Presentation on theme: "Hospital Episode Statistics (HES)"— Presentation transcript:
1Hospital Episode Statistics (HES) Andy Muirhead (Derby City PH)Analyst Training Course 2012Day 2 – Session 6
2Learning Objectives: What is HES? Where does the data come from? What data is available?How is the data used?Examples of HES use.Advanced HES issues.
3What is HES?A data warehouse covering hospital activity relating to NHS patients in England.Contains 3 ‘universes’: Inpatients, Outpatients & Accident and Emergency.HES service run by Northgate Information Solutions on behalf of the NHS Information Centre.
5Inpatients Outpatients A & E What Data is Available? Data from 1989/90*16 Million records annuallyAnnually / Monthly updateOutpatientsData from 2003/04*60 Million records annuallyA & EData from 2007/08* (experimental)12 Million records annually (set to increase to 19m)Annually
6Organisation / Geography HES DATADischarge Info (dates, destination)Admission Info (dates, source, type)Patient Demo-graphicsDiagnosis(ICD10)Procedures(OPCS-4)Bed Days / Waiting times, etc...Organisation / Geography(Treatment and Residence)Patient Identifiers(No Names)
7Key Terms and Definitions Episodes Vs Spells: The DefinitionsEpisodeA continuous period of care under the same consultantIf the patient is transferred to another consultant or to a different provider this would end the current episode and new one would beginSpellA patients entire stay with a hospital provider (from admission to discharge)If the patient dies, is discharged or transferred; this would end the current episode and spellTHEREFORE, ONE SPELL CAN CONTAIN MULTIPLE EPISODESEpisode 2Episode 1Episode 31 Spell
8Structure of HES Data: Admitted Patient Care - 1 All Activity vs Admissions vs Discharges.(1 patient, 1 spell, 3 episodes)Each episode is a separate HES record.Hence the above spell is contained in 3 different years, leading to double counting of patients and spells when comparing years.When comparing years we count only admissions or only discharges.AdmissionDischarge
9Structure of HES Data: Admitted Patient Care - 2 Spells vs Episodes vs Patients.A patient’s entire stay in hospital (admission to discharge) counts as a ‘spell’. Within a spell, each period of care under a consultant is an ‘episode’.Within a given year one patient may have multiple spells, each of which may have multiple episodes.
10How is the data used?Support analysis of NHS activity, including benchmarking, monitoring and clinical audit.Inform public health policies and initiatives.Detailed spatial and temporal picture of the health of England.Support operational decision-making such as commissioning and performance management.Linkage to other data sources (e.g. mortality, crime, NHS costs).Feeds into NHS performance indicators.
11How is the data accessed? Method one: freely available data online.Main source: HES onlineOther websites containing HES data:Information Centre:- (see also: Neighbourhood Statistics).NCHOD: - now the IC Indicator Portal!!APHO: Their e-Atlas:-
12How is the data accessed? Method two: regional Public Health Observatories (PHOs).PHOs provide a responsive ad-hoc service for PCTs, SHAs, other NHS organisations, LAs, academics and the research community.The service is free at the point of enquiry.
18What are PROMs?DH led programme supported by partners including The ICA means of collecting information on the effectiveness of care delivered to NHS patients as perceived by the patients themselves.Cover 4 elective surgical procedures:Unilateral hip replacementUnilateral knee replacementGroin herniaVaricose vein surgery
19What do they involve?Since 1st April 2009, contractual obligation that providers collect and report PROMsPatients invited to complete a pre-operative questionnairePost-operative questionnaires then sent to patients following surgery, after a specified time period.
21Advanced HES issues Linkage Confidentiality Strengths of HES Limitations of HES.
22LinkageLinking HES to other databases makes it even more useful and powerful.Internal linking of data allows new analysis; e.g. readmissions.Exact (deterministic) links can be performed using NHS number / PSEUDO_HESIDApproximate (stochastic) links can be performed using D.o.B / Postcode / Sex etc.Patient names are not on HES.
23Confidentiality HES Protocol Rules about disclosure control Low numbers (1-5)Sensitive fieldsPostcode, DOB, NHS Number, ConsultantRestricted conditionsHIV / AIDSDeathsPersonally responsible23
24Confidentiality (2)National Information Governance Board for Health and Social Care (NIGB)Ethics and Confidentiality Committee (ECC)Undertake the responsibilities of the NIGB for Health and Social Care under section 251 of the NHS Act 2006 and advise on ethical issues relating to the processing of health or social care informationReplace Patient Information Advisory Group (PIAG)Considers applications for access to:Identifiable HES dataIdentifiable and Sensitive HES dataDatabase Monitoring Sub-Group (DMSG)HES data containing sensitive but not identifiable dataPreviously done by Security and Confidentiality Advisory Group (SCAG)24
25Strengths of HESAlmost complete coverage of NHS activity relating to Outpatient and Inpatient care.Spatially and temporally referenced in great detail (down to postcodes and days).Standard codes for diagnoses (ICD10) & procedures (OPCS-4)Freely available data.
26Limitations of HES Specific data-quality issues: Boundary and organisational changes over time.Poor data: Maternity, Critical Care, earlier years.Only covers hospital-based activity...No mortality: “Cause of death data cannot be obtained from HES” (HES protocol).Not everything results in hospital activity, e.g: Alcohol, Drugs, Cancer, Mental Health, Obesity....But we can link to external databases.