may 2005 chd health equity audit primis fifth annual conference 11 – 12 may 2005 piecing together...
TRANSCRIPT
May 2005
CHD Health Equity Audit
PRIMIS
Fifth Annual Conference 11 – 12 May 2005
Piecing Together the Future
Vicky Smith Jane Robinson
May 2005
CHD Health Equity Audit using Primary Care Data
12 May 2005
National PRIMIS Conference
Vicky Smith, Acting Primary Care Information Manager (GPPCP)
Jane Robinson, Senior Public Health Information Specialist (ASP)
May 2005
What is a Health Equity Audit?
“The purpose of HEA is to help services narrow health inequalities by using evidence to inform decisions on investment, service planning, commissioning and delivery and to review the impact of action on inequalities.”
May 2005
HEA’s
• Identifies how fairly services or other resources are distributed
• Help to provide services based on relative need
• Distribute resources relative to health need
May 2005
HEA is a cycle
• It is not just a review of services
• Approximately a three year cycle
• The cycle is not completed until something changes which is likely to reduce inequalities
May 2005HEA Cycle
Use data on health inequalities toSupport decisions at all levels
1. Agree partners and issues
2. Equity profile: identify the gap
3. Agree high impact local action to narrow the gap4. Agree
priorities for action
5. Secure changes in investment & local delivery
6. Review progress & assess impact
May 2005
Process at Greater Peterborough Primary Care Partnership
• Decide on area to audit (previous audits, knowledge of health needs of area)
• Established what parameters we would like to look at• Director of Public Health and Primary care information manager
wrote a joint letter to GP practices explaining process• Primary care information team wrote and tested report style
MIQUEST Queries• Data collected from ALL (33) practices in GPPCP• Response disks handed over to PH information lead to analyse• Data quality analysed• Data analysed against various variables• Draft report currently being written
May 2005
Why Heart Disease?• Biggest killer for both PCTs• Known high incidence in high ethnic minority areas
and deprived areas• CHD NSF• Impact of PRIMIS• Impact of nGMS• Increased commissioned CABGs and PCTAs
several years ago and wanted to know if it was having an effect
• We knew that the data would be robust enough to analyse
May 2005
What we wanted to look at
• Risk factors for IHD – smoking, diabetes, exercise status, BMI
• Prevention – exercise schemes and advice, health eating schemes, access to open spaces
• Primary care – diagnosis and prevention treatment
• Secondary care – hospital activity• Deaths
May 2005
Health Data Items collected• Postcode• Practice ID• Age and gender• Ethnicity• Ischemic heart disease• Diabetes• Hypertension• Hyperlipideamia• Smoking status• BMI• Blood pressure• Exercise status• Aspirin
• Cholesterol
• Statin’s
• Cardiac rehabilitation
• Advice on smoking and exercise
• Non elective admissions to hospital for IHD
• CABGS, PCTAs procedures
• Death from IHD
• Deaths attributable to smoking
May 2005
MIQUEST Queries
• Looked at Report style queries for RUSH for practices
• These were edited to meet our needs
