West Surrey InterPractice Audit

1
West Surrey Inter-Practice Audit

• The lean and hungry approach

2
The West Surrey linked scheme

• A partnership between
• Postgraduate Education deanery
• Primary Care Clinical Audit Group
• Staffing
• Two part time staff - nominal 1 day per week
• Two GPs providing input where required
• 14 practices
• Straddling 4 or 5 shadow PCGs
• Base population 149,867

3
Learning to Manage Health Information - A Theme
for Clinical Education

• Data Quality and ManagementWithin their
  practice health care professionals should apply
  an understanding of the issues around the
  variability and inaccuracy of clinical
  observations, measurement and techniques. They
  should be aware of how to minimise the impact of
  these factors, and take into account the
  potential impact of human, organisational, and
  clinical system characteristics on data quality

4
Not rocket science Lack of knowledge
understanding of

• The basics
• On / off sequences, passwords
• Organising files folders
• Using browsers
• More advanced
• Recording data consistently
• Creating and running reports
• Interpreting the data
• Presenting the results / Managing change

5
I understand what is meant by consistent data
entry and know how to set about achieving it
1 - low up to 5 - high
6
I understand what is meant by consistent data
entry and know how to set about achieving it
1 - low up to 5 - high
7
Who does what, and with what?

• Extraction
• Collection
• Aggregation / processing
• Interpretation
• Feedback
• Evaluation

8
MIQUEST only extracts data

• 1,"REFERENCE","CODE","DATE","CODE","VALUE1","DATE
  ","CODE","VALUE1","DATE","CODE","DATE"
• 1,"3WKW4","H43.","19550101","3395","280","1998082
  6","339C","397.4","19960226","663Z","19960226"
• 1,"WWKW4","H43.","19410101","3395","390","1998050
  5","339C","566.6","19951023","663Z","19980505"
• 1,"KTSW4","H43.","19740101","3395","370","1993102
  5","339C","452.3","19931025","663Z","19931025"
• 1,"66SW4","H43.","19900301","3395","430","1997122
  2","339C","476.2","19971222","663Z","19971222"
• 1,"S9SW4","H43.","19810101","3395","670","1998102
  8","339C","636.4","19981028","663Z","19981028"
• 1,"39344","H43.","19910306","3395","210","1997121
  5","339C","415.4","19971215","663Z","19971215"
• 1,"DK344","H43.","19630101","3395","770","1997080
  6","339C","632.3","19970806","663Z","19970806"

9
The West Surrey view...

• Extraction
• Collection
• Aggregation / processing
• Interpretation
• Paperless feedback
• Evaluation
• Largely automated

• Local query set
• Training in use of Interpreter
• Feedback tailored
• Better presentation
• Education training
• Research potential
• Problems of expansion

10
Turning data into information

• Feedback arranged into topics
• Each practice can declare its particular
  interests
• Graphical presentation
• Exported to Excel spreadsheet
• Macro driven
• Capable of delivery via Internet

11
HbA1c in patients with diabetes
12
Diastolic BP in patients with diabetes
13
Smoking habit in diabetic patients
14
Asthma - ratio of steroid to broncho-dilator
therapy
15
The big picture

• Clinical Governance
• Evidence based approach
• Learning to manage health information
• Life long learning

16
Evidence based health care

• Formulate a question
• Search for the evidence
• Critically appraise the evidence
• Extract / compile useful information
• Implement change
• Evaluate

17
Implementation in the real world

• Three axes to consider
• Evidence
• Context
• Facilitation