Proposal for ROCR Approval
Type of Collection?
See Note
1. Is this: See Note
ROCR
A new ongoing collection?
Enter ROCR reference number:
2. Title of proposed
collection
NCA & Quality Improvement Programme for CKD
3. Contact Details: See Note
Personal Details
Andrew Syme
Department
Organisation
BMJ Informatica
BMJ
Email
asyme@bmj.com
Tel Number
0207 8740770
Informatica Systems Limited’s Audit+ solution will
be installed at participating GP practices. The
solution will provide us with a baseline data
4. What is being collected, and what is
the purpose of the collection?
See Note
extract with further extracts at intervals not
exceeding 1 year. The solution will also provide
the GP with prompts to improve the coding and
primary care management of people with CKD.
Practices will be able to see the results of the
data extract. This is a National Audit. The full list
of data items and explanation is in 4a below.
Chronic kidney disease (CKD) is common, harmful
and treatable. End-stage renal disease (ESRD) is
a preventable condition that carries vast personal,
4a. Why is the information necessary
and not just useful?
social and economic burden. Vascular risk in CKD
is high and undertreated. Early detection and
management in primary care is cost-effective, will
reduce amenable mortality and increase
amenable quality of life as highlighted in the NHS
Outcomes Framework, but current care is
variable. Informatica Systems Limited have been
selected by HQIP to deliver a national primary
care CKD Audit covering all GP Practices in
England & Wales and the interfaces between
Primary and specialist secondary care Nephrology
departments in those jurisdictions.
This project
is funded and approved by NHS England through
the HQIP partnership as part of the NCAPOP. The
overarching aims of this Programme are to:
1. Enable the improvement of the accuracy and
timeliness in identifying CKD, within NICE
national guidance and quality standards.
2. Enable the improvement of outcomes for
patients through the provision of high quality
comparative data.
3. Directly enhance the
capacity of primary care providers to improve the
quality of CKD care they deliver. DATA ITEMS
PRACTICE AND PATIENT INFORMATION • GP
practice. This is required to provide practice
specific feedback in the audit • NHS
number. This is required for HES linkage, and
flagging with ONS • Date of birth. This is
required to calculate age at events at baseline
and during follow-up • Gender. Kidney function is
estimated on a gender- and age-specific basis
using serum creatinine values. This is an audit of
kidney disease in primary care • Ethnicity. CKD
shows ethnic variation, and the estimation of
kidney function requires adaptation to the
estimation formula according to ethnicity. • Date
of extraction. Required to calculate age of patient
at the time of data-extraction •
Postcode. Required to calculate IMD and to link
to HES and ONS data
RISK FACTORS FOR CKD
(all with dates, using read-codes) • Hypertension
• Diabetes • Gout • Ischemic heart disease,
congestive cardiac failure, atrial fibrillation •
Cerebrovascular disease • Peripheral arterial
disease • Kidney stones • Prostatic hypertrophy •
Prescription of lithium last 1 year • Prescription of
tacrolimus or cyclosporin last 1 year • Systemic
lupus erythematosis and connective tissue
disorders
All these fields are needed to define
who should be regularly undergoing kidney
function test for an early diagnosis of CKD.
•
Estimated GFR/corresponding serum creatinine
value in the last 12 months, and the first
estimated GFR/corresponding serum creatinine
value more than 3 months prior to that. If there
is no estimated GFR/ corresponding serum
creatinine value in the last 12 months, then the
most recent estimated GFR/corresponding serum
creatinine value within the last 24
months. Because the recommended formula to
estimate GFR is likely to change in the next year,
we need raw creatinine values as well. • Most
recent proteinuria/urine dipstick codes • Most
recent haematuria code • Most recent albumincreatinine ratio measurements All the above are
required to define kidney function/damage.
•
CKD stages read codes and dates • Renal disease
codes based on kidney diagnosis read code
list
All these codes are required to define a
cohort of people with kidney disease in primary
care and to determine the stage of their kidney
disease. These codes will also help to identify
patients who have not been correctly coded. They
will also enable an assessment of how frequently
patients are being monitored and if the correct
monitoring is being carried out.
• HES
outpatient data on who was seen in specialist
urology, diabetes, and nephrology clinic • Read
code and date for the most recent referral or
attendance at nephrology or diabetic outpatients.
These are required to identify the patients not
under on-going outpatient nephrology follow-up,
and patients with indications for referral who
were discussed with a specialist within 3 months
of identification of the indication.
Read codes for
the most recent occurrence within the last 12
months, (with date): • Haemoglobin, calcium,
phosphate, Vit D and PTH measurements/results
• Vitamin D preparations • Alphacalcidol •
Ergocalciferol • Cholecalciferol • Calcium tablets +
variants • Sevalamer • Lanthanum • Aluminium
hydroxide • Calcium acetate • ‘Dulwich
mixture’/magnesium+calcium These are needed
to determine the patients who have had a
haemoglobin checked within the last year and the
patients who have had a calcium, phosphate and
PTH checked within the last year.
