3rd April 2001Birmingham

PRIMISFirst National Conference

3rd April 2001Birmingham

PRIMISFirst National Conference

MIQUEST Unravelling the Mysteries

3rd April 2001Birmingham

PRIMISFirst National Conference

MIQUEST Unravelling the Mysteries

Lynne WrightPRIMIS Information Manager

Dr Andrew PerryMIQUEST Consultant

Sue TrinderClinical Audit Facilitator, Oxfordshire MAAG

3rd April 2001Birmingham

PRIMISFirst National Conference

Outline

• Introduction• Setting the scene: Sue Trinder• Preparing to write queries: Andrew

Perry• Feedback software: Lynne Wright• Practice feedback: Sue Trinder• Questions

3rd April 2001Birmingham

PRIMISFirst National Conference

Setting the Scene

Sue TrinderClinical Audit Facilitator,

Oxfordshire MAAG

3rd April 2001Birmingham

PRIMISFirst National Conference

Why a CHD Audit

• National Service Framework for CHD• MAAG priority• Each of the 6 PCGs had made CHD a

priority for their clinical governance agenda

• An annual MAAG audit• CHD SQA and Health Promotion

requirements are satisfied by participation in MAAG audits

3rd April 2001Birmingham

PRIMISFirst National Conference

CHD AuditFrom the Beginning

• Agree the team• Find the Evidence• Agree the audit criteria• Decide which Read codes to use• Write the queries• Put queries through Query Manager• Send out to the 62/88 Oxfordshire

practices with MIQUEST software installed

PRIMISFirst National Conference3rd April 2001Birmingham

Audit Criteria Target group A

CHD patients

35-74 years

Target group B

TIA/Strokepatients

35-74 years

Target group C

PVD patients

35-74 years

Numbers in targetage bands

consultation in past15 months

CHD review orpreventionappointment in past15 months

Smoking status inpast 15 months

Current smokerslast record in past15 months

Smoking advicegiven in past 15months

BP measured inpast 15 months

Diastolic BP 89 orless in past 15months (anyrecord)

Systolic BP 149 orless in past 15months (anyrecord)

3rd April 2001Birmingham

PRIMISFirst National Conference

CHD Audit – Next Time!

• We intend to consult far more widely about:– Clinical criteria– Read codes used– Format of feedback

• We will document our decisions and give clearly written and precisely described instructions to Query writers

• We will be careful to avoid making assumptions

3rd April 2001Birmingham

PRIMISFirst National Conference

MIQUEST Unravelling the mysteries

• What can and cannot be done with MIQUEST – Can do almost everything we ask of it

in terms of collecting clinical data– Cannot tell us how or what to ask

• Planning, consulting, checking and then checking again absolutely vital

3rd April 2001Birmingham

PRIMISFirst National Conference

Setting the Scene

Sue TrinderClinical Audit Facilitator,

Oxfordshire MAAG

3rd April 2001Birmingham

PRIMISFirst National Conference

3rd April 2001Birmingham

PRIMISFirst National Conference

Preparing to Write Queries

Dr Andrew PerryMIQUEST Consultant to

PRIMISClinical Information

Consultancy

3rd April 2001Birmingham

PRIMISFirst National Conference

Writing MIQUEST queries

It’s really not difficult…… it’s just the software…

…. that’s confounding

3rd April 2001Birmingham

PRIMISFirst National Conference

All you need• Wonder woman

• Super hero

• Team work

3rd April 2001Birmingham

PRIMISFirst National Conference

All you need

• Knowledge of clinical systems• Audit experience• Read code knowledge • Medical backup

3rd April 2001Birmingham

PRIMISFirst National Conference

Process

• Specify requirements• Create query definitions• Write queries

3rd April 2001Birmingham

PRIMISFirst National Conference

Specify requirements

3rd April 2001Birmingham

PRIMISFirst National Conference

Specify requirements

• Iterative process• Start with existing audit• Reduce to set of questions

– How many patients have …?– Of these how many also have …?– Do they have a record of …?– When was the last …?– How many have a raised …?

• Specify the Read codes• Consultation

3rd April 2001Birmingham

PRIMISFirst National Conference

Specify the Read codes

3rd April 2001Birmingham

PRIMISFirst National Conference

Specify the Read codes

• Initial specification– Start from PRIMIS query sets

• Clinical consensus– Different ways to code conditions– Different systems– PRIMIS Clinical Advisory Group

3rd April 2001Birmingham

PRIMISFirst National Conference

Specify the Read codes

• Need codes for each– diagnosis– treatment– medication

• Require codes for– each version of Read codes– any local or system specific codes

3rd April 2001Birmingham

PRIMISFirst National Conference

Create query definitions

• Identify the subsets required• Query for each type of data• Specify selection criteria• Decide on output and therefore style

– Subset– Analyse– Report

• Specify the output

3rd April 2001Birmingham

PRIMISFirst National Conference

Styles of HQL queryStyles of HQL query

• SUBSET– Selects a sub-population for future analysis or

reporting

• ANALYSE– Counts patients or records meeting selection

criteria– Can count in bands (e.g. by Age, Sex)

