Hip and knee replacement dashboard
The NEQOS hip and knee replacement dashboard builds on initial work undertaken with lower limb orthopaedic surgeons in the north east to develop a Trauma & Orthopeadic (T&O) dashboard. The initial dashboard combined hip and knee replacement data with hip fracture data but producing the Trust level dashboards were complicated by the fact that joint replacement data was reported at a Trust level by the national Patient Reported Outcome Measures (PROMs) programme and hip fracture data was reported at a site level for the National Hip Fracture Database. For this reason, NEQOS has developed the Hip and Knee replacement dashboard to provide a more detailed overview of the quality of care for these elective procedures and enable Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge. The dashboard is currently refreshed twice a year in March and October and distributed to subscribing Trusts in the north east.
During the development of the revised dashboard, NEQOS became aware that the Hospital Episode Statistic (HES) definitions for hip and knee replacement patients varied between the National Joint Registry (NJR) and the PROMs programme. This dashboard consistently uses the NJR definitions for identifying hip and knee replacements for all indicators developed using HES data and this approach has been supported by the British Orthopaedic Association (BOA), British Hip Society (BHS) and the British Association of Surgery of the Knee (BASK).
It is important to note that the dashboard provides an overview of the Trust and highlights where the Trust is different from the national picture and there is a need for further investigation to ascertain if there is an issue with the quality of the data or the quality of patient care. The dashboard is currently refreshed twice a year in March and October and distributed to subscribing Trusts in the North East. The most recent update (October 2015) for all Trusts in England will be included as part of the Getting It Right First Time (GIRFT) orthopaedic reports.
NEQOS would be happy to support Trusts who would like to interrogate the patient level data to better understand the issues highlighted for them.
Shoulder replacement dashboard
During the development of the dashboard, NEQOS coordinated an audit of the Hospital Episode Statistic (HES) data against clinical records of over 460 shoulder replacement cases to establish the quality of the data. The results from this audit highlighted that HES data for shoulder replacement patients was not robust enough at this time to report primary diagnosis, type of implant and type of fixation method. The audit did highlight that side of surgery was consistently recorded in over 98% of cases and for this reason we have been able to develop indicators that link primary shoulder replacements both to previous surgery on the same shoulder (specifically sub acromial decompressions and/or rotator cuff repairs) and subsequent revision shoulder replacement surgery. Findings from this audit will be disseminated nationally to support improving the quality of coding as well as offer to support the National Joint Registry to triangulate this data with NJR records. At this time, there is an urgent need to rapidly improve NJR compliance for shoulder replacements and a real focus of this dashboard has been to highlight to Trusts their compliance rates for shoulders (currently just over 70% nationally) compared to hips and knees.
It is important to note that the dashboard provides an overview of the Trust and highlights where the Trust is different from the national picture and there is a need for further investigation to ascertain if there is an issue with the quality of the data or the quality of patient care. The shoulder dashboard for all Trusts in England will be included as part of the Getting It Right First Time (GIRFT) orthopaedic reports. NEQOS would be happy to support Trusts who would like to interrogate the patient level data to better understand the issues highlighted for them.
Back pain profiles
The back pain profile contains health intelligence produced by NEQOS to support the implementation of a new regional back pain and radicular pain care pathway. The programme of work is to de-medicalise back pain and either reassure patients or, if needed, treat patients in the community. The new pathway will also provide an intensive Combined Physical and Psychological Pathway (CPPP) when core therapies are not sufficient. Development of the profiles for the north east and north Cumbria CCGs has been funded through our north east subscribers.
The utilisation of secondary care services for the management of back pain is shown by CCG and NHS Trust and independent sector providers to demonstrate variation in activity regionally and across England. Information on hospital admissions is presented by admission method, procedure type and over time to enable the identification of areas where changes in the triage and treatment pathways to more evidence based treatments can improve the quality of patient care, provide community based alternatives to secondary care admissions for back pain and reduce secondary care expenditure.
Following a data discovery exercise supported by Professor Charles Greenough (National Clinical Director for Spinal Disorders, South Tees NHS Foundation Trust), definitions for low back and radicular pain were developed based on a combination of diagnosis codes (ICD-10) and relevant secondary care procedures were identified using OPCS 4.7 codes. These codes have been supported by Mr Ashley Cole, Chair of Specialised Spinal Surgery Clinical Reference Group (Consultant Orthopaedic Surgeon, Northern General Hospital and Sheffield Children’s Hospital).
The aim of this tool is to assist clinicians and commissioners in comparing treatment activity rates between regional providers and against national data to reduce variation and develop evidence based care pathways to improve patient outcomes.
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