• Read Codes were based on nGMS contract business rules and PRIMIS queries
May 2005
Collection process• Made appointment to visit practice• Wrote query disks using MIQUEST Query
Manager (local queries)• Visited practices and ran local MIQUEST
queries• Saved responses to floppy disk• Checked responses before leaving practice• Returned disks to HQ and handed over to PH
Analyst
May 2005
Potential pitfalls• Need to access ALL practices• Time to write three query sets (Vision 5 byte,
Torex 4 byte and EMIS 5 byte)• Time to collect data (33 practices)• Technical problems with systems at some
practices• Need to check response disk before leaving
practice
May 2005
Analysing data – primary careIHD Prevalence: Percentage across GPPCP
0
1
2
3
4
5
6
30
80
2
30
80
3
30
80
4
30
80
5
30
80
6
30
80
7
30
80
8
30
80
9
30
81
0
30
811
30
81
2
30
81
3
30
81
4
30
81
5
30
81
6
30
85
3
30
85
4
30
85
5
30
85
6
30
85
7
30
85
8
30
85
9
30
86
0
30
86
2
30
86
3
30
87
1
30
87
2
30
87
4
30
87
5
30
87
7
30
87
8
Practices
Pe
rce
nta
ge
of
IHD
All Scheme average
May 2005
Analysing data – primary careGreater Peterborough Primary Care Partnership
Ischaemic Heart Disease prevalence by electoral ward
0
5
10
15
20
25
30
35
40
45
50
Bar
nack
Nor
thbo
roug
h
Ben
wic
k C
oate
s an
d E
astr
ea
St
And
rew
s
Bar
nwel
l
Kin
gsm
oor
Low
er N
ene
Del
ph
Bas
senh
ally
Stil
ton
St
Mar
ys
Glin
ton
and
Witt
erin
g
Wes
t
Kin
g's
For
est
Latt
erse
y
Sta
ngro
und
Cen
tral
Sta
ngro
und
Eas
t
Par
k
Pre
bend
al
Oun
dle
Wer
ringt
on S
outh
New
boro
ugh
Elto
n an
d F
olks
wor
th
Bre
tton
Sou
th
Yax
ley
and
Far
cet
Wal
ton
Wer
ringt
on N
orth
Rav
enst
horp
e
Nor
th
Dog
stho
rpe
Fle
tton
Eas
t
Eye
and
Tho
rney
Pas
ton
Ort
on W
ater
ville
Cen
tral
Ort
on w
ith H
ampt
on
Bre
tton
Nor
th
Ort
on L
ongu
evill
e
Electoral ward
Rat
e p
er 1
,000
PCP rate = 25.72
Source: HEA Audit, Autumn 2004
May 2005
Analysing data – primary careGreater Peterborough Primary Care Partnership
Ischaemic Heart Disease and 2004 IMD
R2 = 0.282
0
5
10
15
20
25
30
35
40
45
0 5 10 15 20 25 30 35 40 45 50
IMD Score
IHD
Pre
va
len
ce
, ra
te p
er
1,0
00
Source: HEA Audit, Autumn 2004
May 2005
Analysing data – secondary careGreater Peterborough Primary Care Partnership
Non Elective admissions for Ischaemic Heart Disease by Electoral Ward, 2002/03 - 2004/05
-1
0
1
2
3
4
5
6
7
8
Nor
thbo
roug
h
Bar
nack
Low
er N
ene
Stil
ton
Glin
ton
and
Witt
erin
g
Kin
g's
For
est
Bar
nwel
l
Ben
wic
k C
oate
s an
d E
astr
ea
Oun
dle
Elto
n an
d F
olks
wor
th
Bre
tton
Sou
th
New
boro
ugh
St M
arys
Pre
bend
al
Wer
ringt
on S
outh
Wes
t
Yax
ley
and
Far
cet
Ort
on L
ongu
evill
e
St A
ndre
ws
Par
k
Ort
on W
ater
ville
Eye
and
Tho
rney
Sta
ngro
und
Eas
t
Sta
ngro
und
Cen
tral
Wer
ringt
on N
orth
Latte
rsey
Pas
ton
Wal
ton
Bas
senh
ally
Del
ph
Ort
on w
ith H
ampt
on
Bre
tton
Nor
th
Rav
enst
horp
e
Fle
tton
Dog
stho
rpe
Nor
th
Eas
t
Kin
gsm
oor
Cen
tral
Electoral Ward
Rat
e p
er 1
,000
Source: HEA Audit, Autumn 2004
PCP rate = 3.21
May 2005
Analysing data – secondary careGreater Peterborough Primary Care Partnership
Non Elective Admissions to 2004 IMD
R2 = 0.4605
0
1
2
3
4
5
6
7
0 5 10 15 20 25 30 35 40 45 50
2004 IMD
AS
R N
on
Ele
