Sources of Demography and Health Information - UK PDF

OBJECTIVE 2 Sources of Health Information in UK Assessment of a population's health is complex Need range of health information No one source of health data is perfect Many sources of data Mortality data – previously covered Morbidity data (1) Cancer registration system (2) Hospital Epi...

OBJECTIVE 2 Sources of Health Information in UK Assessment of a population's health is complex Need range of health information No one source of health data is perfect Many sources of data Mortality data – previously covered Morbidity data (1) Cancer registration system (2) Hospital Episode Statistics (3) Quality and Outcomes Framework (QoF) (4) Notifications of Infectious Diseases  (1) Cancer Registration National Cancer Registration and Analysis Service (NCRAS): Public Health England Cancer diagnosis triggers registration. Sends core dataset (personal details, diagnosis, treatment, outcomes). Uses: - Monitoring cancer rates - Evaluation and improvement of cancer treatment - Evaluation of screening programmes - Aiding cancer research Strengths: - Detailed information updated over time - Record linkage to cancer deaths (ONS) Weaknesses: - Expensive - Access is difficult due to confidentiality  Incidence and Mortality from Breast Cancer in UK: 1975-2011 (European age standardised) Rate per 100,000 females 1988 Screening Programme Source of data: Cancer Research UK Cancer survival at 1 and 5 years – women, 2013-18 (2) Hospital Episode Statistics (HES) All admissions, out-patient and A&E visits to NHS hospitals in England http://content.digital.nhs.uk/hes Information on: – personal information (e.g. age, gender, ethnicity) – clinical information - diagnoses and operations – administrative data (e.g. date of admission, discharge) – geographical information - where treated & lives  Uses of HES Who? Commissioning organisations (for payment) Provider organisations Researchers What? Trends in NHS hospital activity Supports local service planning Health trends over time Fair access to healthcare http://content.digital.nhs.uk/hes  Data Coding Systems Two main clinical classifications currently used in HES are: – ICD-10 (International Classification of Diseases, 10th Revision, WHO) Describes conditions treated or investigated, e.g. myocardial infarction, fractured skull. (Also used for coding Mortality statistics) (NB. ICD-11 released June 2018, coming in Jan 2022) – OPCS-4 (OPCS Classification of Surgical Operations and Procedures, 4th Revision) Records details of operations e.g. hip replacement  ICD-10 Chapters (22) http://apps.who.int:/classifications/icd10/browse/2010/en Certain infectious and parasitic diseases Diseases of the musculoskeletal system Neoplasms and connective tissue Diseases of the blood and blood-forming organs and Diseases of the genitourinary syste certain disorders involving the immune mechanism Pregnancy, childbirth and the puerperium Endocrine, nutritional and metabolic diseases Certain conditions originating in the Mental and behavioural disorders perinatal period Diseases of the nervous system Congenital malformations, deformations Diseases of the eye and adnexa and chromosomal abnormalities Symptoms, signs and abnormal clinical Diseases of the ear and mastoid process and laboratory findings, not elsewhere Diseases of the circulatory system classified Diseases of the respiratory system Injury, poisoning and certain other Diseases of the digestive system consequences of external causes Diseases of the skin and subcutaneous tissue External causes of morbidity and mortality Factors influencing health status and contact with health services Codes for special purposes  Chapter IVEndocrine, nutritional and metabolic diseases (E00-E90) Chapter contains the following blocks: E00-E07 Disorders of thyroid gland E10-E14 Diabetes mellitus E15-E16 Other disorders of glucose regulation and pancreatic internal secretion E20-E35 Disorders of other endocrine glands E40-E46 Malnutrition E50-E64 Other nutritional deficiencies E65-E68 Obesity and other hyperalimentation E70-E90 Metabolic disorders  Diabetes mellitus (E10-E14) E10 - Insulin-dependent diabetes mellitus E11 - Non-insulin-dependent diabetes mellitus E12 - Malnutrition-related diabetes mellitus E13 - Other specified diabetes mellitus E14 - Unspecified diabetes mellitus 4 character used with E10-E14 th.0 - With coma.1 - With ketoacidosis.2 - With renal complications.3 - With ophthalmic complications.4 - With neurological complications.5 - With peripheral circulatory complications.6 - With other specified complications.7 - With multiple complications.8 - With unspecified complications.9 - Without complications  ICD-10 code Work these two out: E11.3 Insulin dependent diabetes without complications  ICD-10 code E11.3 Non-insulin-dependent diabetes mellitus, with ophthalmic complications Insulin dependent diabetes without complications E10.9  Hospital Episode Statistics STRENGTHS Completeness – as covers all hospital activity Accuracy – standard codes used Representative - Routine national data WEAKNESSES Accessibility – to individual data (3) Quality and Outcomes Framework (QOF) Introduced in GP contract in 2004: Linked to GP payments, voluntary, ‘rewarding good practice’to improve care QOF 2019 /20 - Points (max 559) awarded in 4 domains: Clinical domain (19 areas) – managing common chronic diseases e.g. AF, CHD, diabetes, CKD, asthma, dementia. (379 points) Public Health domain – CVD (primary prevention); blood pressure; obesity 18+; smoking 15+ (106 points) Public Health – additional services - cervical screening Quality Improvement – prescribing safely, end of