National clinical audits and patient registries can offer real insight into the quality of care provided by the NHS and be powerful tools for improving it. The application of these data sets is potentially huge. While audits have traditionally focused on health care providers comparing their services with accepted standards and other similar organisations, the data collected are potentially also valuable for research, evaluation and service planning, as well as identifying variation in care across populations.
The value of clinical audits and registries is in part related to the rich information they contain on clinical outcomes and care processes. Many other NHS data sets focus on how often patients use services (for example, emergency admission rates), whereas the audits and registries contain rich information on clinical outcomes and care processes. They also have deeper clinical engagement, with data collection extending into front line services. This means they offer insights into aspects of care quality that would not otherwise be captured in a systematic way.
Recognising the potential of the audits and registries, we’ve just launched five projects that form the current round of our Insight research programme, each aimed at using audit and registry data to improve the quality of health care.
Artificial intelligence and health
The first project is looking at stroke care in England and Wales, using data from the Sentinel Stroke National Audit Programme. What’s particularly interesting about this project is the novel use of artificial intelligence (AI) to detect and interpret variations in care. AI is becoming increasingly topical, especially given the government’s industrial strategy sector deal and the recent comments by the chair of the Commons Science and Technology Committee. But media coverage and debate on the topic is highly mixed. This project uses machine learning algorithms to more accurately predict patient outcomes after a stroke, providing valuable learning relating to the use of AI in the health sector.
Linking national datasets
Two of our other Insight projects focus on novel data linkages as a mechanism for improving the quality of health care.
To my knowledge, there have been few (if any) cases where primary care data and national clinical audit data has been linked. I’m therefore excited to see the findings from a project linking the National Chronic Obstructive Pulmonary Disease (COPD) Audit and the Clinical Practice Research Datalink primary care data. Linking data in this way means they’ll be able to explore the full patient pathway, including visits to primary care before hospital admission, prescribed medications and any previous episodes of worsening respiratory symptoms. They will investigate how this, together with variations in practice, affects hospital admissions.
The other project is ambitiously linking five audit and national datasets to get a highly detailed picture of congenital heart services: the National Congenital Heart Disease Audit, the Paediatric Intensive Care Audit Network, the Intensive Care National Audit and Research Centre Case Mix Programme, data from the Office of National Statistics and finally the Hospital Episode Statistics. Linkage on such a large scale will offer unique insights, not only into congenital heart services, but also into the technical and governance aspects of linking national datasets, and the approaches to tracking patient trajectories among individuals with long-term conditions.
These research projects make use of the rich information on clinical outcomes and care processes that are included within the clinical audits. There is also the possibility to strengthen national clinical audits and registries with the inclusion of routinely collected patient-reported data. Patient reported outcome measures have most extensively been used within orthopaedics, but less so in other areas.
Electronic patient reported outcomes
Another of the Insight projects will be engaging patients, clinicians and commissioners in routinely collecting electronic patient reported outcomes (ePROs) data using the UK Renal Registry. They’re exploring how renal units can implement and sustain routine collection, as well as capturing vital learning to guide routine ePRO collection by other disease registries.
While innovation is valuable, it is essential to maintain a focus on improving care for patients. With this in mind, we are also funding a randomised controlled trial using the National Endoscopy Database, to measure the impact of regular, automated feedback of both endoscopist and endoscopy unit-level performance data and best practice guidance. This project team is also exploring the reasoning behind recipient decisions on whether to act on the feedback received. It will be fascinating to see how this complements learning from the Healthcare Quality Improvement Partnership’s recently launched National Clinical Audit Benchmarking online portal, which brings together trust-by-trust results across key specialties set against individual national benchmarks.
This ambitious programme of work has the potential to significantly move us forward in using national clinical audit and patient registry data to improve the quality of health care. Each project is keen to share their learning throughout this journey, so look out for blogs from the teams to see how the projects are developing.
Diane Redfern-Tofts is Assistant Research Manager at The Health Foundation