internal 2014 - data signposting

Data signpostingwhat, where and how much

Evan Kontopantelis123

1Centre for Health Informatics2Centre for Primary Care3Centre for Biostatistics

Manchester, 28 May 2014

Kontopantelis (IPH) Data signposting 28 May 2014 1 / 27

Outline

1 Primary Care Databases

2 General Practice datasets

3 Population datasets

4 Hospital episode statistics

5 Linking and mapping


The Clinical Practice Research DatalinkCPRD

Established in 1987, with only a handful of practicesSince 1994 owned by the Secretary of State for HealthIn July 2012:

644 practices (Vision system only: in Eng mainly London, SE, SC,NW, WM; see /pubmed/23913774)13,772,992 patients (≈5m active)covering ≈7.1% of the UK population

Access to the whole database is offered and costs ≈£130,000 paOffers the ability to extract anything adequately recorded inprimary care and construct a usable dataset


http://www.ncbi.nlm.nih.gov/pubmed/23913774

The Health Improvement Network databaseTHIN

Established in 2003 as a collaboration between In PracticeSystems Ltd and CSD Medical Research UK (EPIC)Now part and parcel of UCLIn May 2014:

562 practices (Vision system only, 50-60% overlap with GPRD)11.1m patients (3.7m active)covering ≈6.2% of the UK population

Usually offered under a 4-year license which costs £119,000Similar structure to CPRD and possibly more efficient patientmatching for socio-demographic characteristics


QResearch

Collaboration with the University ofNottinghamIn May 2014 reports:

754 practices (EMIS systems: biggestUK provider)over 13m patients (??m active)covering ≈7% of the UK population?

Datasets limited to 100k patients forexternalsRan as a fiefdom? Publication list,90-95%: Vinogradova, Couplandand/or Hippisley-Cox


ResearchOne

Collaboration between TPP and the University of LeedsIn May 2014 reports:

??? practices (SystmOne: Yorkshire&H, East Mid, East Eng, NE)GP, Community Care, Hospital Care.30m research recordscovering ≈?% of the UK populationcosts?

New potentially important playerUniformity of SystmOne and central databases for TPP systemslikely to provide better quality data at lower cost


Primary Care Databases structurebased on CPRD

Event files.Clinical: all medical history data (symptoms, signs and diagnoses).Referral: information on patient referrals to external care centres.Immunisation: data on immunisation records.Therapy: data relating to all prescriptions issued by a GP.Test: data on test records.

Lookup files.Medical codes: READ codes, ≈100k available.Product codes: ≈80k available.Test codes: ≈300 available.


GP clinical systems

North East

North West

London

West Midlands

Yorkshire & the Humber

South West

East Midlands

East of England

South Central

South East Coast

(90.2,90.5](89.9,90.2](89.6,89.9](89.3,89.6](89,89.3](88.7,89][88.4,88.7] EMISIn Practice SystemsTPPMicrotestISoft

NOTE: Chart size proportional to number of practices in area

Average practice scores by Strategic Health Authority, 2010−11

Overall reported achievement (62 indicators)and GP systems suppliers

North East

North West

London

West Midlands

Yorkshire & the Humber

South West

East Midlands

East of England

South Central

South East Coast

(5.5,5.7](5.3,5.5](5.1,5.3](4.9,5.1][4.7,4.9] LVVision 3ProdSysOneXPCSSynergyPractice ManagerPremiere

NOTE: Chart size proportional to number of practices in area

Average practice scores by Strategic Health Authority, 2010−11

Overall exception reporting (62 indicators)and GP systems products


Quality and Outcomes FrameworkQOF datasets

Pay for performance scheme that started in 1/4/2004Costs over £1bn paVoluntary scheme but participation over 99.9%Freely available on Health & Social Care Information Centre(HSCIC), by financial year:

NHS practice code and list sizePrevalence on 15 key chronic conditions (e.g. diabetes, asthma,CHD, COPD etc)Practice level performance on various clinical indicators for theseconditionsPractice level exception rates for each indicator


General Medical ServicesGMS datasets

Data from around 2000Information on general practicesAvailable on request (not free but cheap) from the HSCIC, bycalendar year:

