DATA quality and KPIs. David Hopkins King s College Hospital London

Transcription

1 DATA quality and KPIs David Hopkins King s College Hospital London

2 The DAFNE trial changes in HbA1c DAFNE Study Group, BMJ 2002;325:746

3 The DAFNE trial changes in HbA1c At 42 months A1c 0.4% from baseline DAFNE Study Group, BMJ 2002;325:746

4 Database development 7 interested centres ran DAFNE courses in 2002 to test translation from research into routine care National office set up to co-ordinate programme National database established to facilitate audit

5 DAFNE database mark 1 Ambitious scope aimed to collect comprehensive biomedical and psychological data to facilitate audit Data collected at baseline and annually No specific resources for data collection done by centres from within local budget for running DAFNE programme

6 Aims: Real world DAFNE audit To determine outcomes of DAFNE in routine clinical practice across the collaborative Methods: Biomedical and psychological data collected at all participating centres prior to DAFNE and at one year follow-up visit on a central database. Data extracted for audit on all subjects entering DAFNE over 1 year Hopkins D Care 2012

7 Data Quality 1108 patients entered DAFNE in 2005 Complete data available for: HbA1c: 523 (47%) Psychological data 458 (41%) Patients lacking follow-up data had a mean baseline HbA1c 0.2% higher than those included in audit (p=0.01) but did not differ in baseline psychological parameters

8 Changes over 1-year follow-up HbA1c Mean baseline % Mean follow-up % Mean Change 0.28% p= <0.001 For those with baseline A1c >8.5% mean change 0.76% A1c of < 7.5 achieved by 35 % (22% baseline) Weight Mean Change +0.1 kg p= 0.67

9 Hypoglycaemia At baseline 25.4% experienced SH in year prior to DAFNE, 42% subjects reported HU at baseline. After 1 year Mean SH rate fell from 7.8 to 2.2 episodes/yr (p=<0.001) 91/ 189 (48%) reported restoration of HA at 1 year

10 EQ5D EQ5D EQ5D VAS HADS PAID p< HADS Anxiety HADS Depression 0.00 PAID

11 From 2009 two databases Core: Baseline demographic and biomedical data collected for audit / QC purposes together with reduced follow up dataset active in all centres Research: Active in 10 centres. Extended baseline and annual data collection including comprehensive health economic data and psychological data

12 Data Ascertainment HbA1c Baseline: 99% 1 year: 55% 3 year 34% 5 year 28% Low ascertainment risk of bias Target > 70% participants with complete 1 year data No further post 1 year data collection for core dataset

13 Auditing for Quality Assurance Core database has considerable potential to optimise QA across the collaborative and allow centres to benchmark performance against national data Will enable generation of data to support commissioning Need to ensure high level of data ascertainment and use of Key performance indicators to define performance

14 Key Performance Indicators Need to be easy to collect / analyse Must be relevant to clinical practice and patient expectations Three potential KPIs identified mean reduction in A1c from baseline achievement of target A1c reduction in severe hypoglycaemia

15 KPI 1: Mean change in A1c Ideal target: mean A1c reduction of > 0.5% for all patients at centre over 3 year period Excludes patients with A1c < 7.5% at baseline Scoring: > 0.5 Green 0.25 to 0.5 Amber <0.25 Red

16 KPI 2: % Achieving < 7.5 Ideal target: > 40 % of patients will achieve A1c < 7.5% at 1 year post DAFNE Scoring: > 40 % Green % Amber < 24% Red For comparison 28% of type 1 DM in England have A1c <7.5% (National Diabetes Audit)

17 KPI 3: % Free of severe hypos Based on patients who have had severe hypos in the year preceding DAFNE only Ideal target: > 50 % of patients who have had severe hypo in year before DAFNE will be free of further severe hypos Scoring: > 50 % Green % Amber < 30% Red

18 Example: Mean change in A1c by centre A -0.6 B -0.7 C -0.3 D -0.4 E -0.2 F -0.2 G -0.5 H -0.5 I -0.6 J -0.1 K -0.3 L -0.5 M -0.9 N 0.2 O -0.9 P -0.4 Centres anonymised: 1 yr post-dafne data for patients with base A1c >7.5.

19 Example 2: Freedom from severe hypoglycaemia Centre ID % free of hypoglycaemia Percentage of those with SH at baseline free of further SH 1 y post DAFNE

20 Percentage of subjects achieving A1c < 7.5% Achieved Achieved Based on HbA1c data collected 1 yr post-dafne Centre ID < 7.5 <7 % A B C D E 25 6 F G H 26 7 I J 12 0 K L M N O P 26 16

21 In conclusion DAFNE database has proved an effective tool for demonstrating efficacy of DAFNE Simplification of data collection for audit database will allow greater focus on data completeness New KPIs will provide a way of benchmarking centres and facilitate quality assurance across the collaborative