New Core Data Set

1
New Core Data Set

• Presented By
• Kellie Peters Regina Lally
• Drug Treatment Monitoring Unit

2
Objectives

• Understand the new 47 field dataset
• Understanding Waiting Times and Retention.
• Understand the flow of data and relate to agency
  processes
• Understand what DTMU can offer
• Update on Information Systems

3
The Role of the DTMU

• The role of the South East Drug Treatment
  Monitoring Unit (DTMU) is to
• communicate the ever-changing data collation
  agenda to key stakeholders,
• whilst supporting drug treatment agencies in the
  collection and management of client data.

4
SE DTMU Team

• Based in Oxford with SEPHO
• Team consists of
• Kellie Peters Manager
• Vacancy Systems Integration
• Regina Lally Liaison
• Sue Dales Database Support
• Vacancy Information Analyst
• Laura Kesseboom DIR Administrator

5
NTA-DTMU Relationship
6
NTA Targets

• To double the number of people in effective,
  well-managed treatment between 1998 and 2008 and
• To increase the proportion of people who
  successfully complete or, if appropriate,
  continue treatment.
• In addition
• Reducing waiting times as an indicator for
  improving efficiency, and
• Building the drug treatment workforce as an
  indicator for increasing capacity.
• Client retention in treatment is being used as an
  indicator of quality in structured drug treatment.

7
Client Treatment Journey Diagram
Client makes contact with a service provider
(Tier 1, 2 or 3)
Engagement
Screening and briefing initial risk assessment
Triage and brief initial risk assessment
Initial care plan focusing on engagement and
initial needs (if required)
Comprehensive assessment and risk assessment (may
involve other service providers)
Comprehensive care plan developed by key worker
and client. Goals identified in one or more of
the four key domains
Delivery phase of treatment journey (in
conjunction with key working)
Key working conducted in conjunction with care
planned phase of the treatment journey
Care plan review (if more than one agency/service
involved in care delivery then all involved in
care plan review)
Treatment completion or maintenance to include
further work to assist client integration into
the community
Please note Care Planning Toolkit is currently
in consultation
Discharge plan
Discharge plan implemented
Discharge
8
Core dataset 06-07Key fields

• Without these fields, a record cannot be
  processed and will be rejected
• Agency ID
• First Initial of Client
• Surname Initial of Client
• Date of Birth
• Gender
• DAT of Residence
• Main Problem Substance
• Referral Date
• Triage Date

9
Referral Date Definitions

• Referral date
• (referral to agency date) date agency becomes
  aware that the client is waiting. Date of
  receipt of phone-call, letter, client walks
  through door asking to be seen etc.
• Referral to modality date
• 1st Intervention
• this is the date the client is referred into the
  treatment system.
• E.g. GP and client agree that client will be
  referred. Date of appointment where possible, but
  practically likely to be date on letter or date
  of phonecall. This date then may be BEFORE the
  referral to agency date.
• Subsequent interventions
• this is always the date that it is agreed with
  the client that they will progress to another
  intervention. Where this is at a different
  agency, the referral to modality date will be the
  date agreed with the client. The referral (to
  agency) date will be the date that the new agency
  becomes aware of the client waiting. This date
  could be before the referral to agency date.
  Unless being treated at same agency, then only
  new information is modality information.

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Triage Assessment

• Triage Assessment aims to identify the nature
  and the extent of a clients drug and alcohol
  use, then focuses specifically on identifying any
  immediate needs that will impact on the clients
  likely engagement with the service or treatment
  process
• (Care Planning Toolkit,
  Nov 2005, NTA)

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Other Client Information

• Client Reference
• Ethnicity
• Postcode
• Postcode Incode
• Local Authority
• PCT of Residence
• Referral Source
• Previously Treated
• Consent for NDTMS

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Consent

• Clients should give written consent to share
  information about their care plan. This consent
  should specifically state which agencies the
  client consents to have information received
  about them and which they do not. A form
  recording the clients consent should be kept in
  the notes. Consent should be reviewed at the
  time of reviewing the care plan.

13
Confidentiality

• Part of the assessment process should be
  establishing with a client how information
  relating to them may be shared and for what
  purpose. This may be done as part of the care
  planning process and should have started at the
  time of assessment.
• Agencies should have clear policies about how
  assessment information and care plans are shared.

