National Oesophago-Gastric Cancer Audit
National Oesophago-Gastric Cancer Audit
Summary for Clinical Reference Group
Overview of audit aim and structure
The aim of the audit is to measure the quality of care received by patients with oesophagogastric cancer in the UK. Its purpose is to assess whether care is consistent with
recommended practice and to identify areas where improvements can be made. The
principal audit questions will examine:
 the timescale of the process of care
 determinants of treatment and outcomes
 the factors that influence decisions about curative and palliative treatment
 short-term outcomes of surgical treatment
 survival at 1 year, quality of life, and patient satisfaction with care
The audit will last for three years, and started in October 2006. Collection of prospective
data will begin in October 2007 and last for 15 months. The Audit will be managed by a
project team consisting of members from:
 National Clinical Audit Support Service (NCASS) of the Information Centre
 Association of Upper Gastrointestinal Surgeons (AUGIS)
 British Society of Gastroenterology (BSG)
 Clinical Effectiveness Unit (CEU) of the Royal College of Surgeons of England and
London School of Hygiene and Tropical Medicine
A Clinical Reference Group of stakeholders will support the project team, including
members from (but not limited to) clinical Colleges and Associations whose members are
involved in OG cancer care, the UK Association of Cancer Registries, Local Cancer
Networks, and DH Cancer Policy Team. The audit will also seek input from the Cancer
Registries, to inform the design of the Audit, enable the assessment of case ascertainment
and data quality, and ensure existing data are exploited fully.
Wherever possible, the audit will use existing information and infrastructure to minimise
the burden of data collection. However, to collect data required for the process and
outcomes element of the audit, we expect to design a web-based IT solution. This will
build on existing IT systems as well as being compliant with current data definition
standards. This will allow integration with NPfIT and the development of an electronic
patient record. The size of the audit dataset will be kept to the minimum required.
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National Oesophago-Gastric Cancer Audit
Audit objectives
•
To analyse existing datasets to provide an initial description of the process and
outcomes of care. The analysis will aim to include all appropriate existing data sources
such as Hospital Episode Statistics (HES) database, Cancer Registry data, and Cancer Wait
Times (CWT) database. The analyses of the data will help to refine the audit questions and
procedures. The findings should also encourage units to participate in the audit and
provide a framework for assessing the quality of the data collected for the process audit and
outcomes audit.
•
To perform an organisational audit that will collect information on the local
organisation of care for patients with oesophago-gastric cancer. It will be based on a
national survey of all networks and units involved in upper gastro-intestinal cancer care.
The survey will include questions on the staff involved and their qualifications, access to
diagnostic and therapeutic facilities, referral systems and multi-disciplinary teams.
•
To undertake a qualitative study to identify determinants of variation in care and
outcomes. The study will be based on semi-structured interviews of healthcare
professionals and patients, and will be performed early in the course of the audit to provide
information on the more complex relationship between determinants of process and
outcome than can be studied in a quantitative audit. It will also inform the development of
the minimum dataset for the process and outcome audits as well as the mechanism for data
collection and feedback.
•
To undertake a process audit based on analysis of prospectively collected data to
answer process related audit questions related to: disease staging and co-morbidity of
patients, access to treatment, delays for diagnostic and therapeutic procedures, description
of therapeutic managements, case-mix adjusted determinants of variation in care.
To support the prospective data collection, the audit will develop a web-based IT
infrastructure. The system will cover all patients who receive care within oesophagogastric units across England and Wales. The proposed data collection system will feature:
o
web-based data collection
o
central patient linkage
o
individual data value validation and cross-validation
o
online analysis and feedback
The system will provide the facility to upload data from local databases via a csv file and
download centrally held data to a local database via a csv file.
•
To undertake an outcomes audit based on analysis of prospectively collected data to
identify case-mix adjusted determinants of variation in outcomes. This will primarily focus
on determinants of patient survival up to 1 year.
•
To perform a patient and carer survey, based on a sample of enrolled patients, on
their experiences of diagnosis and treatment, communication and information, satisfaction
with primary care, hospital care and palliative care. Patients will be asked to give consent
to participating in this survey. Consenting patients will then be asked to complete a
questionnaire about their health status, and the care they have received so far.
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National Oesophago-Gastric Cancer Audit
Audit deliverables
The results of the audit will be published in three annual reports. The First Annual Report
will contain:
 An analysis of existing data that will provide preliminary results on process and
outcomes of care
 An organisational audit of all units involved in upper gastro-intestinal cancer care
that will describe variation in access to diagnostic and therapeutic facilities, referral
systems, multi-disciplinary teams
 A qualitative study consisting of semi-structured interviews of healthcare
professionals and patients that will be used to identify potential determinants of
variation in care and outcomes.
The Second Annual Report will describe the results of the prospective audit of care
processes.
The Third Annual Report will describe the results of the audit of outcomes of care.
It will contain a description of the case-mix adjusted determinants of variation in outcomes,
and the results from a Patient and Carer survey.
Audit organisation and governance: Clinical Reference Group
The role of the Clinical Reference Group will be:
 To represent the views of the associated professional and patient groups
 To be consulted and to advise on the nature of the audit questions and aims
 To act as a consultative group on issues such as publication strategy, including
identification or anonymity of participating organisations
 To provide specialist input or advice to the Project Team
The project team will work with a Clinical Reference Group, who will oversee the direction
and delivery of the audit. The stakeholder organisations or specialties involved in the
Clinical Reference Group are expected to include:
 UK Association of Cancer Registries
 Local Cancer Networks
 Patient Representative
 Royal College of Pathologists
 Royal College of Radiologists
 British Association of Cancer Surgeons
 Medical Oncology
 Specialist Nurses representative
 BSG Endoscopal Committee Member
 AUGIS Audit Committee Member
 Endo-luminal ultra sound
 Cancer Policy Team (DH)
 Healthcare Commission
 IT Supplier
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National Oesophago-Gastric Cancer Audit
Proposed time schedule National Oesophago-Gastric Cancer Audit
3 month quarters
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Project Management
Outline management plan
Full management plan
Design process and
outcomes audit
Organisational audit
Including analysis
Analysis of existing data
Qualitative study
First Annual report
Based on existing data produce Organisational audit and Qualitative study
Development data
collection procedures for
process and outcome audit
IT development
Pilot process and outcome
audits
Recruitment of centres /
rolling out
Data collection process and
outcome audits
Analysis of process audit
Second Annual report
Process audit
Patient survey
Analysis of outcome audit
Third Annual report
Patient survey
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Outcomes audit
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