midlands (by June 2019) and then to ‘early followers’ in UK-wide (by December 2019).
Service and pathway transformation for patients with palliative care needs. Redesigning care pathways on behalf of CCGs requires access to activity data which is accurate and complete. HES are the only source for this.
The analysed results will be disseminated in a report form to members of the palliative and supportive care research team, community palliative team, hospices, NHS trusts in the West Midlands area and academic support from Warwick University for development of interventions to support patients with palliative care needs. The results of the study will be published in a peer reviewed journal and access to HES data will be acknowledged. All outputs will contain only aggregate level data with small numbers suppressed in line with the HES analysis guide.
The findings will also be disseminated to lay people/the general public via the UHCW NHS Trust's Facebook page and Twitter account, and their Communications Team will also release a press release. In addition, the findings will be presented at the Hospice UK National Conference in Autumn 2019, the audience for which is very diverse, and includes lay delegates as as well as palliative care specialists.
Phase 1 of the study will involve the collection and analysis of pseudonymised HES data only. Phase II will be a qualitative exploration of patient and carer experience, for which the HES data will not be used. There will be no direct linkage between the HES data and the qualitative experience data.
The HES data obtained from NHS Digital will be managed in accordance with Data Protection Act 1998 and standard operating procedures at UHCW NHS Trust. Data will be received and stored by the research team on secure password protected computer at UHCW and accessed by authorised research team members for analysis.
UHCW NHS Trust is the data controller who processes the HES data, and the University of Warwick is a data processor. However, processing of the HES data will take place at the UHCW NHS Trust only. This applies to all individuals processing the data, including the statistician who is a substantive employee of the University of Warwick, and the lead researcher, who is a substantive employee of both organisations.
Only aggregate data will leave UHCW NHS Trust. Small numbers will be suppressed in line with the HES analysis guide.
Pseudonymised data are required to enable calculation of benchmarked metrics on a per patient basis e.g. reason for admission into hospital such as pain control.
For clarity, this request is for non-identifiable, pseudonymised data on which descriptive statistics such as frequencies of outcomes will be undertaken.
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 ie: employees, agents and contractors of the Data Recipient who may have access to that data).
Project 2 — DARS-NIC-388494-W3L6K
Type of data: information not disclosed for TRE projects
Opt outs honoured: N ()
Legal basis: Health and Social Care Act 2012
Sensitive: Non Sensitive
When:2016.04 — 2016.11.
Access method: Ongoing
- Hospital Episode Statistics Accident and Emergency
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Outpatients
1. To provide University Hospitals Coventry & Warwickshire NHS Trust (UHCW) with the means to undertake clinical benchmarking against their peers for the following themes:
a. Length of stay at a HRG sub-chapter level across elective and non-elective activity
b. Emergency admission rates at a HRG sub-chapter level
c. The proportion of outpatient new attenders who are followed up (first to follow-up ratio) for every clinical specialty.
d. Elective care activity volumes at a specialty and HRG-sub-chapter level.
e. A&E activity volumes at a HRG level.
with the overall aim of helping UHCW to identify variations in practice and efficiency opportunities.
2. To provide UHCW with the means to undertake clinical coding benchmarking analysis which specifically focuses on reviewing casemix differences from the perspective of ICD and OPCS coding.
3. To provide UHCW with the means to undertake market share analysis, with a specific focus on: comparing elective care, non-elective care and outpatient care activity volumes for the Trust compared to peers. UHCW Trust falls within the Midlands and East Commissioning Area, this is the area that will be used in regards to market share analysis to understand how activity across the region has changed and what effect this will have on UHCW’s operation.
The Trust will be undertaking benchmarking analysis against Trusts within the Association of University Hospitals (AUKUH) group. These trusts are similar sized to UHCW, all teaching hospitals like UHCW and offer similar services.
Objective One – Undertaking benchmarking against peers – to be achieved within 3 months of the report being made available to the users, i.e. UHCW internal colleagues.
• By comparing Length of stay at a HRG sub-chapter level across elective and non-elective activity, this will enable UHCW to quantify the opportunities available for reducing hospital length of stay at UHCW.
