Cancer Outcomes and Services Dataset. What is COSD? Skin Cancers Workshop October 2012

Transcription

1 Cancer Outcomes and Services Dataset What is COSD? Skin Cancers Workshop October 2012

2 17 years ago......cancer registration and careful monitoring of treatment and outcomes are essential... Calman-Hine Our aspiration is that England should achieve cancer outcomes which are comparable with the best in the world Improving Outcomes: a Strategy for Cancer, 2011

3 Why are we doing this the impact of information? 31 Days - CWT

4 Why are we doing this newer Information? Routes to Diagnosis

5 Age-standardized FCE Breast Lung Colon Skin H&N FCE / incidence Bed-days / PCT incidence Age-standardized /100,000 PCT 1 PCT 1 PCT 2 PCT 3 Age-standardized /100,000 FCE Age-standardized /100,000 Excess Bed-days Male PCT 1 Female PCT 1 Male UK Female UK FCE / incidence Average LoS / FCE Age-standardized /100,000 Age-standardized /100,000 of cancer deaths in the Hospice successfully quit compliance Rate per 1000 women screened of all TWRs of cancer deaths in hospital 31 days meeting National Standards successfully quit compliance of all TWRs of cancer hospital deaths by Trust of women screened 62 days meeting National Standards # not referred as TWR /100,000 meeting TWR standard # TWR with cancer Diagnosis /100,000 # not referred as TWR /100,000 # not referred as TWR /100,000 meeting TWR standard # TWR with cancer Diagnosis /100,000 There are 100s of aspects that must be taken into account when making decisions about a Clinical Service Actual incidence Survival PCT-1 Source: CIS, Date Prevalence LUNG Cancer trends per Male Female cancer type and PCT Source: CIS, Date PCT 2 PCT 3 Choose trust Choose admission type Choose procedure All All Episodes by trust (not normalisied) - LUNG Trust 1 Trust 2 Trust 3 Activity per Source: HES, Date All Trusts admission Choose PCT 1 Choose procedure All type and Activity PCT trend per PCT - LUNG PCT Source: HES, Date England average bed-days above trim point 100 Drug budget per indication Excess Itembed-days by PCT Description LUNG (normalised by incidence) Prevalence All Cancers PCT 1 PCT 1 Source: CIS, Date Male PCT 2 PCT 3 PCT 2 PCT 3 Female LUNG incidence past and projections PCT Here commentary about assumptions made in projections Choose PCT 1 Choose procedure All Episodes by PCT (not normalisied) - LUNG Source: HES, Date Elective Non-elective Trust 1 Trust 2 Trust 3 Trust 4 5-year rolling average mortality LUNG 5-year rolling average mortality All Cancers Source: CIS, Date Source: CIS, Date Choose PCT 1 Choose procedure All Male PCT 1 Female PCT 1 Male UK Male PCT 1 Female PCT 1 Male UK Activity trend per PCT - LUNG PCT 1 England average Female UK Female UK Core present at meetings Named Core team Members Compliance with # of core Members Present at meetings Source: C-Quiins Date All Cancers At ½ of meetings LC 1 LC 2 LC 3 LCT1 LCT2 LCT 3 At 2/3 of meetings All Localities PCT Collective Measures Met Source: C-Quiins Date SHA 1 SHA 2 SHA PCt 1 PCT 2 pct 3 There Source: HES, Date is a wealth of information Data LCT2 Choose Trust LCT1 LCT 3 