Developing

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Developing using local statistics for analysing
variations in health Presentation to
Statistical User Forum Annual Conference, Nov. 06

• Professor Denise Lievesley, Chief Executive The
  Information Centre

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Content

• Role of a national organisation
• Why use administrative data?
• Management administrative sources
• Local health information applications
• Examples of use
• Issues

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Role of a national organisation(abide by
principle of subsidiarity)

• Establish standards
• Provide comparative data
• Promote development of comparative indicators
• Share good practice
• Act as honest broker (eg for data integration)
• Purchase/ develop common tools
• Participate in cross-governmental or
  international initiatives

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We promote the use of the data for

• Understanding the current situation
• Developing policies and underpinning options
  appraisals
• Implementing new policies
• Informing decisions
• Managing the system
• Judging successes and failures
• Improving the system

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Why use administrative data?

• Unrivalled untapped level of detail
• Survey data has limitations
• eg HSE is national survey, sample error too high
  for fine-grained geographical analyses
• Administrative data has full coverage
• and better temporality
• Reduces respondent burden
• Has potential cost benefits
• Opportunities for data linkage with other sources
• Local ownership and involvement

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Management administrative sources

• Opportunity to turn data collected to administer
  the system into accessible, useful, relevant
  information
• Monitoring of admin. processes
• - e.g. NHS Stop smoking services
• Hospital Episode Statistics
• e.g. CHD, Stroke, AE, outpatients
• Secondary Users Service
• pooled data from the patient care record
• integrated with other data sources
• Quality Outcomes Framework (performance data)
• recorded prevalence data

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Data integration

• Synthetic local estimates
• Combine health and demographic data to produce
  local estimates
• e.g. local smoking estimates for Neighbourhood
  Statistics (NeSS) website

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Local health info applications (1)

• Identify variations in health social status
  amongst communities
• Compare benchmark performance between service
  providers
• Identify hotspots
• Disease or (ill)health
• Poor performance
• Put information at the heart of decision-making
• Local national

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Local health info applications (2)
Source Adapted from Gould (1992)
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Payment system for primary care (GP) practices
Quality Outcomes Framework
http//www.qof.ic.nhs.uk/search.asp
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access to local indicators Quality Outcomes
Framework
http//www.qof.ic.nhs.uk/search.asp
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Cross-government initiative - Neighbourhood
Statistics (NeSS)

• Provide information to identify small area
  variations and needs with a focus on inequalities
  
• Nine themes including for example
• Health and Care
• Physical environment
• Access to Services
• Community well-being social environment
• Crime
• Housing

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Neighbourhood Statistics (NeSS)

• The Information Centre is responsible for health
  care theme
• Healthy lifestyles
• Hospital Episode Statistics
• Access to primary care services
• GPs, NHS dental surgery, pharmacies ophthalmic
  organisations

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Neighbourhood Statistics (NeSS)
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Neighbourhood Statistics (NeSS)
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National services-Secondary Uses Service
(SUS)

• Information Centre working in partnership with
  CfH
• Part of the NHS National Patient Care Record
  Service
• Providing quick ready access tabular outputs
  (standard bespoke)
• Access to unit record (pseudonymised) data for
  approved management and research purposes
• SUS will provide information for
• Payment by results
• Improved precision on financial flows
• Informing patient choice
• Measuring quality of care
• Understanding the use of resources

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Sharing good practice and using common tools
Improving immunisation uptake Luton PCT
Luton GPs relative to the Index of Multiple
Deprivation 2004 (IMD 2004)
Map of crude rates of MMR defaulters (Cohort DOB
Jan-Jun 2004)
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Sharing good practice and using common tools
Measuring national health indicators to improve
service provision

• South Birmingham Primary Care Trust
• Project
• For improving diagnosis and disease management
  programmes
• OS information
• QOF GP Practice data

Prevalence of coronary heart disease in
Birmingham based on postcode data
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Sharing good practice and using common tools
Reduce incidents of falls among the elderly in
Bolton

Source North West Ambulance Service
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Public Health Indicators

• Work commissioned by the IC for the NHS and
  public health community
• NCHOD (National Centre for Health Outcomes
  Development)
• - compendium of Clinical Health Indicators
• - used by analysts in NHS, government
  departments, the Healthcare Commission, LAs and
  academic researchers
• HPI (Health Poverty Index)
• - displays data via a spider diagram or radar
  chart
• - visual web-tool aimed at managers
• LBOI (Local Basket of Inequalities Indicators)
• - focuses on indicators to enable local action
  on health inequalities

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The Health Poverty Index (HPI) Making comparisons
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Compendium of Health Indicators Instant Atlas
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Issues for local health information (1)

• Embracing new opportunities to excite, inform and
  support high-quality decision making
• BUT.. statistical issues...
• Caution needed with administrative data
• Quality reliability needs to be considered
• Coding practices level of detail
• Small numbers problem
• May be just be mapping/comparing noise when
  population denominators small
• Need appropriate statistical techniques to take
  this into account
• Health boundaries and administrative boundaries
• not co-terminous
• Administrative data not readily
  available/possible for individuals or unit
  postcode

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Issues for local health information (2)

• BUT.. access issues..
• Balancing user needs with best-practice
  governance for information dissemination
• Need to ensure outputs are not disclosive
• ONS Disclosure Review for Health Statistics
• Planned new Information Governance Board
• Forthcoming legislation for statistical
  independence
• Opportunities for extending access
• achieving clarity with respect to data sharing?

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The Information Centre for health and social care

• www.ic.nhs.uk