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Client Treatment Journey Diagram
Client makes contact with a service provider
(Tier 1, 2 or 3)
Engagement
Screening and briefing initial risk assessment
Triage and brief initial risk assessment
Initial care plan focusing on engagement and
initial needs (if required)
Comprehensive assessment and risk assessment (may
involve other service providers)
Comprehensive care plan developed by key worker
and client. Goals identified in one or more of
the four key domains
Delivery phase of treatment journey (in
conjunction with key working)
Key working conducted in conjunction with care
planned phase of the treatment journey
Care plan review (if more than one agency/service
involved in care delivery then all involved in
care plan review)
Treatment completion or maintenance to include
further work to assist client integration into
the community
Please note Care Planning Toolkit is currently
in consultation
Discharge plan
Discharge plan implemented
Discharge
15
Care Planning

• As soon as possible, the allocated keyworker
  will ensure that the client undergoes a
  comprehensive assessment of needs. Following
  this a comprehensive care plan is drawn up.
• all clients need a comprehensive care plan if
  they are to receive standard treatment
  interventions.
• (Care Planning Tool
  Kit, November 2005, NTA)

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Care Planning Domains

• Care Plan Start Date
• Drug and Alcohol Use
• Route of Administration of Primary Substance
• Age of first use of Primary Substance
• Problem Substance Two
• Problem Substance Three
• Injecting Status
• Injected in last four weeks
• Ever Shared

17
Care Planning Domains

• Physical and Psychological Health
• HepC Latest Test Date
• Date of the most recent test for Hepatitis C.
• HepB Vaccination Count
• 1,2,3,4 or c(course completed)
• HepB Intervention Status
• Whether vaccination was offered, accepted or
  refused, or immunised
• Previously Hep B Infected
• Hep C Positive
• Drug Treatment Healthcare Assessment Date

18
Care Planning Domains

• Social Functioning
• Accommodation Status
• Parental Status
• Employment Status
• Sex Worker Category

19
Client Treatment Journey Diagram
Client makes contact with a service provider
(Tier 1, 2 or 3)
Engagement
Screening and briefing initial risk assessment
Triage and brief initial risk assessment
Initial care plan focusing on engagement and
initial needs (if required)
Comprehensive assessment and risk assessment (may
involve other service providers)
Comprehensive care plan developed by key worker
and client. Goals identified in one or more of
the four key domains
Delivery phase of treatment journey (in
conjunction with key working)
Key working conducted in conjunction with care
planned phase of the treatment journey
Care plan review (if more than one agency/service
involved in care delivery then all involved in
care plan review)
Treatment completion or maintenance to include
further work to assist client integration into
the community
Please note Care Planning Toolkit is currently
in consultation
Discharge plan
Discharge plan implemented
Discharge
20
Core dataset 06-07Modality Data

• Date Referred to Modality
• This date for the first modality / intervention
  should be thought of as the date a client is
  first referred for Tiers 3 or 4 treatment.
• This field will also be used to record the start
  of the wait for any subsequent modalities /
  interventions within the episode. It should again
  be used as defined within the waiting times
  guidance notes, as the date that the referral for
  this subsequent modality / intervention was
  agreed with the client.
• Waiting times for Tiers 3 and 4 will be measured
  from the date entered in this field.
• If Modality is entered, Date Referred to Modality
  must be present and vice versa.

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Core dataset 06-07Modality Data

• Date of First Appointment Offered
• This is the first suitable appointment date for
  the modality/intervention, as agreed with the
  client.
• The date of first appointment offered may be the
  same as the actual modality / intervention start
  date, but this may not always be the case (eg. if
  the client fails to attend the first
  appointment).
• Enter date of first appointment offered when it
  is actually offered to the client.
• Do not enter Modality start date until the client
  actually attends an appointment.

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Core dataset 06-07Modality Data

• Date Referred to Modality
• Date of First Appointment Offered
• Treatment Modality
• The above fields are conditionally mandatory.
• Modality Start Date
• Modality End Date
• If End Date is entered, the other four fields
  must be populated.
• Multiple modalities can be captured. In order to
  do this, all other fields must be identical.

23
Continuity of care planning

• If a client is transferred, either to another
  agency or from secondary to primary care, the
  care plan can be forwarded to the new service or
  practitioner to facilitate communication. This
  can be done using the written care plan record.

