Skin Cancer Network Group
Audit of Clinical Performance Indicators:
Data quality and treatment quality
Anna Murray BSc
Cancer Information Analyst
Anna.Murray@mccn.nhs.uk
Standards for Better Health
• Clinical performance indicators
• Measurable and comparative data
• Progress assessment locally and at network level
• Merseyside and Cheshire CNG:
 Access to services
 Consistency of service provision
 Compliance with national targets
Clinical Performance Indicators
I.
The number of newly diagnosed patients
referred by trust and ICD-10 code:
i. 31 day first definitive treatment
ii. 62 day standard
II.
Performance of radiotherapy:
i. Number of patients being treated
ii. Waiting times for treatment
Clinical Performance Indicators
III. Clinical trial activity
i. Accrual by MDT in to clinical trials
IV. Sentinel lymph node biopsy
i. Number of patients referred by Breslow score
ii. Number of procedures performed
V. Primary care excisions
i. Number of primary care excisions taking place
I.
The number of newly diagnosed patients referred
by trust and ICD-10 code:
2500
Treated after 31 days
Treated on or within 31 days
1
Total treated
2000
Number of patients
1139
1
1500
772
1000
0
500
1140
367
773
367
0
C43 - Malignant melanoma of the skin
C44 - Other malignant neoplasms of the skin
(except basal cell carcinoma)
Combined
31 day first definitive treatment: Total number of patients by tumour type for Merseyside and Cheshire
(January to December 2008)
I.
The number of newly diagnosed patients referred
by trust and ICD-10 code:
1200
Treated after 62 days
Number of patients
1000
2
Treated on or within 62 days
Total treated
542
800
600
2
0
400
287
255
544
200
255
289
0
C43 - Malignant melanoma of the skin
C44 - Other malignant neoplasms of the skin
(except basal cell carcinoma)
Combined
62 day standard: Total number of patients by tumour type for Merseyside and Cheshire (January to
December 2008)
Data discrepancies
•
•
•
•
•
•
Apparent between CWT data and local trust data
Suggests issues across the network for data uploads
Are performance figures inaccurate?
Somerset Cancer Register should address this
Must make sure that trusts are uploading all of their data
Good quality data is the key
Cancer waiting times data
Local trust data
Southport and Ormskirk
43
30
Warrington & Halton
12
15
Arrowe park
57
52
St Helens and Knowsley
40
93
Aintree
6
Awaiting data
Countess of Chester
70
Awaiting data
RLBUHT
91
90
Total
319
298
Trust
Comparison of total numbers of patients first seen for Malignant Melanoma in
Merseyside and Cheshire Cancer network by trust (January to December 2008)
V.
Primary care excisions
Research and audit:
‘…the planned treatment of low-risk BCCs should be restricted to
approved doctors…, usually a GPwSI…or the LSMDT/SSMDT. All
other skin cancers should be referred to the LSMDT in the first
instance (National Institute for Clinical Excellence, 2006).’
•If the lesion is not a BCC, then the patient should be urgently
referred (National Institute for Health and Clinical Excellence, 2006)
Abnormal growths/inflammations to be treated by GPs unless there
is doubt with regards to diagnosis (National Institute for Health and Clinical
•
Excellence, 2006)
V.
Primary care excisions
C43 - Malignant
melanoma of the
skin
C44 - Other malignant
neoplasms of the skin (except
basal cell carcinoma)
Combined
RLBUHT
9
23
32
WUTH
2
20
22
St. Helens & Knowsley
6
13
19
Southport & Ormskirk
Awaiting data
Awaiting data
Awaiting data
Countess of Chester
Awaiting data
Awaiting data
Awaiting data
17
56
73
Trust
Network
• Malignant melanoma – 4.6%
• Squamous cell carcinoma – 7.2%
• Combined – 6.4%
V.
Primary care excisions
Findings:
• Not all patients diagnosed with either malignant
melanoma or squamous cell carcinoma are urgently
referred via 2 week wait
• What are the reasons for this?
• Can such cases be avoided in the future?
• Poorer patient experience?
What next?
•
•
•
•
•
Clinical Performance Indicators
Audit of excision completeness in primary care
Monitoring uptake in to clinical trials
Audit of patients referred for SLNB
Breach analysis in CWT data