PRIMISFirst National Conference 3rd April 2001 Birmingham

PRIMISFirst National Conference 3rd April 2001 Birmingham MIQUEST Unravelling the Mysteries

PRIMISFirst National Conference 3rd April 2001 Birmingham MIQUEST Unravelling the Mysteries Lynne Wright PRIMIS Information Manager Dr Andrew Perry MIQUEST Consultant Sue Trinder Clinical Audit Facilitator, Oxfordshire MAAG

PRIMISFirst National Conference 3rd April 2001 Birmingham Outline Introduction Setting the scene: Sue Trinder Preparing to write queries: Andrew Perry Feedback software: Lynne Wright Practice feedback: Sue Trinder Questions

PRIMISFirst National Conference 3rd April 2001 Birmingham Setting the Scene Sue Trinder Clinical Audit Facilitator, Oxfordshire MAAG

PRIMISFirst National Conference 3rd April 2001 Birmingham Why a CHD Audit National Service Framework for CHD MAAG priority Each of the 6 PCGs had made CHD a priority for their clinical governance agenda An annual MAAG audit CHD SQA and Health Promotion requirements are satisfied by participation in MAAG audits

PRIMISFirst National Conference 3rd April 2001 Birmingham CHD Audit From the Beginning Agree the team Find the Evidence Agree the audit criteria Decide which Read codes to use Write the queries Put queries through Query Manager Send out to the 62/88 Oxfordshire practices with MIQUEST software installed

PRIMISFirst National Conference 3rd April 2001 Birmingham

PRIMISFirst National Conference 3rd April 2001 Birmingham CHD Audit – Next Time! We intend to consult far more widely about: –Clinical criteria –Read codes used –Format of feedback We will document our decisions and give clearly written and precisely described instructions to Query writers We will be careful to avoid making assumptions

PRIMISFirst National Conference 3rd April 2001 Birmingham MIQUEST Unravelling the mysteries What can and cannot be done with MIQUEST –Can do almost everything we ask of it in terms of collecting clinical data –Cannot tell us how or what to ask Planning, consulting, checking and then checking again absolutely vital

PRIMISFirst National Conference 3rd April 2001 Birmingham Setting the Scene Sue Trinder Clinical Audit Facilitator, Oxfordshire MAAG

PRIMISFirst National Conference 3rd April 2001 Birmingham

PRIMISFirst National Conference 3rd April 2001 Birmingham Preparing to Write Queries Dr Andrew Perry MIQUEST Consultant to PRIMIS Clinical Information Consultancy

PRIMISFirst National Conference 3rd April 2001 Birmingham Writing MIQUEST queries Its really not difficult… … its just the software… …. thats confounding

PRIMISFirst National Conference 3rd April 2001 Birmingham All you need Wonder woman Super hero Team work

PRIMISFirst National Conference 3rd April 2001 Birmingham All you need Knowledge of clinical systems Audit experience Read code knowledge Medical backup

PRIMISFirst National Conference 3rd April 2001 Birmingham Process Specify requirements Create query definitions Write queries

PRIMISFirst National Conference 3rd April 2001 Birmingham Specify requirements

PRIMISFirst National Conference 3rd April 2001 Birmingham Specify requirements Iterative process Start with existing audit Reduce to set of questions –H–How many patients have …? –O–Of these how many also have …? –D–Do they have a record of …? –W–When was the last …? –H–How many have a raised …? Specify the Read codes Consultation

PRIMISFirst National Conference 3rd April 2001 Birmingham Specify the Read codes

PRIMISFirst National Conference 3rd April 2001 Birmingham Specify the Read codes Initial specification –Start from PRIMIS query sets Clinical consensus –Different ways to code conditions –Different systems –PRIMIS Clinical Advisory Group

PRIMISFirst National Conference 3rd April 2001 Birmingham Specify the Read codes Need codes for each –diagnosis –treatment –medication Require codes for –each version of Read codes –any local or system specific codes

PRIMISFirst National Conference 3rd April 2001 Birmingham Create query definitions Identify the subsets required Query for each type of data Specify selection criteria Decide on output and therefore style –Subset –Analyse –Report Specify the output

