Getting good quality complete data

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Getting good quality complete data

• Richard Wight
• Graham Putnam
• DAHNO PROJECT TEAM

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What is good quality complete data ?

• Gold standard 100 of every field filled in with
  accurate validated data
• But is this realistic ?
• Has anyone achieved this ?
• What is an acceptable standard to aim for ?
• Aim for gold standard but recognise developmental
  process, that can only ultimately achieve by a
  stepwise progressive improvement
  

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What does poor quality incomplete data reflect?

• Poor internal data collection processes
• Disjointed fragmented delivery of care
• May be the only mechanism by which quality of
  care can be assessed
• May reflect poor patient care???

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WHY IS IT SO IMPORTANT RECORDS ARE?

• COMPREHENSIVE
• OF GOOD QUALITY / COMPLETE
• VALID
• HAVE OWNERSHIP
• CONSISTENT

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So you can -

• TRUST YOUR OWN DATA
• USEFULLY TURN DATA TO INFORMATION
• OTHERS TRUST YOUR DATA
• MEET PERSONAL, PROFESSIONAL AND CORPORATE
  GOVERNANCE AGENDAS

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COMPREHENSIVE RECORDS

• Involve all aspects of the patient pathway
• Reflect actual care given
• Reflect results of treatment
• Dynamically reflect the current disease status

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RECORDS OF GOOD QUALITY / COMPLETE RECORDS

• For each part of the patient journey, data on the
  essential elements of care are recorded and
  reflect the actual care given
• From these building blocks outputs reflecting
  comparative delivery can be assembled leading to
  improved standards of care

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VALIDATING RECORDS

• Validation requires cross checking of data with
  clinical records
• Needs a process to underpin it
• Must be undertaken to a timescale
• Involves clinical ownership by the head and
• neck team (and ideally sign off!!)

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CONSISTENT RECORDS

• Reflect an organised process with agreed and
  defined responsibilities
• The processes have been tested and confirmed
• Are resilient and robust to change in personnel
• Confirm high levels of team ownership and
• co-operation

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OWNERSHIP

• Allows team members to feel confident that the
  recorded information accurately reflects the care
  given
• Allows local and National improvements in care to
  be developed from confidence in any subsequent
  analysis
• Allow team members to confidently report
  compliance with local and national standards (eg
  peer review, standards for health)
• Reinforces further audit cycles and drives up the
  desire to achieve the gold standard

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Ownership and the team

• The others wont play
• Clinicians have a significant responsibility to
  work with the team to assist in all aspects of
  achieving good quality data input
• No one aspect of the team can achieve this on
  their own
• Systematic and reliable liaison between data
  clerks / MDT Coordinators and clinical team
  members is essential to meet these goals
• Clinicians have a responsibility to feed back to
  all of the team the audit outcomes to encourage
  their continued support

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PRACTICAL STEPS TO IMPROVE COMPLETENESS

• WHAT DOESNT WORK FOR ANYONE!!!!!
• DIPPING IN AND OUT
• LEAVING ALL DATA ENTRY TO OTHERS
• LEAVING IT FOR A RAINY DAY
• GUESSING AND GOING BACK TO FILL IT IN CORRECTLY
• COMPLAINING AFTER THE EVENT!

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What data items are being collected well?

• MOST RECORDS
• Site codes
• Demographics
• Age
• Sex
• Postcode deprivation
• Referral information
• Diagnosis date
• Imaging type
• MDT discussion
• Care plan agreed

• SOME RECORDS
• Imaging type and date
• Stage at MDT
• Careplan and careplan decision
• Date first symptom
• Date primary care notification
• Operation details

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What items are not being collected well?

• Performance status
• Comorbidity
• Complete staging
• Certainty factor
• Integrated stage ie input from post resective
  pathology
• Date dental assessment
• Date SALT assessment
• Date dietetic assessment

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PRACTICAL STEPS TO IMPROVE COMPLETENESS - WHAT
CAN YOU DO?

• Identify patient population
• Define and refine clinical processes
• Determine local mechanisms that work
• Involve the clinical sign off process as an
  assessment

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PRACTICAL STEPS TO IMPROVE COMPLETENESS - WHAT
CAN YOU DO?

• The detailed practical aspects of this will be
  picked up in training session 2 which Gary will
  be leading
• The clinical training session-session 3- will
  look in more detail at clinical aspects of
  improving record quality

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PRACTICAL STEPS TO IMPROVE COMPLETENESS - WHAT IS
DAHNO DOING TO HELP?

• DAHNO data completeness views
• Gives event percentage completeness
• Now available
• Committed resource to liaise with users over
  aspects of incomplete / inconsistent data
• Identified individual to contact users
• Algorithms in development to highlight key fields
  for use by support team in assisting users to
  improve data completeness for use within the
  system

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Screenshots from Ronnie of local analysis
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Conclusion

• Data collection requires equal weighting with the
  other parts of the treatment pathway.
• As self regulating professional groups patients
  expect audit to be an essential part of the
  reassurance process in the delivery of quality
  care
• No evidence equates to a professional failure