NHS practice code, list size, contract type, full address (includingpostcode, sha, pct, lsoa)Number of GPs, FTE, names, country/area where qualified, sex,agePatient counts by age group and sex

Part of the Workforce theme: more info for other healthprofessions


Patient SatisfactionGP Patient Survey

Data from 2007Run by Ipsos MORI, data collected twice a yearStratified random sampling of patients to collect data onsatisfaction with GP servicesData freely at the practice and higher levels, weighted (to matchpatient population) and unweighted satisfaction scores on:

access, making an appointment, waiting times speaking to GP ornurse, ease of accesslast GP and last nurse appointment, opening hours, overallexperienceand many more domains


Primary Care MortalityPCM database

Data from 2006Managed by the HSCIC andaccessible remotelyMonthly and annual extracts ofindividual record level data ondeaths supplied by ONS:

registered GP/practice,patient details e.g. age,causes of death, NHS no

Data for use by LocalAuthorities and NHSorganisations only


Census 2011 datasetsbut also 2001, 1991 etc

Information aggregated at various levels, as low as lower superoutput area (LSOA) levelFreely available from the ONS websites, including:

Counts by age groups and sexHealthEthnicityReligionOccupationQualificationsHousehold-accommodation


Deprivation datasetsIndex of Multiple Deprivation (IMD): 2004, 2007, 2010, 2014

Important covariate, available at the 2001 LSOA levelEngland only (although there is a Welsh IMD as well)Free at the Neighbourhood Statistics ONS websiteAggregate of 7 domains:

IncomeEmploymentHealth deprivationEducation and skillsHousingCrimeEnvironment

2010 range was 0.5-87.8 (9.8 and 30.2 for 25th and 75th centiles)


Mortality datasetsFrom 1998

As counts available at the LSOA level (2001 or 2011) but specialrequest to the ONS mortality teamAs standardised mortality rates freely available but at electoralward level or higher from the main ONS websiteSpecific mortality causes available:

using ICD-10 codes from 2001, ICD-9 beforecounts at the LSOA level can be broken down by sex and age-group


Admitted patient care datasetand outpatient

Data more or less available from 1989Patient-level data, with various organisational markers:

GP, SHA, PCT, site of treatmentAvailable upon request from the HSCIC, including:

patient characteristics (incl IMD), admissions, discharges,episodes, clinical, maternity, psychiatric

Additional sensitive info: dob, NHS number, patient residencepostcode, LSOA etcData for outpatient care available from 2003: similar but lessdetailed


Critical care data

Data available from 2008Add-on dataset which should be matched with inpatient dataset,on request from the HSCICIncludes:

critical care datesadmission typesupport infocritical care levelsdischarge info


Accident and Emergency data

Data available from 2007Similar covariate and organisation info as inpatient-outpatientdatasets Available upon request from the HSCIC, with info on:

attendancesclinical diagnosisclinical investigationclinical treatment

Additional sensitive info: dob, NHS number, patient residencepostcode, LSOA etc


Lookup tables

To combine datasets reported at different levelsUsually the postcode is the best start, if knownThe UK Data Service (previously UK Borders) contains tables tohelp merge data at various levels, at 1991, 2001, 2011 or 2013boundaries:

PCTsWardsLSOAsSHAsClinical Commissioning Groups (CCGs formerly PCTs)NHS Area Teams


Spatial mapping

After merging at a geographical level spatial coordinates areuseful for plotting or accounting for spatial correlations inregression analysesONS Geoportal holds various digital vector boundaries files(shapefiles) for 2001, 2011 and more recent geographies:

LSOAsPCTs-CCGsSHAsRegions


OverviewHealth Sciences related

QOF

PC Mortality Database

GMS

GP patient satisfaction

other LSOA-PCT

LSOA-SHA

Postcode-LSOA

other

Admitted Patient Care

Outpatient

Critical CareA&E

other

Census

Mortality

Deprivation

other

Terminology

Training resources

Classifications

other

SHAs

LSOAs

PCTs (CCGs)

other

CPRD

QResearch

THIN

ResearchOne


Comments and questions: [email protected]


internal 2014 - data signposting

Science

gp services data

better quality data

medical history data

general practice datasets

east eng

patient population

practices emis systems

number of practices