Read codes for
the most recent occurrence (with date): • Aspirin
prescription • Contraindication to aspirin
prescription • Statin prescription •
Contraindication to statin prescription • Declines
statin prescription • Declines aspirin prescription
• Exercise advice/weight loss advice • Stop
smoking advice • CV risk assessment (e.g Q risk,
Framingham) • Declines CV risk assessment
These are needed to determine the patients with
CKD assessed for cardiovascular risk. Read codes
for the most recent occurrence within the last 12
months, (with date): • Systolic BP • Diastolic BP •
Antihypertensive medication classes:
Angiotensin Converting Enzyme
Receptor Blocker
-
- Angiotensin
- Alpha Blocker
- Beta
Blocker
- Calcium Channel Blocker
-
Diuretic
- Aldosterone antagonists
- Other
Antihypertensive
- Contraindication to
ACE/ARB These are needed to determine the
patients with CKD who have blood pressures in
the NICE recommended target range, with use of
drugs targeting the renin-angiotensin system in
appropriate patients. Read codes for the most
recent occurrence within the last 12 months,
(with date): • influenza immunization •
pneumococcal immunisation • hepatitis B
immunisation • Hepatitis B test results These are
needed to check that patients with CKD are being
protected by vaccination
appropriately.
OUTCOME DATA Audit data using
the cohort of people with kidney disease will be
linked to the hospital episode statistics (HES and
PEDW) and the office for national statistics (ONS)
using ICD-10-codes:
1. Distribution and number
of hospitalisation events via A&E in patients with
CKD by CKD-stage within a 6-month period
(HES/PEDW) 2. Patients with CKD who had either
one, or two or more non-elective ICU admissions
within a 6-month period (HES/PEDW) 3. CKD
patients who had either one, or two or more
hospitalisations with acute kidney injury/kidney
failure within a 6-month period (HES/PEDW) 4.
CKD patients with cardiovascular events (stroke,
myocardial infarctions) within a 6-month period
(HES/PEDW) 5. CKD patients who die within a 6month period (ONS) In subsequent years the
burden for practices that have previously installed
the software will be nil as the audit is automated
without further practice input. There will remain a
one-off install burden per practice of circa 30
minutes for the 4000 to 6000 practices expected
to participate.
5. What has changed since this collection
was last approved, and what is the
overall effect of the changes?
6. What is the latest date for approval?
See Note
7. Which organisation will be collecting
this information?
01/01/2014
NHS England
1st Keyword:
8. List top three Keywords
2nd Keyword:
3rd Keyword:
9. What is the start date for this
proposed collection?
See Note
9a. Please state when you would like the
ROCR licence to run from.
10. What is the finish date for this
proposed collection? Please also include
the date if the collection is ongoing.
See Note
01/03/2014
01/03/2014
01/12/2016
CKD
Kidney
Renal
The National CKD Audit is part of the National
Clinical Audit and Patient Outcomes Programme
(NCAPOP). NCAPOP is a closely linked set of
11. What Operating Framework
commitment does the proposal support? centrally-funded national clinical audit projects
See Note
that collect data on compliance with evidence
based standards, and provide local trusts with
benchmarked reports on the compliance and
performance. They also measure and report
patient outcomes.
12. Who supports this proposal? See
Note
Minister:
Earl Howe
Group Director:
Prof Bruce Keogh
Policy Lead/Section Head support from:
Simon Bennett
Senior Civil Servant, to whom correspondence about the collection can be addressed:
(give name, organisation, section, telephone and email address)
Name
Organisation
Simon Bennett
NHS England
Section
Telephone
Quality Framework Team, Clinical Directorates
07768 486422 simonbennett1@nhs.net
Email
Has evidence of Gateway Support: (eg date, person, Gateway number if
applicable)
No
Proposal for ROCR Approval
ROCR Contact Details
13. Burden calculation?
See Note
Frequency
Annual
See Note
Organisational Type
GP Practice
Number of organisations
400
Occupational Group
See Note
Days Hours Minutes
Burden
Days
Burden
Years
Annual
Burden £
Senior Managers
0
0
0
0
0
0
Managers
0
0
0
0
0
0
Clerical & Administrative
0
0
30
26.67
0.13
6070.4
Maintenance & Works
0
0
0
0
0
0
Healthcare Assistants and other support
staff
0
0
0
0
0
0
Healthcare scientists
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
4.44
0.02
6068.31
All Nurses, Midwives and health visiting
staff
Scientific, therapeutic & technical staff
(ST&T) (Inc. AHP's)
Consultants
GPs
Hospital Doctors
0
0
0
0
0
0
CEO
0
0
0
0
0
0
Directors
0
0
0
0
0
0
Total
0
0
35
31.11
0.16
12138.71
Insert another Organisation type
Grand Total Days
31.11
Grand Total Years Grand Total Burden
0.16
12138.71
1. The software install is a one off activity of circa 30
mins. 2. The annual audit collection is automated
without practice input. 3.