User notes Jul Aug Sept Costs of emergency admissions by Trust (not Costs by FCE Add to basket All SHAs Source: CWT, CIS, Date normalised) - LUNG Source: Screening Date Actual success Trust 1 Trust 2 Trust 3 numbers rate Rate of success of TWR meeting Standards quitters by quitters at 4 Successfully quit at 4 weeks 100,000 pop weeks All cancers # TWR with cancer diagnosis - All cancers Target (99) PCT1 Successfully quit after 4 weeks PCT3 PCT 1 England PCT England All Trusts (self report) Source: HES, Date Source: HES, Date England Average Lung Breast Prostate Etc. Choose PCT 1 Choose Network Source: Choose HES, Scenario Date abc and network Drug Indication Manufacturer and PCT A B C Etc Status costs due to excess bed-days 100 Planned expenditure of current drugs or Source: HES, Date Manage scenarios NICE guidance Cost per patient per annum ( ) Incidence per 100,000 Assumptions: England population = 55 million, Network population = 1m, PCT population = 100,000 Source: HES, Date Here the user could type action items that he/she considers important Excess Bed-days time trend - LUNG Source: HES, Date PCT 1 England average Number of patients expected in PCT / network per annum Total Costs per PCT / Network Source: HES, Date Expected total costs per drug ( ) etc Average LoS by PCT LUNG Previous year spend ( ) etc Zoom up Notes Source: IC, NHS Date Coverage Cancer Source: HES Date Detected TWR target Rate of cancer detected Women aged Not Referred as TWR of TWR with cancer diagnosis Source: CWT, CIS, Date admissions without a diagnosis of cancer by PCT LUNG Source: HES, Date of cancer deaths in the Hospice Source: HES Date All cancers TWR with Cancer Diagnosis All cancers (2006) of cancer deaths in hospital All cancers Source: IC, NHS Date All Cancers LC 1 LC 2 LC 3 Coverage All Localities Test Results Test results Women aged Negative Dyskaryosis Data User notes Add to basket Trend of TWR with cancer diagnosis Jul Aug Sept Source: CWT, CIS, Date of 31 days meeting Standards Vs National Target All cancers - PCT1 Jul Aug Sept Source: CWT, CIS, Date PCT National Target of TWRs meeting standard (98) England Which Hospital - All cancers T1 T1 T3 T1 T1 T3 PCT1 PCT3 All cancers - PCT1 PCT T1 T1 T3 England 62 day trend PCT4 T1 T1 T3 In trust and transfer breakdown Source: CWT, CIS, Date View Dyskaryosis Level 62 day trend PCT In house treatment Trust transfer # not referred as TWR All cancers Mild # of TWR with cancer diagnosis Source: CWT, CIS, Date PCT1 Source: CWT, Date of 62 days meeting Standards Vs National Target All cancers - PCT1 National Target of TWRs meeting standard (995) England Jul Aug Sept All cancers PCT2 62 day cases breakdown all cancers PCT1 100 July Aug Sept Source: HES Date In trust and transfer breakdown In Trust treatment Trust transfer Place of death per PCT of patient and trust # not referred as TWR - All cancers PCT PCT1 England Source: CWT, CIS, Date of TWR meeting Standards - All cancers PCT1 trust and PCT PCT England Source: CWT, CIS, Date Jul Aug Sept # not referred as TWR Lung # TWR with cancer diagnosis Excess beddays per Jul Aug Sept cancer type,