• By comparing Emergency admission rates at a HRG sub-chapter level, this will enable UHCW to quantify the opportunities available for reducing short stay admissions at UHCW.
• By comparing the proportion of outpatient new attenders who are followed up this will enable UHCW to quantify the opportunities available for reducing unnecessary follow-up outpatient activity at UHCW.
• By comparing Elective care activity volumes at a specialty and HRG-sub-chapter level this will enable UHCW to quantify the opportunities available for increasing the proportion of elective work undertaken as a daycase at UHCW.
• By comparing A&E activity volumes at a HRG level this will enable UHCW to quantify the opportunities available for reducing A&E attendances at UHCW.
Objective Two – Undertaking clinical coding benchmarking analysis which specifically focuses on reviewing casemix differences from the perspective of ICD and OPCS coding benchmarking against peers – to be achieved within 3 months of the report being made available to the users, i.e. UHCW internal colleagues.
• By comparing against peers, UHCW will improve the accuracy and depth of clinical information by investigating how other Trusts code. Using the data to investigate differences in coding will mean that the UHCW can understand where improvements to clinical reports e.g. clinical notes, discharge summaries, may have to be improved.
• The overarching benefit to Heath and Social Care would mean that commissioners and regulators would be provided with a more accurate description clinical pathway complexity being operated by UHCW
Objective Three – Undertaking market share analysis by comparing elective care, non-elective care and outpatient care activity volumes for the Trust compared to peers - to be achieved within 3 months of the report being made available to the users, i.e. UHCW internal colleagues.
• Using the data to understand the relative volume of different activity types across the health economies, where UHCW has a presence, will inform UHCW’s development of service redesign offering to commissioners.
• The overarching benefit to Health and Social Care would be a service redesign offering which focuses on reducing variation in secondary care provision and overall cost.
Overarching principle to be applied
All outputs will only contain aggregated level data with small numbers suppressed in line with the HES analysis guide.
Output to be created to satisfy all objectives
Microsoft Excel based reports will be sent to the following teams within UHCW, at the end of each financial quarter:
• UHCW Commercial Finance Managers (x4)
• UHCW Head of Clinical Coding (x1)
The excel based reports will include the following data items:
• *Inpatient: data items: Provider code – Commissioner code – SUS generated HRG – Method of admission - Treatment specialty – date of discharge – duration of spell.
• *Outpatient data items: Provider code – Commissioner code – SUS generated HRG – Treatment specialty – attendance date – attended or did not attend
• *A&E data items: Provider code – Commissioner code – SUS generated HRG – date of attendance
Specifically For objective 2, the additional data items which will be included in the report includes; Inpatients: All diagnosis codes -- All operative procedure codes. Outpatients: All operation codes. A&E: A&E investigation – A&E diagnosis.
All reports will be presented in the form of a pivot table, enabling the recipient to modify as necessary.
All persons who will be processing the data and/or receiving reports arising from analysis of the data will be UHCW employees.
Please see data flow diagram i.e. “SD1 – Data Flow Diagram”. The data processing activities apply to all three objectives.
Receive data from HSCIC in psuedonymised/non-sensitive format
UHCW commercial analytics team upload data into SQL server, stored as a table formatting
UHCW commercial analytics team run data queries which will result in output tables (in aggregated format with small numbers suppressed)
UHCW commercial analytics team export data into Microsoft Excel (in aggregated format with small numbers suppressed)
UHCW commercial analytics team produce reports using Microsoft Excel and distribute to internal UHCW colleagues i.e. Commercial Finance Managers and Head of Clinical Coding. The reports will be presented in the form of a pivot table, enabling the recipient to modify as necessary.
All persons who will be processing the data and/or receiving reports arising from analysis of the data will be UHCW employees. The Trust will not be using the HES data extracts to develop any commercial products. Any reference to the UHCW “commercial analytics teams” or “commercial finance manager” relates to the fact that there is a consistency in team name and structure within the Trust’s Finance Department.