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COFFEE TIME!!!!
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Client Treatment Journey Diagram
Client makes contact with a service provider
(Tier 1, 2 or 3)
Client wait starts as referred to Tx system
Screening and briefing initial risk assessment
Wait for 1st Modality
Triage and brief initial risk assessment
Initial care plan focusing on engagement and
initial needs (if required)
Client offered appointment to start modality and
accepts.
Comprehensive assessment and risk assessment (may
involve other service providers)
Comprehensive care plan developed by key worker
and client. Goals identified in one or more of
the four key domains
Client attends appointment starts first
modality. End of wait
Delivery phase of treatment journey (in
conjunction with key working)
Key working conducted in conjunction with care
planned phase of the treatment journey
Care plan review (if more than one agency/service
involved in care delivery then all involved in
care plan review)
Treatment completion or maintenance to include
further work to assist client integration into
the community
Please note Care Planning Toolkit is currently
in consultation
Discharge plan
Discharge plan implemented
Discharge
26
Client Treatment Journey Diagram
Client makes contact with a service provider
(Tier 1, 2 or 3)
Please note Care Planning Toolkit is currently
in consultation
Screening and briefing initial risk assessment
Triage and brief initial risk assessment
Initial care plan focusing on engagement and
initial needs (if required)
Comprehensive assessment and risk assessment (may
involve other service providers)
Client key worker agree subsequent modality.
Wait starts. Date referred to modality
Comprehensive care plan developed by key worker
and client. Goals identified in one or more of
the four key domains
Delivery phase of treatment journey (in
conjunction with key working)
Client offered appointment accepts
Wait for subsequent modality
Key working conducted in conjunction with care
planned phase of the treatment journey
Care plan review (if more than one agency/service
involved in care delivery then all involved in
care plan review)
Client misses appointment. End of Wait
Treatment completion or maintenance to include
further work to assist client integration into
the community
Assuming
Discharge plan
Client starts modality at next / future agreed
appointment.
Discharge plan implemented
Discharge
27
Waiting Times

• This is defined as the wait for Tier 3 or 4
  structured drug treatment for individuals (based
  on partnership area of residence). It is
  measured from an individuals date of referral
  for a structured intervention to the date an
  individual commences or is admitted for that
  care-planned structured treatment, following
  triage/ assessment.
• (Waiting Times, 3rd October
  2005, NTA)

28
Waiting Times

• From April 2006, the expectation will be that
  service users voluntarily seeking treatment will
  be able to access treatment within three weeks,
  with faster access for priority groups.
  Partnerships will be expected to initiate local
  investigations if service users wait longer than
  six weeks.
• (Models of Care Update 2005, Consultation Report)

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Reporting of Waiting Times

• Starting from 1 April 2006 the only waiting times
  that the NTA will require are those generated
  from NDTMS. This will relieve partnerships of the
  need to report waiting times data from parallel
  self-reported systems.
• From 1 April 2006 onwards partnerships will be
  performance managed on the percentage of clients
  accessing treatment within three weeks.
• Average waiting times for each treatment
  intervention will continue to be reported by
  NDTMS and will be used for background information
  to assess the functionality of the local
  treatment system.

30
Waiting Times FAQs

• How are changes to software being implemented and
  who will fund any costs arising from this?
• Our providers software cannot record referrals
  between different modalities/interventions at the
  moment and therefore we are only reporting
  waiting times for entry into first modality.
• What will be the process of populating the
  quarterly review document with NDTMS waiting
  times data?

31
Client Treatment Journey Diagram
Client makes contact with a service provider
(Tier 1, 2 or 3)
Engagement
Screening and briefing initial risk assessment
Triage and brief initial risk assessment
Initial care plan focusing on engagement and
initial needs (if required)
Comprehensive assessment and risk assessment (may
involve other service providers)
Comprehensive care plan developed by key worker
and client. Goals identified in one or more of
the four key domains
Delivery phase of treatment journey (in
conjunction with key working)
Key working conducted in conjunction with care
planned phase of the treatment journey
Care plan review (if more than one agency/service
involved in care delivery then all involved in
care plan review)
Treatment completion or maintenance to include
further work to assist client integration into
the community
Please note Care Planning Toolkit is currently
in consultation
Discharge plan
Discharge plan implemented
Discharge
32
Core dataset 06-07Discharge Data

• Discharge Date
• Discharge Reason
• If a Discharge Date is entered, then a Discharge
  Reason must be given and vice versa.
• A Discharge Reason of Other should only be
  entered if no other reason is appropriate.
• Discharge information must be reported accurately
  and in a timely fashion as it is used to
  calculate Retention Rates.
• Modality End Date(s) must be populated for
  discharged clients.