• REPORT– Extracts selected data about patients in a sub-

population– Allows more detailed subsequent analysis

3rd April 2001Birmingham

PRIMISFirst National Conference

Writing queries

• Create new set for each disease area

• New query for each – Subset– Condition

• Add selection criteria as specified• Add the output • Quality assurance and piloting

3rd April 2001Birmingham

PRIMISFirst National Conference

3rd April 2001Birmingham

PRIMISFirst National Conference

Feedback Software

Lynne WrightPRIMIS Information Manager

3rd April 2001Birmingham

PRIMISFirst National Conference

Creating a Rush feedback spreadsheet

3rd April 2001Birmingham

PRIMISFirst National Conference

Structure

• Rush Import directory on local hard drive– Containing:

• RushImport ini file• Response import ini file

• Rush template in the template directory of Microsoft office

• Directory of aggregated responses

3rd April 2001Birmingham

PRIMISFirst National Conference

Aggregated Responses

• Using Response Manager• Select responses to aggregate• Select Rush layout• Click the aggregate button

3rd April 2001Birmingham

PRIMISFirst National Conference

Response Manager

3rd April 2001Birmingham

PRIMISFirst National Conference

Aggregated Layout

F F F F F F F F Query name Site Date series 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 [TARGAAGE] Age Sex breakdown of target group A PIT20 01/04/01 0 0 0 0 0 0 0 0 PIT22 01/04/01 0 0 0 0 0 0 0 0 PIT23 01/04/01 0 0 0 0 0 0 0 0 PIT24 01/04/01 0 0 0 0 0 1 0 0 PIT25 01/04/01 0 0 0 0 0 0 0 1 PIT26 01/04/01 0 0 0 0 0 0 0 0 PIT27 01/04/01 0 0 0 0 0 0 0 0 PIT28 01/04/01 0 0 0 0 0 0 0 0 PIT29 01/04/01 0 0 0 0 1 0 0 2

3rd April 2001Birmingham

PRIMISFirst National Conference

Two Control (ini) files

• ‘RushImport’ – Controls the import directory

• ‘Response import’– Lists all responses to be imported– Order of the responses– Title of the responses to be shown

both on the sheet tab and in the sheet heading

3rd April 2001Birmingham

PRIMISFirst National Conference

Ini File

3rd April 2001Birmingham

PRIMISFirst National Conference

Preparing a Rush Spreadsheet

• Aggregated analyse responses in Rush format

• Control (ini) files for import• Rush import sheet• Rush Excel template

3rd April 2001Birmingham

PRIMISFirst National Conference

Rush Excel Template

• Using the Import data button to select:– Control (ini) file– Response directory

• Check the response files• Import the response files

3rd April 2001Birmingham

PRIMISFirst National Conference

Rush Template (1)

3rd April 2001Birmingham

PRIMISFirst National Conference

Rush Template (2)

3rd April 2001Birmingham

PRIMISFirst National Conference

Rush Template (3)

3rd April 2001Birmingham

PRIMISFirst National Conference

So ... let’s do it

3rd April 2001Birmingham

PRIMISFirst National Conference

Feedback Software

Lynne WrightPRIMIS Information Manager

3rd April 2001Birmingham

PRIMISFirst National Conference

3rd April 2001Birmingham

PRIMISFirst National Conference

CHD Audit Feedback

Sue TrinderClinical Audit Facilitator,

Oxfordshire MAAG

3rd April 2001Birmingham

PRIMISFirst National Conference

Individual Practice Feedback

• Individual practice report– Crude and age/sex standardised prevalence– All audit criteria reported on– List of patients with operation codes without

diagnosis codes given– List of patients with either monitoring or

relevant drug codes without a diagnosis code given

• Aim to improve CHD registers

3rd April 2001Birmingham

PRIMISFirst National Conference

Individual Practice Feedback

• Practice-based 2-hour workshop offered to all practices built around their audit results– Part of each workshop looks at data

management issues within the practice• The use of recommended Read codes• Computer templates• Protocols

• Training needs identified and training arranged– Read Code training– Creating templates– Use of clinical system search engine

3rd April 2001Birmingham

PRIMISFirst National Conference

Comparative Feedback

• PCG report– Anonymised data compared at PCG and

county level

• PCG clinical governance CHD workshops held– CHD NSF implementation plans agreed– Training needs identified

• Practice nurse / GP 20-hour CHD workshops arranged

• One PCG funded clinical system training

3rd April 2001Birmingham

PRIMISFirst National Conference

CHD Audit Feedback –Next Time

• Include a list of all of the codes used in each query in the practice reports

• 2-hour workshops – huge time commitment– Include clinical governance leads?– Commission specialists?

• Would like to have the Rush software available for MAAG use

3rd April 2001Birmingham

PRIMISFirst National Conference

Discussion Session

• MIQUEST– software questions?– query questions?– Rush questions?

3rd April 2001Birmingham

PRIMISFirst National Conference