ctiv
e ad
mis
sio
ns
per
1,0
00
Source: HEA Audit, Autumn 2004
May 2005
Analysing data – deathsGreater Peterborough Primary Care Trust
Death from IHD (1997-2003) by electoral ward
-50
0
50
100
150
200
250
300
350
Pre
bend
al
Low
er N
ene
Oun
dle
Bar
nwel
l
Bre
tton
Glin
ton
and
Kin
g's
For
est
Wes
t
Bar
nack
Ort
on w
ith
Elto
n an
d
Ort
on
Wer
ringt
on
Del
ph
Yax
ley
and
Wal
ton
Sta
ngro
und
Nor
thbo
roug
h
Wer
ringt
on
Sta
ngro
und
Eye
and
New
boro
ugh
Stil
ton
Par
k
Bas
senh
ally
Kin
gsm
oor
Pas
ton
Ort
on
Ben
wic
k
Eas
t
Bre
tton
Nor
th
Latt
erse
y
St
And
rew
s
Fle
tton
Dog
stho
rpe
Nor
th
Rav
enst
horp
e
St
Mar
ys
Cen
tral
Electoral ward
Rat
e p
er 1
00,0
00
Source: ONS deaths data
PCP rate = 145.42
Work in progress – conversion ratios for change in coding not yet performed
May 2005
Analysing data – deathsGreater Peterborough Primary Care Partnership
Deaths from IHD (1997 - 2003) and 2004 IMD
R2 = 0.4209
0
50
100
150
200
250
300
0 5 10 15 20 25 30 35 40 45 50
2004 IMD
Dea
th r
ate
per
100
,000
Source: HEA Audit, Autumn 2004Work in progress – conversion ratios for change in coding not yet performed
May 2005
Analysing data – deathsGreater Peterborough Primary Care Partnership
Non Elective Admissions to Deaths
R2 = 0.3262
0
1
2
3
4
5
6
7
0 50 100 150 200 250 300
Death rate per 100,000
No
n E
lect
ive
adm
issi
on
s ra
te p
er 1
,000
Source: HEA Audit, Autumn 2004Work in progress – conversion ratios for change in coding not yet performed
May 2005
Potential pitfalls• Too many variables: length of time to
perform initial profile• “activity” for wards on the boundary
probably not complete – only collected data for PCP GPs (deaths for whole ward)
• Data quality issues – not regularly collected items– Ethnicity 35% recorded– Exercise status 57% recorded– Exercise advice 30% recorded
May 2005
Ethnicity coding by practiceGreater Peterborough Primary Care Partnership
CHD HEA Ethincity by electoral ward
0
10
20
30
40
50
60
70
80
90
Bar
nwel
l
Kin
gsm
oor
Low
er N
ene
Oun
dle
St
Mar
ys
Ben
wic
k C
oate
s an
d E
astr
ea
Latt
erse
y
Bas
senh
ally
St
And
rew
s
Stil
ton
Pre
bend
al
Del
ph
Yax
ley
and
Far
cet
Kin
g's
For
est
Eye
and
Tho
rney
Elto
n an
d F
olks
wor
th
New
boro
ugh
Glin
ton
and
Witt
erin
g
Sta
ngro
und
Eas
t
Sta
ngro
und
Cen
tral
Bar
nack
Fle
tton
Ort
on W
ater
ville
Ort
on L
ongu
evill
e
Wer
ringt
on S
outh
Wes
t
Ort
on w
ith H
ampt
on
Eas
t
Dog
stho
rpe
Wal
ton
Nor
th
Par
k
Pas
ton
Rav
enst
horp
e
Nor
thbo
roug
h
Wer
ringt
on N
orth
Cen
tral
Bre
tton
Sou
th
Bre
tton
Nor
th
electoral ward
% c
om
ple
tio
n
PCP % = 35.64
May 2005
What next?
• Agree draft report with those involved/ partners• Publish report with agreed actions• Secure changes in investment & local delivery• Complete HEA Self Assessment tool kit• Review progress and assess impact (2006/07)
May 2005
More information
• http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/HealthInequalities/fs/en
• http://www.publichealth.nice.org.uk/page.aspx?o=502511
May 2005
Any questions?
May 2005
Contacts
• Vicky SmithActing Primary Care Information [email protected] 758547
• Jane RobinsonSenior Public Health Information [email protected] 758524
May 2005
Thank you