33
Retention

• Retention in structured drug treatment has been
  built into mainstream health performance
  management systems. Retention targets are now
  built into primary care trust and strategic
  health authority local delivery plans, and the
  Healthcare Commission star ratings of mental
  health trusts now include retention in treatment
  for 12 weeks.
• (Models of Care Update 2005, Consultation Report)

34
Retention

• Information taken from a small study involving
  Community Drugs Teams in the North West. NTA are
  doing further research into the validity of their
  findings
• Factors found not to affect retention were
• ethnicity,
• type of drug misused,
• whether the client injected or not and
• whether the client had been using methadone at
  the time of presentation for treatment.
• Factors found to be associated with early dropout
  from treatment were
• age (younger clients drop out earlier),
• gender (males are 1.5 times more likely to drop
  out)
• treatment experience (those with no experience
  are 1.7 times more likely to drop out), and
• referral route (those referred from the criminal
  justice system are 2.7 times more likely to drop
  out).
• The latest data from the NDTMS can be used to
  show current trends in client retention across
  the country. Retaining clients in drug
  treatment, 2005

35
Retention Measure

• Only clients who have presented in reporting
  period included (i.e. 2006/7)
• From these new presentations, a client will have
  been
• Discharged before 12 weeks
• Discharged at or after 12 weeks
• Retained in treatment for 12 weeks or over but
  not discharged
• Retention measure will be proportion of all new
  presentations in the reporting period in measures
  (b) and (c)

36
Continuous EpisodesScenario 1

• Episodes that overlap
• Episode 2 modality start date before Episode 1
  discharge date
• Episode 2 modality start date during Episode 1
  which is still open

37
Retention Diagram Scenario 1
These two episodes for an individual are
overlapping and denoted as being continuous. The
client has been in contact with the treatment
system for more than 12 weeks.
Episode 1, Agency 1
Triage 1 Jul 2006
Modality Start (Strcd Daycare) 15 Jul 2006
Episode 2, Agency 2
38
Continuous EpisodesScenario 2

• Episodes that do not overlap
• Discharge date given for Episode 1 prior to
  Episode 2 starting. To be considered continuous
• Modality start date of Episode 2 must be within
  21 days of discharge date of Episode 1.
• Where First Appointment Offered for Modality in
  Episode 2 is within 21 days, but the actual
  Modality Start date is over 21 days, the episodes
  will still be considered continuous.

39
Retention Diagram Scenario 2
Referral to agency 27 Sept 2006
As the gap between the two episodes meet the
agreed criteria for continuous treatment, they
are both used in the retention calculation. Gap
between episodes Discharge date to
Modality Start (Episode 1)
(Episode 2) 12 days 25/9/06 to
06/10/2006
Triage 27 Sept 2006
Episode 1, Agency 1
Episode 2, Agency 2
Care Plan 2 Oct 2006
Retention Triage date to
Discharge Date (Episode 1)
(Episode 2) 230 days 10/6/06 to
24/1/2007
Modality Start (Strcd Daycare) 6 Oct 2006
Discharge 25 Sept 2006
Time period met to denote episodes are continuous
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LUNCH TIME!!!
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NDTMS Dataflow
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www.ndtms.net
43
Improving Service Provision

• Drug treatment services are managed using close
  to real-time data provided from the NDTMS and
  client satisfaction and client outcome data
• (Models of Care Update 2005, Consultation)

44
DTMU Validation

• When agency files are first received, they will
  be validated to identify any recodes required and
  any errors in agency files.
• The validation process produces error and
  validation logs.
• These logs are passed back to the agencies, to
  permit the agencies to correct errors and to
  resubmit data.
• Files containing fatal errors should be
  considered a higher priority for passing back to
  the agency.
• Many non-fatal errors, included in agency files,
  can be repaired by the application through
  recodes

