North Staffordshire GP Research Network

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North Staffordshire GP Research Network

• Started January 1997
• 10 Practices recruited
• 90,000 patients - 20 of DHA population
• Represents patient population
• Doesnt represent range of GPs
• Rough leaders in IT (top 20)

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OBJECTIVE

• Improve the quality and quantity of research in
  primary care
• Answering questions of interest to primary care
  practitioners
• Increasing research by primary care practitioners
• Improving research awareness among practitioners

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Focus

• The Epidemiology
• of common problems
• in Primary Care

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Using routine clinical data for research

• Patterns and predictors of occurrence,
  consultation and outcome
• Indications for investigation, referral and
  diagnosis
• Social variation and access to health care
• Evaluation of management and common treatments

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Developing a high quality epidemiological
resource

• Clear recording guidelines
• Data quality audits and feedback
• Involving all practice staff
• Data entry templates

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DATA VALIDATION

• CORE ASSUMPTIONS
• a coded entry for all consultations
• understand local usage of codes to ensure
  complete data capture
• influence local usage of codes to encourage
  consistency

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HOLES IN DATA
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Holes in the Data

• Copious use of free text
• Clerical staff entering data - loss of meaning
• Historical data - summarisers
• Software problems
• bugs
• slow search engines
• system failures
• human error

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THE GOLD STANDARD

• ALL GP CONSULTATIONS RECORDED ON COMPUTER
• Surgery
• Home visits
• Out of hours
• Telephone contacts
• Locums and trainees

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DOCTORS - OF CONSULTATIONS CODED
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Surgery Consultations with GP
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Location of Consultation with Dr Coded
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THE GOLD STANDARD

• ATTACHED STAFF
• All practice team consultations recorded
• Practice Nurse
• CPN
• Health Visitor and District Nurse
• Midwife
• NB Design of templates, training and duplication

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OTHER STAFF - OF CONSULTATIONS CODED
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THE GOLD STANDARD

• RECORDING OF OUT-OF-SURGERY CONTACTS
• Referrals - link to a reason/morbidity
• Tests and investigations
• lablinks?
• radiology
• Hospital letters

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THE GOLD STANDARD

• PRESCRIPTIONS
• Repeats
• Acute
• Link between drug prescribing and morbidity

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DRUG TO DISEASE VALIDATION

• Hydroxocobalmin Pernicious Anaemia
• Digoxin Dysrhythmia
• Amiodarone Dysrhythmia
• Inhaled Steroids Respiratory Disease
• Fluoxetine Depression
• Tamoxifen Breast Cancer

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Pernicious Anaemia - level of disease coding
against Hydroxocobalmin
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Dysrhythmia - level of disease coding against
Amiodarone
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Breast Cancer- level of disease coding against
Tamoxifen
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READ CODING
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READ CODING

• Keep it simple
• use illness and disease (codes that start with a
  letter) and surgical procedures
• be consistent
• try to enter all significant problems reported in
  the consultation
• GPRN/CHDGP recommended codes
• access templates via a problem title

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IHD AND CARDIAC MONITORING
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MYOCARDIAL INFARCTION
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HYPERTENSION
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DIABETES - plus monitoring
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ASTHMA - H33 plus 663 codes
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The Way Forward

• Ongoing data validation
• Feedback at practice and individual level
• Training
• clinical software
• read codes
• Policies/procedures translated into practice
  strategies

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The Way Forward

• Systems development
• Tweaking systems
• read code support
• prompts
• user defined screens and templates
• Suppliers support

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The Value of It

• Health Care Utilisation Data
• Improvement in Care

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ANNUAL GROWTH OF CODED DATA FOR 6 ASPECTS
IN DIABETES
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What has CHDGP done for us

• Excellent guidelines
• Benchmarking data quality .. BUT
• what does it mean
• need to be careful - high expectations
• Excellent presentation of data
• Practices accept data extraction

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Some thoughts for the future

• IMT strategy
• Nature of the queries
• MIQUEST
• Remoteness from Practices, and from schemes
• How do we know data is of an acceptable standard?