Head

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Head Neck Cancer Audit DAHNO

• An update from the DAHNO workshops
• Gaining Momentum
• April 2005

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Content

• About DAHNO
• Progress Highlights
• Roll Out Update
• System Releases
• Data Collection, Completeness, Quality
  Submission
• Frequent Clinical Questions
• Update on Deprivation
• Next Steps During 2005/06
• Helpful Hints How to Make DAHNO a Success
• Further Information Sources

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About DAHNO

• Aim to enhance the care of head neck cancer
  patients through the continuous process of
  reviewing and making changes to meet agreed
  standards
• Context
• Peer Review
• NICE Guidance
• Public Accounts Committee
• Delivered by the NHS Health Social Care
  Information Centre
• Joint working with NHS Connecting for Health,
  professional organisations (BAHNO) and Cancer
  Registries
• Commissioned by the Healthcare Commission

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DAHNO Progress Highlights

• DAHNO Audit was rolled out during 2004
• The DAHNO Project Team uses a collaborative
  approach project management clinical
  leadership IT system user interface reporting
• Participation and enthusiasm is increasing
• Working with the Information Standards Board
  (ISB) to mandate the DAHNO minimum dataset
• Helpdesk support user with technical and clinical
  queries
• Website recently redesigned (www.dahno.com)

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Network Summary of Connectivity to DAHNO as at
mid April 2005
71 of cancer sites have connected to DAHNO
All main or all sites connected
Approx 50 sites connected and making progress
Few or no sites connected
29 of cancer sites are still not connected to
DAHNO
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Network Summary of Data Submitted to DAHNO as at
mid April 2005
44 of cancer sites have submitted data to DAHNO
at least once
At least one data submission from all sites or
all main sites
56 of cancer sites have not submitted any data
to DAHNO
At least one data submission from approx 50 sites
At least one data submission from few sites or no
sites
1,052 patient records submitted as at mid March
2005
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DAHNO System Releases National Data Analysis
Reports

• Available from 2 May 2005, including
• Demographics
• Diagnosis Staging, including cancer waiting
  intervals
• Patient Outcomes
• Provide a summary of the national statistics
• Enable comparison with local data
• Figures must be treated with caution until system
  has bedded down and enough data has been gathered
• Reports in subsequent releases will include
• Treatment larynx
• Treatment oral cavity

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Example Report - Demographics Report
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Data Collection

• The provision of accurate, complete and timely
  data is inextricably linked to the quality of
  care delivered in a patient episode
• Graham Putnam, Consultant Maxillofacial Surgeon,
  North Cumbria Acute Hospitals NHS Trust
• The challenge
• assimilating and incorporating disparate
  information sources to accurately reflect the
  care pathway and allow analysis of that episode

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Data Collection Considerations

• Mechanisms for data collection and entry
• Key levels of responsibility
• Single point of control
• Clinician involvement
• Clinical sign off
• Use of proforma or direct data entry
• Maximum or minimum data set
• Trigger event
• Histological conformation
• 2 week rule referral
• Corporate responsibility for the process

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Clinician
Audit clerk
Hospital
Referral Site
Patient 1st seen
DAHNO Data Entry Flow
Diagnostic tests
Clinic visit patient given diagnosis
Register Carespell Diagnostic tests Imaging Diagno
stic summary
Register Carespell Diagnostic tests Imaging Diagno
stic summary
MDT discussion
Clinic care plan agreed
Careplan
Surgery
Surgical Info
Surgical Info
Radio or chemo
Radio or chemo info
MDT discussion
Any further information Including further care
plans, tests, treatment etc
Follow-up
Clinical status assessment
Clinical status assessment
Clinical governance meeting
Sign off
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Data Completeness

• Ideally 100
• Lack of data should not prevent record generation
• Process of data collection should be well defined
• The MDT forms a useful forum for
• Collecting data
• Resolution of queries
• Identify difficult to collect items
• Local strategy to ease collection

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Data Completeness for Meaningful Analysis

• It is important that clinicians ensure high
  levels of data completion for
• Clinical sign off of patient Care Spell records
• Staging
• Very variable levels of recording so far
• It is the responsibility of clinicians - ideal
  time is at MDT
• Help text/staging guide is available
• UICC version 5 at present
• Co-morbidity
• Co-morbidity co-existent disease
• Major role in outcome of cancer therapy
• Adult Co-morbidity Evaluation 27 index
• Applicable
• Accurate and reliable
• Impact on the outcome
• Overall grade simple integer by summation or
  highest ranked ailment