6 What is COSD? The new national cancer dataset Cancer Outcomes and Services Aligned with patient management Proposed and supported by clinicians Incorporates previous cancer registration dataset Updated and aligned with other datasets Clarified definitions of data items, codes and values Specifies Provider submissions Compiled by registries from Providers and other sources

7 CENTRAL NERVOUS SYSTEM BREAST COLORECTAL CHILDREN,TEENAGERS, YOUNG ADULTS GYNAECOLOGY HAEMATOLOGY HEAD & NECK LUNG SARCOMA SKIN UROLOGY COSD - Structure UPPER GI Site specific Clinical and Path Cancer Outcomes and Services Dataset CANCER WAITS CORE - CANCER REGISTRATION Demographics/Referral/Diagnostics/Diagnosis/Care Plan/Treatment Patient pathway referral to treatment

8 What s different about COSD? (1) Complete patient pathway Referral details for all cases All treatments Includes palliative and supportive care New core data items including TNM Edition Number Involvement of Clinical Nurse Specialist Duration of symptoms Mandatory for Children,Teenagers,Young Adults (CTYA), Optional for others Year/Month/Day as appropriate or available All registerable conditions including in situ bladder, in situ melanoma, benign brain tumours

9 What s different about COSD? (2) Site specific data Key site specific clinical items patient management Site specific stage Stage components of RCPath datasets Includes recurrences Breast cancers to start with New record including referral information

10 COSD Dataset Data Item Name Primary Diagnosis (ICD) Multidisciplinary Team Discussion Date (Cancer) Cancer Care Plan Intent Performance Status (Adult) TNM Stage Grouping (Final Pre Treatment) Site Code (Of Imaging) Procedure Date (Cancer Imaging) Imaging Code (Nicip) Cancer Imaging Modality Imaging Anatomical Site Consultant Code Care Professional Main Specialty Code Procedure Date Primary Procedure (Opcs) Procedure (Opcs) Investigation Result Date Service Report Identifier Service Report Status Care Professional Code (Pathology Test Requested By) Organisation Site Code (Pathology Test Requested By) Cancer Treatment Event Type Treatment Start Date (Cancer) Cancer Treatment Modality Organisation Site Code (Provider Treatment Start Date (Cancer) Suggested System/Source MDT MDT MDT MDT MDT RIS RIS RIS RIS RIS PAS/HES PAS/HES PAS/HES PAS/HES PAS/HES PATH PATH PATH PATH PATH CWT CWT CWT CWT PAS Radiology Pathology MDT National Feeds datasets and other sources e.g. CWT, RTDS, SACT, (ONS)

11 What does this mean for you? (Informatics 1) Multiple Trust systems (MDT, PAS, Path, RIS) Separate files for MDT, PAS, Path, RIS Compiled by registries Method of transmission Agreed with registries Secure transmission - nhs.net Aim towards XML Path data extracted from path reports by registries Complete Data Transfer Agreement Minimising duplication of data flows

12 What does this mean for you? (Informatics 2) XML Action Plan to develop XML Support for in house developers Interim arrangements with Registry

13 What does this mean for you? Monthly submission Current cancer registry feeds expanded to include COSD items 25 working days after diagnosis or treatment Send updates as applicable Aim for three months to complete initial record (to first treatment) Final updates to first treatment within 6 months Further treatments - submit 25 working days after treatment How to collect in real time? Clinical ownership/sign off for MDT extract PAS extract Path extract RIS extract

14 Key sources MDT System Resources Point of care recording Clinical sign off/ownership Review and revise processes Inter Provider pathways Network wide implementation Data collection agreements Alignment with national audits Differences identified Move towards integrated submission

15 Key Sources Pathology System Existing extracts continue Path items may also be recorded in MDT system Can send from both systems Free Text Reports Data items extracted by registries Direction of travel Structured reporting Clinical oversight Summary feedback reports

16 Key sources PAS Existing extract Use SUS/CDS/PbR return Check COSD data items included Discuss with regional registry Process for Clinical oversight Feedback reports

17 Key sources Radiology System How to identify cases Can system identify cancer cases automatically Can CWT be used to identify reports for cancer investigations Identified by registries to request reports for specified cancer Remote access to RIS for registries IEP future option? Use of Diagnostic Imaging Dataset (DID)? Free Text reports Data items extracted by registries Clinical oversight Summary feedback reports Radiology items recorded in MDT system Can send from both systems

18 GAP Analysis Conformance Checklist

19 Support

20 Conformance Included in National Contract Information Standard Possible financial penalty Simple criteria Monthly feedback to Providers (raw data) e.g. data submitted on time? Staging data completeness Quarterly and annual feedback to follow (processed data) Potential Escalation process Informal discussions Notification to CEO Formal notification to commissioners NHS Commissioning Board

21 Implementation Timetable Jan 13 July 13 SITE SPECIFIC CLINICAL Jan 14 SITE SPECIFIC PATHOLOGY Jan 15 FULL COSD DATASET submitted in XML ISB Approval June 12 July 12 ISN issued CORE and SITE SPECIFIC STAGE

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