45
DTMU Error ReportsFile submission

• Verification Report
• This report is based on the monthly submission
  and will indicate Error, Warning and Information
  Messages that require attention, and where
  appropriate amendments to the database.
• File submission Reports
• File quality I Core dataset B or C submissions.
  Expect C
• Files submitted 20060401-20060430-Treat-in-C.csv
• File quality II Missing column headings
• Missing Data Where no information has been
  provided in a column
• File Load Reports
• Data quality I Load percentage records
  rejected/records accepted (ERRORS)
• Data quality II Data quality percentage quality
  of submitted records (Warnings)
• File Quality Triage/Discharge dates are
  inconsistent between same client with multiple
  modalities

46
(No Transcript)
47
DTMU Data Quality ReportFor DATS

• Error messages record why a record could not be
  counted, each record may have one or more of
  these missing / invalid items. These items are
• Date of Birth Records with an invalid / missing
  date of birth
• Attributors Records with an invalid / missing
  first initial, second initial or both
• Triage Date / Referral Date Records with an
  invalid / missing either referral or triage dates
• Drug1 Records with an invalid / missing primary
  presenting substance
• DAT Records with an invalid / missing DAT

48
DTMU Error ReportsData quality

• Data Quality Reports
• Duplicate Clients (Similar Attributers same
  Client Ref)
• Indicate whether error or correct
• Duplicate Open Episodes
• Provide discharge date reason for earlier
  episode

49
DTMU Error ReportsHistoric Records

• Long Open Episodes Report
• ALL episodes started before April 2004. 
• Where clients are no longer in treatment,
  discharge information needs to be entered in the
  database.

50
DTMU Error ReportsOngoing data checks

• Episodes with No Modalities
• Monitored closely to ensure that modality
  information is being completed timely
  accurately
• This could affect waiting times calculations if
  not populated accurately!

51
DTMU Error ReportsMiscellaneous

• DTMU generate numerous other reports that are
  used to monitor various aspects of data quality.
• Where particular problems are found agencies will
  be contacted.

52
What should you expect from DTMU?

• Agency Training and Support Dedicated Liaison
  Officer, Systems Integration Officer and Database
  Administrator providing telephone and in-house
  training on Core 47 Field dataset.
• Improved Guidance Documentation Updated A Rough
  Guide to the NDTMS Data Collection Guide
  2006 due April 2006.
• Monthly Validation and Data Quality Reports
  Reporting erroneous client records, requiring
  correction. New reports April.
• Quarterly Newsletter 3rd Issue due April 2006.
• SE Region Drug Misuse Report In collaboration
  with the South East Public Health Observatory
  (SEPHO) the report combines NDTMS data with
  Hospital Episodes data, British Crime Survey,
  Mortality data and much more. Due to be
  published in spring 2006.
• Access to DTMU documents online Using the SEPHO
  website to provide essential DTMU documents
  available for download via web.
• Frequently Ask Questions (FAQs) Release of FAQs
  to assist agencies and DAT. Due April 2006.

53
DTMU Data Quality Standards

• All monthly agency submissions must contain at
  least 99 valid records.
• All 47 fields of Core Dataset populated, if
  appropriate.
• Files must be in a CSV format.
• Initially monthly submission must be sent to
  ndtms.datareturns_at_phru.nhs.uk
• From June onwards, all agencies should submit via
  the File Upload Portal.

54
January Data Quality

• Data Quality for South East Region was
• 99
• Thank you for all your hard work!!! ?

55
Software Update

• Bomic
• NTA Data Entry Tool (DET)
• NTA File Upload Portal
• Excel Spreadsheet

56
NTA Data Entry Tool

• Aimed at agencies currently using spreadsheets
• NOT a clinical system
• Interim solution until IT investment is realistic
  for agency/DAAT
• Rolled out to South East agencies in June,
  following testing and piloting by the NTA in
  London.
• 47 field spreadsheet to be used until the DET is
  received
• DTMU will work with you to support data migration
  and process of implementing the tool.

57
NTA File Upload Portal

• Designed to provide secure way of transferring
  files to regional teams.
• Will replace current e-mail submissions.
• Opportunity for agencies to take control of
  amendments prior to submitting files to DTMU
• DTMU can still decide whether or not to accept
  file if it is lower than the 99 load quality
  threshold. Amendments will still be requested to
  improve quality.
• Verification and Load reports will be posted back
  on the portal for agency staff to access
• Rolled out in May/June and DTMU will provide
  further training and support to all agencies.

58
ANY QUESTIONS
Kellie.Peters_at_phru.nhs.uk Regina.Lally_at_phru.nhs.uk
Sue.Dales_at_phru.nhs.uk