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Data Quality

• Regular assessment
• Routine record check
• Dummy record for standardisation
• Comparison to national figures
• Difficult areas include
• Staging
• Interpretation of operative records
• Maintenance of quality

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Data Submission

• DAHNO application direct data entry
• At sign off
• At addition of subsequent events
• Database replication will deal with populating
  DAHNO server
• CSV upload
• Monthly
• Good database housekeeping to prevent duplicates

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Clinical Helpdesk

• Categories of clinical enquiries
• Errors
• Data manual errors e.g. incorrect statement
• Transcription errors e.g. missed item in code
  list
• Translational errors e.g. incorrect attribution
  code
• Mandatory field prevents progression
• Negative value calculation
• Maximum v Minimum Dataset
• Coding Knowledge
• Patient Pathway issues
• Desirability changes

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Frequent Clinical Questions

• Maximum v minimum dataset
• Minimum fields requested for PHASE I of audit
• Maximum optional extension assisting broader
  collection
• Searching for fields in minimum which are part of
  maximum
• Some confusion on sites bordering oral cavity and
  larynx
• E.g. base of tongue or tonsil - oropharynx
  partial laryngectomy as part of tonsil tumour
  treatment procedure
• Coding knowledge
• Consultant code e.g. adding a new consultant
• Consultant code is C followed by GMC number
• i.e. Joe Bloggs C 1234567
• Operation codes
• codes included match National Cancer Dataset head
  and neck - mapped to OPCS and Reed
• limitation of what is available which hopefully
  will be improved in the future

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Frequent Clinical Questions

• Patient Pathway
• Difficulties faced where referring trust does not
  enter information to prime pathways data
  sharing agreements
• Recognise that all patient transfers are
  initiated as a referral
• Review of rule base
• Time intervals and negative values
• Desirable changes
• Adjusting screen design to make system a closer
  match a full clinical system
• Have to balance against prime function as an
  audit system
• Future network-based comprehensive cancer
  information systems from which Secondary Uses
  Service (SUS) has the potential to seamlessly
  extract cancer and other audit data

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Update on Deprivation

• How will it be done?
• Cant do for every home
• Use census super output area average 1500
  people
• An index IMD (index of multiple deprivation) is
  calculated as an average of the elements of
  geographic location by postcode
• IMD is not a linear score so tend to use IMD rank
  
• (1 most deprived to 32482 least deprived)
• DAHNO will assign by each individual postcode IMD
  rank to each patient record
• Based on national census data
• Reflects
• Income
• Employment
• Crime
• Health and disability
• Living environment
• Education, Skills and Training
• Housing and social services
• Find out more about deprivation at www.DAHNO.com

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Next Steps During 2005/06

• Focus
• Providing support to sites not yet connected,
  i.e. site visits
• Escalating sites unwilling to connect/non
  responsive sites to the Healthcare Commission
• Data quality, quantity, completeness submission
  frequency
• Developments
• Compliance and data monitoring
• Full set of analysis reports on the DAHNO system
• First Annual Report to be published during last
  qtr 2005/6
• Mandating the minimum dataset
• Working on the (Secondary Uses Service) migration
• Developing browser view
• Considering Cancer Waiting Times (CWT) linkage
  facility

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Helpful Tips How to Make DAHNO a Success?

• Where possible have a full time staff member to
  manage the audit
• Plan sign off and integrate with clinical
  governance
• Agree data sharing and transfer at network level
• Understand the local process for data collection
• Feedback and compare with national norms
• Manage the data collection process
• Agree trigger for record generation
• Involve 2nd trust and agree data flows
• Capture late events
• Have network wide MDTs with good representation
• Success comes from everyone involved
  understanding the process of data collection

• Plan the implementation carefully
• Minimise the amount of time the clinician is
  involved in routine data collection
• Not necessary for clinicians to record referral
  or admin details, but input invaluable for
  clinical items
• Enable clinicians to supplement data collection
  without placing entire burden upon them
• Engage clinical teams and encourage clinical
  ownership of the audit
• Include consultants, dieticians, speech
  language therapists, clinical nurse specialists
• Allocate and define key roles/responsibilities
• Build relationships with opposite number at other
  sites/trusts to share best practice and
  coordinate the data flow

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Secondary Uses Service (SUS)
Further Information Sources

• www.dahno.com
• Helpdesk Gary Sargent or Sandy Garrity
• Helpdesk_at_dahno.com

DAHNO
NHS Health Social Care Information Centre
www.ic.nhs.uk
www.npfit.nhs.uk/programmes/sus