Please state if this is an
increase or decrease in burden.
See Note
Data quality is already a
required part of the patient management and the
focussed QI tool will help GPs to manage data quality
for CKD patients.
Are you planning on collecting
from Independent and
Voluntary
Sector Organisations?
No
Proposal for ROCR Approval
ROCR Contact Details
14. If sampling of organisations is not
being used please state why.
See Note
15. Are the estimates above and the
design of the collection supported by
any pilots, consultation exercises, trials
or other tests of the proposal? If so,
please give details.
See Note
HQIP requirement is a national audit of all CKD
patients. Therefore sampling is not appropriate in this
case.
1. The collection is fully automated without GP or
Practice involvement. This is achieved using
the BMJ Informatica iCAP product (installed
base more than 2000 GP practices) which is a
proven technology. 2. The quality
improvement tool, builds on the Audit+
product, and provides assistance to GPs in
undertaking an activity which is already part of
patient management. The efficacy of the QI
tool will be subject to pilot testing and the tool
will be subject to continuous improvement
based on user feedback.
16. If your proposal results in an
Not required as this is a new collection. See question 2
increase to the ongoing burden (as
indicated in Q13 above), please
indicate what measures you propose to
reduce the burden elsewhere to result
in a net zero change or decrease.
See Note
17. What collection method do you
Web based collection
propose to use?
Email
See Note
Extract from existing NHS systems
Other electronic (e.g. spreadsheet or disk)
Unify2
Input to Database
Database extract
Telephone
Paper
Omnibus collection See Note
Other (give details)
17a. If other, please state:
18. For Non Foundation Trusts is the
collection statutory, mandatory, part
mandatory, voluntary or not required?
See Note
VOLUNTARY
18a. For Foundation Trusts is the
collection statutory, mandatory, part
mandatory, voluntary or not required?
See Note
NOT REQUIRED
19. Which of the following equalities
dimensions are included in the
collection?
See Note
Age/Date of Birth
Gender
Ethnicity (NHS standard 16 + 1)
Sexual Orientation
Faith
Disability
20. Of those you propose to include in
Q19, please give details of the
definitions you intend to use for each?
Collecting from GP Systems so definitions will be set
by the systems producing the data which will in turn
be driven by the MIM Specification.
21. Is this request accompanied by a
No
position statement from the NHS Data
Model & Dictionary Service and the
Information Standards Board for Health
and Social Care (ISB HaSC)? If
required, please contact Data
Standards - datastandards@nhs.net, or
ISB information.standards@nhs.net
See Note
22. Is the information to be collected
intended for publication or other
release? If not, please give reasons
why.
See Note
23. If the answer to Q22 was yes,
please state your publication or release
strategy.
See Note
Yes.
1. Practice level data will be provided to CCGs & GPs
through the National CKD Audit website. A Public &
Patient version of the report will be provided to HQIP &
published on the National CKD Audit Website.
2. Subject to suitable anonymisation, and agreement
from HQIP, raw data will be made available through
National CKD Audit Website and data.gov.uk in line
with the Transparency & Open Data Agenda.
24. Will the data collection generate
The RCGP has identified CKD as a clinical priority,
any media interest, and if so, what
therefore some media interest is expected. BMJ
measures do you have in place to deal
Informatica have a communications and media team,
with it?
and will work with HQIP to respond to any media
enquiries.
25. Does the proposal have any impact
on Social Services?
See Note
25a. If the answer to Q25 was yes,
please give reason.
26. Do you intend to collect
information from NHS Foundation
Trusts?
See Note
No
No
Please attach documents that support
your ROCR application. Without a list of
the questions to be asked we will not
be able to process your application
Insert item
Proposal for ROCR Approval
ROCR Contact Det
27. If the answer to question 26 is yes, state why?
28. Is the information or any part of it already collected? If
so please state why this should be collected again.
29. Please explain why you propose the frequency of
collection as stated in Question 13.
30. If you are proposing to collect from all Foundation
Trusts, please give reasons why a sample cannot be used?
31. Can the proposed information be provided by
commissioners rather than directly from Foundation
Trusts? If not, why not?
32. Does all the data requested fall into one or more of
these categories?
See Note
a. Vital for Patient Care
b. Essential for the flow of funds to
NHSFTs
c. The requesting body has a statutory
duty to provide the information
d. Very High ministerial profile
See Note
e. Necessary for Care Quality Commission
assessment
f. Directly underpins delivery of a target
(State which).