PRIMISFirst National Conference 3rd April 2001 Birmingham Styles of HQL query SUBSET –Selects a sub-population for future analysis or reporting ANALYSE –Counts patients or records meeting selection criteria –Can count in bands (e.g. by Age, Sex) REPORT –Extracts selected data about patients in a sub- population –Allows more detailed subsequent analysis

PRIMISFirst National Conference 3rd April 2001 Birmingham Writing queries Create new set for each disease area New query for each –Subset –Condition Add selection criteria as specified Add the output Quality assurance and piloting

PRIMISFirst National Conference 3rd April 2001 Birmingham

PRIMISFirst National Conference 3rd April 2001 Birmingham Feedback Software Lynne Wright PRIMIS Information Manager

PRIMISFirst National Conference 3rd April 2001 Birmingham Creating a Rush feedback spreadsheet

PRIMISFirst National Conference 3rd April 2001 Birmingham Structure Rush Import directory on local hard drive –Containing: RushImport ini file Response import ini file Rush template in the template directory of Microsoft office Directory of aggregated responses

PRIMISFirst National Conference 3rd April 2001 Birmingham Aggregated Responses Using Response Manager Select responses to aggregate Select Rush layout Click the aggregate button

PRIMISFirst National Conference 3rd April 2001 Birmingham Response Manager

PRIMISFirst National Conference 3rd April 2001 Birmingham Aggregated Layout

PRIMISFirst National Conference 3rd April 2001 Birmingham Two Control (ini) files RushImport –Controls the import directory Response import –Lists all responses to be imported –Order of the responses –Title of the responses to be shown both on the sheet tab and in the sheet heading

PRIMISFirst National Conference 3rd April 2001 Birmingham Ini File

PRIMISFirst National Conference 3rd April 2001 Birmingham Preparing a Rush Spreadsheet Aggregated analyse responses in Rush format Control (ini) files for import Rush import sheet Rush Excel template

PRIMISFirst National Conference 3rd April 2001 Birmingham Rush Excel Template Using the Import data button to select: –Control (ini) file –Response directory Check the response files Import the response files

PRIMISFirst National Conference 3rd April 2001 Birmingham Rush Template (1)

PRIMISFirst National Conference 3rd April 2001 Birmingham Rush Template (2)

PRIMISFirst National Conference 3rd April 2001 Birmingham Rush Template (3)

PRIMISFirst National Conference 3rd April 2001 Birmingham So... lets do it

PRIMISFirst National Conference 3rd April 2001 Birmingham Feedback Software Lynne Wright PRIMIS Information Manager

PRIMISFirst National Conference 3rd April 2001 Birmingham

PRIMISFirst National Conference 3rd April 2001 Birmingham CHD Audit Feedback Sue Trinder Clinical Audit Facilitator, Oxfordshire MAAG

PRIMISFirst National Conference 3rd April 2001 Birmingham Individual Practice Feedback Individual practice report –Crude and age/sex standardised prevalence –All audit criteria reported on –List of patients with operation codes without diagnosis codes given –List of patients with either monitoring or relevant drug codes without a diagnosis code given Aim to improve CHD registers

PRIMISFirst National Conference 3rd April 2001 Birmingham Individual Practice Feedback Practice-based 2-hour workshop offered to all practices built around their audit results –Part of each workshop looks at data management issues within the practice The use of recommended Read codes Computer templates Protocols Training needs identified and training arranged –Read Code training –Creating templates –Use of clinical system search engine

PRIMISFirst National Conference 3rd April 2001 Birmingham Comparative Feedback PCG report –Anonymised data compared at PCG and county level PCG clinical governance CHD workshops held –CHD NSF implementation plans agreed –Training needs identified Practice nurse / GP 20-hour CHD workshops arranged One PCG funded clinical system training

PRIMISFirst National Conference 3rd April 2001 Birmingham CHD Audit Feedback – Next Time Include a list of all of the codes used in each query in the practice reports 2-hour workshops – huge time commitment –Include clinical governance leads? –Commission specialists? Would like to have the Rush software available for MAAG use

PRIMISFirst National Conference 3rd April 2001 Birmingham Discussion Session MIQUEST –software questions? –query questions? –Rush questions?

PRIMISFirst National Conference 3rd April 2001 Birmingham