life care (74 points) https://www.england.nhs.uk/wp-content/uploads/2019/05/ gms-contract-qof-guidance-april-2019.pdf  How does the QOF work? Point system: GP practices are scored against indicators Higher score  Higher GP income (adjusted for caseload and casemix) Significant expenditure and a significant incentive: £187.74 per QOF point per General Practice in 2019/20 £670 Million per year 15% of NHS primary care costs Source: NICE 15% of GP practice income Does QOF improve outcomes? – summary from NICE Recording? – definitely Process? – mostly yes Intermediate/proxy outcomes? – yes for some but not for others Clinical outcomes? – unclear – Strong evidence of initially improved health outcomes for a limited number of conditions but subsequently fell to the pre-existing trend; “limited impact on improving health outcomes due to its focus on process-based indicators...” (Langdown et al. 2014, J Pub Health) – Some evidence that the poorest performing practices have improved the most with narrowing of inequalities in care (Gillam et al. 2012, Annals Fam Med)  QOF disease registers – S and W Strengths Weaknesses Completeness Almost 100% response Excludes practices who from GPs do not participate Accuracy e.g. Not sure how accurate / complete the disease registers are for individual practices ? Representative/ Representative of all Only get aggregated relevance population: data for each practice data at surgery, CCG, i.e. no age/sex national levels breakdown Timeliness Updated annually, so reasonably timely Access http:// Aggregated data only content.digital.nhs.uk/  (4) Notifications of Infectious Diseases 32 notifiable diseases in England & Wales Doctor suspects a Laboratories case of a notifiable identifying a notifiable disease organism Public Health England (PHE) Notify ‘proper officer’ at local council or Local Health Protection Team (part of Public Health England) PHE collates and produces national trends each week Uses of surveillance: - Action to prevent further infection - Identify outbreak - Monitor trends https://www.gov.uk/government/ collections/notifications-of-infectious-  Notifiable Infectious Diseases in England & Wales (2020) Acute encephalitis Haemolytic uraemic Mumps Acute meningitis syndrome (HUS) Plague Acute poliomyelitis Infectious bloody Rabies Acute infectious diarrhoea Rubella hepatitis Invasive group A SARS Anthrax streptococcal disease Smallpox Botulism and scarlet fever Tetanus Brucellosis Legionnaires’ Disease Tuberculosis Cholera Leprosy Typhus COVID-19 Malaria Viral haemorrhagic Diphtheria Measles fever (VHF) Enteric fever (typhoid Meningococcal Whooping cough or paratyphoid fever) septicaemia Yellow fever Food poisoning www.gov.uk/guidance/notifiable-diseases-and-causative-organisms-how-to-report Tuberculosis notifications, England and Wales, 1913-2018 https://www.gov.uk/government/publications/tuberculosis-tb-annual- notifications-1913-onwards Meningococcal disease (a bacteria causing meningitis/septicaemia), England and Wales 1989 - 2006 Men C vaccine 3000 2500 Ungrouped 2000 Other 1500 Y W135 1000 C B 500 0 1998 1999 2000 2001 2002 2003 2004 2005 2006  Laboratory confirmed cases of invasive meningococcal disease in England by capsular group, 2008/09 to 2017/18 Men B vaccine – infants MenACWY – 14 years https://assets.publishing.service.gov.uk/government/uploads/system/uploads/ attachment_data/file/751821/hpr3818_IMD.pdf  Outbreaks of notifiable diseases… 1996 1988 2002 / 2013 2003  More outbreaks… 2014 / 2015 2019 2019 2015 / 2016  Notifications of Infectious Diseases STRENGTHS Timeliness – weekly report by PHE Representative - Routine national data Linked to other data to improve accuracy e.g. lab reports WEAKNESSES Poor or variable completeness for some diseases e.g. not all food poisoning notified, some treated at home Accuracy can be questionable due to diagnostic uncertainty, as asked to notify ‘suspected’ cases, although increasingly linked to lab reports  Objective 2 - Summary Various sources of data for health and disease in UK, some with specific purpose Health information sources have strengths and weaknesses Standard coding systems  Self Assessment Qs (1) Name the national source of the data/information for… - Prevalence of diabetes - Cancer survival - Hospital admissions (2) What data coding system is used in hospital for: (a) surgical procedures, (b) the medical condition treated ? (3) Give 1 strength and 1 weakness of Death statistics (4) A patient is suspected to have malaria. After appropriate clinical management, what is the next step?  Self Assessment Qs ANS (Q1) (Q1) Name the national source of the data for… - Prevalence of diabetes: Quality and Outcomes Framework (QoF) or Health Survey for England - Cancer survival: National Cancer Registration and Analysis Service - Hospital admissions: Hospital Episode Statistics Self Assessment Qs ANS (Q2) (a)Surgical Procedure - OPCS-4 (OPCS Classification of Surgical Operations and Procedures, 4th Revision) Records details of operations e.g. hip replacement (b) Medical Condition - ICD-10 (International Classification of Diseases, 10th Revision) Describes conditions treated or investigated, e.g. myocardial infarction, fractured skull.  Self Assessment Qs ANS (Q3) Mortality data Strengths Complete coverage in UK (for births as well) Weaknesses Accuracy? e.g. underlying cause of death subject to diagnostic uncertainty, coding issues and variable quality. Ethnicity not collected Derivation of socio-economic status - posthumous inflation of status Self Assessment Qs ANS (Q4) A patient is suspected to have malaria. After appropriate clinical management, what is the next step?