UNDERSTANDING THE SYSTEM THE TRICKIER BITS

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UNDERSTANDING THE SYSTEM THE TRICKIER BITS !

• Richard Wight
• National Clinical Lead
• DAHNO Project

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Clinical Helpline Questions
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Clinical Helpline Questions

• QUITE WIDE AND VARIED IN NATURE
• DIFFER BETWEEN DIRECT ENTRY AND UPLOAD
• HIGH VOLUME VERSUS LOW VOLUME ENQUIRERS
• USUALLY SOLVED IN SINGLE REPLY

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Clinical Helpline Questions

• CATEGORIES OF ENQUIRIES
• ERRORS
• MAXIMUM VERSUS MINIMUM DATA SET
• CODING KNOWLEDGE
• PATIENT PATHWAY ISSUES
• DESIRABILITY CHANGES

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Clinical Helpline Questions- ERRORS

• THANK YOU TO EVERYONE FOR THEIR DILIGENCE
• THE ERRORS !!!!!!
• DATA MANUAL ERRORS e.g. incorrect statement
• TRANSCRIPTION ERRORS- e.g. missed item in code
  list
• TRANSLATIONAL ERRORS e.g. incorrect attribution
  code
• MANDATORY FIELD PREVENTS PROGRESSION
• NEGATIVE CALCULATION VALUES

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Clinical Helpline Questions- MAXIMUM v MINIMUM

• Minimum represents those fields which are
  requested to be filled to meet the basics of the
  PHASE I audit
• Maximum is an optional extension for users which
  assists broader collection
• Searching for fields in minimum which are part of
  maximum
• Some confusion on sites bordering oral cavity and
  larynx
• E.g. base of tongue or tonsil -OROPHARYNX
• E.g. partial laryngectomy as part of tonsil
  tumour treatment procedure

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Clinical Helpline Questions- coding knowledge

• Demonstrates this at present probably does not
  sit with clinical teams
• Some common points of query -
• Consultant code- eg adding a new consultant
• Consultant code is C followed by GMC number
• i.e. Joe Bloggs C 1234567
• Operation codes - codes included match to
  National Cancer Data set head and neck - mapped
  to OPCS and Reed - have limitation of what is
  available which hopefully will be improved on in
  the future

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Clinical Helpline Questions- PATIENT PATHWAY

• Difficulties faced where referring trust does not
  enter information to prime pathways data
  sharing agreements
• Recognise all patient transfers are initiated as
  a referral
• Review of rule base
• Time intervals and negative values

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Clinical Helpline Questions- DESIRABILITY CHANGES

• Number of enquiries to adjust screen design to
  make system closer match a full clinical system
• Have to balance against prime function is an
  audit system
• In coming years LSPs will provide network based
  comprehensive cancer information systems from
  which SUS has the potential to seamlessly extract
  cancer and other audit data

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Preparing the ground for meaningful analysis

• THE IMPORTANT BITS FOR CLINICIANS to be ensuring
  high levels of completion for -
• CLINICAL SIGN OFF
• STAGING
• CO-MORBIDITY

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STAGING

• Very variable levels of recording so far
• Believe responsibility of clinicians, ideal time
  is at MDT
• Help text/ staging guide available
• UICC version 5 at present

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CO-MORBIDITY

• Comorbidity co-existent disease
• Major role in outcome of cancer therapy
• Adult Comorbidity Evaluation 27 index
• Applicable
• Accurate and reliable
• Impact on the outcome
• Overall grade simple integer by summation or
  highest ranked ailment

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Example of integer scoring system Congestive
heart failure

• Mild (1) exertional or paroxysmal dyspnea which
  has responded to treatment
• Moderate (2) CHF with dyspnea which limits
  activities
• Severe (3) hospitalised within last 6 months or
  ejection fraction lt20

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Test Example 1

• Well controlled hypertension
• Intermittent claudication
• Insulin dependent diabetic
• Score

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Example 2

• Myocardial infarct gt 6 months
• Old stroke with residual deficit
• Score

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UPDATE ON DEPRIVATION

• How will it be done ?
• Based on national census data
• Relects
• Income Employment Crime
• Health and disability Living environment
• Education, Skills and Training
• Housing and social services

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UPDATE ON DEPRIVATION

• Cant do for every home
• Use census super output area average 1500 people
• An index IMD (index of multiple deprivation) is
  calculated as an average of the lements
  previously described
• IMD is not a linear score so tend to use IMD rank
  
• (1most deprived to 32482least deprived)
• DAHNO will assign by each individual postcode IMD
  rank to each patient record

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SUMMARY

• CLINICAL HELPLINE REMAINS
• PLEASE HELP PROMOTE THE BEST RECORD COLLECTION BY
  ASSISTING IN STAGING AND CO-MORBIDITY SCORING
• DEPRIVATION WILL AUTOMATICALLY BE ADDED BY
  POSTCODE
• KEEP UP THE GOOD WORK!!!!