We are pleased to welcome Dr Martin Allen, Getting It Right First Time (GIRFT) clinical lead for respiratory medicine, on the Model Health System project.
Perhaps you could start by setting the scene. Why is collecting data so vital?
Data drives change. This a bold truism, but unless we know about the services we are delivering for our patients, it is difficult to improve them.
In contrast to other major specialties where there are longstanding datasets that are completed, such as cardiology and renal medicine, respiratory has relatively few. It is important that colleagues are aware of the various data sets that now exist, and I hope this article helps to highlight current developments.
The NHS Long Term Plan for England aims to target investment in improved treatment for people with respiratory disease. We hope these new metrics will help to help increase the support available for providers in priority areas when it comes to improving patient flow.
What data is currently available?
The National Respiratory Audit Programme (NRAP) has developed over time to include adults and children and young people (CYP) with asthma, and pulmonary rehabilitation (PR) as well as COPD. This programme is our primary source of current information, but that is limited in part by being “hand collected” by nursing staff and entered manually, ie there is no electronic data flow. While there is good news that the audit has been re-commissioned in the form of the National Respiratory Audit Programme (NRAP) this will still collect a relatively small amount of data for what is one of the larger medical specialties.
Other data is available on prescribing from EPACT 2, the Atlas of Variation and Right Care information continues to be available on an annual basis.
National registry data, in contrast to other specialties (for example the National Joint Registry) is limited to specialised services such as cystic fibrosis and asthma. The new BTS UK ILD Registry draws together the existing UK Idiopathic Pulmonary Fibrosis (IPF) and UK Sarcoidosis Registries, and now includes all fibrosing ILDs, but more data in other respiratory disease areas is still required.
The lack of information needs to be addressed if we are to improve care, so the development of metrics as part of the Long Term Plan agenda is a welcome improvement. While this is somewhat limited at present, the ambition is to grow this over time.
The availability of GIRFT data has been a major step forward. This was based on a variety of sources, including Hospital Episode Statistics (HES), mortality data and site-specific questionnaires, which provided a snapshot of several respiratory services.
While this information was important at the time of collection to allow peer-to-peer ‘deep dives’ and the generation of the GIRFT national report for respiratory medicine, it was unfortunately only a snapshot. In-depth audits by BTS, as well as surveys, reports recommendations from Asthma + Lung UK and other charities, are a major way of driving change, but any data collected is once again a snapshot at a one-time point and can be time-consuming to collect and analyse.
This is a really helpful summary of what has been available up to now. Where does the Model Health System fit?
It is a welcome development that there is now information based on the GIRFT data template available via the Model Health System.
Over the course of several months, a dataset has been developed, which will pull information from a variety of different sources on some 70 metrics for respiratory medicine. Depending on the data flow these will be updated on a quarterly basis, and therefore it will be possible to track changes over time as appropriate interventions take place.
The data is available at provider level and allows a ranking within England and with similar-sized “benchmarked” Trusts. The information is displayed both numerically and as a bar histogram. Additionally, we have been able to import information from RightCare which gives an Integrated Care System (ICS) context to the hospital provider, such as information about vaccination rates.
Whilst this respiratory information on the Model Health System is a step forward to allow monitoring and change, it does depend on accurate information being collected. Therefore, coding remains crucial to ensure this accuracy. Unfortunately, the information does lack patient-related outcomes, with only surrogate data such as re-admission available as a crude marker.
How can people access the Model Health System?
The information can be accessed by logging on to the Model Health System, browsing for ‘respiratory’ under ‘acute hospital services’ and clicking on the GIRFT metrics.
The Model Health System can be accessed by anyone who works within NHS trusts and systems, and you can register via the NHS Applications System which will verify your details before granting access.
Clicking on the respiratory icon shows some of the general financial opportunities that may exist for respiratory medicine in England. Moving to the top right, you can select your region and acute provider, and see your dataset displayed as bar charts and rankings.
How might teams use this data?
I would recommend that this becomes a focus for discussion at local audit meetings to help inform quality improvement projects. The advantage is that colleagues can now see where their hospital sits and consider the changes that need to be made, based upon NICE, GIRFT report and BTS audits etc, to improve services for our patients.