DAHNO: Starting from scratch

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DAHNO Starting from scratch

• Vin Paleri
• Consultant Surgeon
• Newcastle upon Tyne Hospitals NHS Trust

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Why me?

• Tried to set up the DAHNO data collection process
  from scratch
• Second generation user
• Conflict of interest
• Worked with DAHNO chair and vice chair
• Contributed to the comorbidity piloting process

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Where did it all start?

• Calman-Hine report (1995) and National Cancer
  Plan (2000)
• Evidence of widely differing standards of care
• No comprehensive mapping of care delivered
• Patterns of delivery vary
• Different specialties provide care
• Need for monitoring and audit
• NCDS template for many cancers devised by NHS IA
• NCASP to run national comparative audits

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National Clinical Audit Support Program
DAHNO
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National Clinical Audit Support Program
DAHNO
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DAHNO Project Structure
Courtesy Annamarie OConnor
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How does it work?

• Central software
• Each organisation submits data
• Directly on DAHNO
• Upload from third party software
• Local analysis and comparing with peers
• Annual report

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Local Reality NuTH

• Newcastle upon Tyne Hospitals NHS Trust
• 250 new patients per year
• Excel file of demographics and staging info
• Treatment info not integrated
• Talks with IT dept issues with personnel,
  firewall, platform, etc. 5 months
• Setting the data collection process in place 3
  months
• Attending workshop
• Feb 2006

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Secretary
Clinician
NCCT
Patient 1st seen
Diagnostic tests
Clinic visit patient given diagnosis
Register Carespell Diagnostic tests Imaging
MDT discussion
Diagnostic summary
Sign off
Clinic care plan agreed
Careplan
Surgery
Surgical Info
Surgical Info
Radio or chemo
Radio or chemo info
Any further information Including further care
plans, tests, treatment etc
MDT discussion
Follow-up
Clinical status assessment
Clinical governance meeting
Sign off
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Hierarchy
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Division of labour

• Co-ordinator
• Secretary
• Clinician

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Problems?

• Personnel
• Comorbidity and UWQoL
• Staging info
• Helpdesk

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Next phase

• Secured 3 year funding from Healthcare Commission
• Improved interface
• Grid to identify missing fields
• Standards of outcome
• Add more MDT data
• SVR / SaLT
• Nursing
• Radiology

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What can be improved?

• Contributors clinicians
• Flaws as seen in the annual report
• Technical issues
• Personnel

Data collection
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Vision

• Ability to identify the strengths and weaknesses
  of local, regional and national services
• Increased clinical ownership
• Plan and prioritise service developments
• service improvement initiatives
• investment priorities
• re-configuration of services
• manpower planning
• training requirements

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Vision

• Improved outcomes for patients
• improved survival
• greater consistency of care
• improved palliation of symptoms
• Reduction in inappropriate treatments
• Better information on service quality and
  outcomes
• Better experience of care
• Establish performance and outcome benchmarks
  which can help inform future guideline
  development and monitor their implementation

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Thank you!