SQUID

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SQUID

• Sharing Quality in Data
• Department of General Practice and Primary
  CareSt Bartholomews and the Royal London
  Schoolof Medicine and Dentistry

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Healthy Eastenders Project

• Established 1984 - GPs and nurses in Tower
  Hamlets, east London
• Prevention of heart disease, smoking related
  cancer, cervical and breast cancer
• Preventive audit

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Preventive audit

• Process
• BP, smoking history, smoking advice, family
  history IHD
• alcohol, weight, height, dietary advice
• peak flow
• cholesterol
• smear, mammogram
• Where the data was recorded

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Growth of Audit
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Computer recording in 12 practices
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Sharing Quality in Data

• Develop computerised disease registers
• CHD
• Raised BP
• Diabetes
• Asthma
• Computer audit

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Data extraction

• MIQUEST
• EMIS
• Meditel
• Systems search facilities
• Import into Excel
• Analyse

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New arrangements for Health Promotion

• Abandonment of top-down data collection
  requirements for health promotion
• Need for bottom-up practice driven data
  collection
• Consensus building amongst practices about what
  data to collect in liaison with PCGs
• Development of our collaborative work with the
  Guidelines Project

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Feasibility study

• One 6 doctor practice
• 80 CHD
• 84 Asthma/COAD
• 96 Diabetes

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16 pilot practices

• 14 EMIS
• 1 Meditel
• 1 Paradoc

• 6 1-2 partners
• 10 3 partners
• 5 Tower Hamlets
• 4 Hackney
• 7 Newham

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Identifying a dataset

• Steering group
• GPs and nurses from participating practices
• Process recording
• BP, weight etc
• Morbidity recording
• Disease registers
• Interventions
• Aspirin prophylaxis advised

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Baseline questionnaire

• Frequency of recording
• Which codes?
• Do they have disease registers?
• Are they prepared to establish maintain them?
• What are their training needs?
• How can we facilitate this?

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What do practices need?

• Training for individual staff
• Comparison manual computer disease registers
• Editing templates
• Seminar for Registrars
• Identifying odd bugs!!

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Results

• Three levels
• practice (anonymised)
• each locality/borough
• three boroughs combined

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Blood pressure recorded last 5 yrs
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Prevalence Raised Blood Pressure recorded ever
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Blood pressure recorded last year in patients
with raised blood pressure
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Smoking history recorded last 5 years
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Smoking advice given to current smokers in last 5
years
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Prevalence COPD (excl asthma) recorded ever
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Peak Flow recorded in last year in patients with
COPD
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Prevalence of IHD
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Aspirin prophylaxis recorded in patients with IHD
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Prevalence of diabetes
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HbA1c recorded in last year in diabetics
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Audit feedback sessions

• Sessions one hour duration
• PGEA approved
• Joint between Squid Project and our Clinical
  Guidelines facilitators now jointly merged in
  Clinical Effectiveness Group
• Multidisciplinary - practice nurses, GPs,
  practice managers, GP registrars, and reception
  staff

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More on feedback sessions

• History of project explained
• Practice results presented and discussed often in
  great detail
• Session finishes with summary of discussion,
  action points, and strategy for dealing with
  training needs

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More on feedback sessions

• Its useful to compare like to like its good
  to know where we stand in relation to others.
• We can learn from other practices what theyre
  doing, which in turn can help us to get better
• It really does show we need to address how we
  record our clinical management. We cant allow
  even 15 or 10 of our high risk groups to slip
  through we have to go back and make sure we
  have everyone.

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Outcomes from feedback sessions

• IT training on data entry provided by
  facilitators
• Affirmation of hard work and good practice
  especially by practice nurses
• Facilitators enabled practices to identify
  priorities
• Further training needs identified, and further
  visits offered
• Squid data compared to recent practice audits
• Team discussion on use of their templates
• Decisions made on need for further practice
  audits
• Suggestions for refinements of future Squid audits

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New clinical effectiveness cycle

• Establishing priorities and aims
• Guidelines production
• Guidelines implementation
• Information requirements
• Resource implication consideration
• User/community involvement