COPD Analyses Updated – 7th February February 2011

Table of Contents – COPD Indicators COPD o C1.1 – Admissions to secondary care where COPD is the primary diagnosis by acute trust o C1.2 – Admissions to secondary care where COPD is the primary diagnosis by o C2.1 – Readmissions within 30d to secondary care where COPD is the primary diagnosis by acute trust o C2.2 – Readmissions within 30d to secondary care where COPD is the primary diagnosis by o C3.1 – Median length of stay for admissions to secondary care where COPD exacerbations are the primary diagnosis by acute trust o C3.2 – Median length of stay for admissions to secondary care where COPD exacerbations are the primary diagnosis by PCT o C4.1 – Current prevalence rate for COPD by PCT vs. Predicted rate by PCT o C4.2 – Current prevalence rate for COPD by GP practice vs. Predicted rate by PCT (data only and NE only) o C5.1 – In-hospital mortality for admissions where COPD is the primary diagnosis by acute o C5.2 – In-hospital mortality for admissions where COPD is the primary diagnosis by PCT 2

C1.1 – Admissions to secondary care where COPD is the primary diagnosis by acute trust 3 Data Table 1: Indirectly standardised ratio Data obtained from HES 2008/09, 2009/10 Data Table 1b: Observed values

C1.1 – Admissions to secondary care where COPD is the primary diagnosis by acute trust 4 Chart 1: Time series (indirectly standardised ratio) Data obtained from HES 2008/09, 2009/10

C1.1 – Admissions to secondary care where COPD is the primary diagnosis by acute trust 5 Chart 2: Funnel Plot (indirectly standardised ratio) Data obtained from HES 2009/10

C1.2 – Admissions to secondary care where COPD is the primary diagnosis by PCT 6 Data Table 1: Directly standardised rate per 100,000 population Data obtained from HES 2008/09, 2009/10 and ONS 2008

C1.2 – Admissions to secondary care where COPD is the primary diagnosis by PCT 7 Data Table 1b: Observed values Data obtained from HES 2008/09, 2009/10

C1.2 – Admissions to secondary care where COPD is the primary diagnosis by PCT 8 Chart 1: Time series (directly standardised rate per 100,000 population) Data obtained from HES 2008/09, 2009/10 and ONS 2008

C1.2 – Admissions to secondary care where COPD is the primary diagnosis by PCT 9 Chart 2: Funnel Plot (directly standardised rate per 100,000 population) Data obtained from HES 2009/10 and ONS 2008

C2.1 – Readmissions within 30d to secondary care where COPD is the primary diagnosis by acute trust 10 Data Table 1: Indirectly standardised ratio Data obtained from HES 2008/09, 2009/10 Data Table 1b: Observed values

C2.1 – Readmissions within 30d to secondary care where COPD is the primary diagnosis by acute trust 11 Chart 1: Time series (indirectly standardised ratio) Data obtained from HES 2008/09, 2009/10

C2.1 – Readmissions within 30d to secondary care where COPD is the primary diagnosis by acute trust 12 Chart 2: Funnel Plot (indirectly standardised ratio) Data obtained from HES 2009/10

C2.2 – Readmissions within 30d to secondary care where COPD is the primary diagnosis by PCT 13 Data Table 1: Directly standardised rate per 100,000 population Data obtained from HES 2008/09, 2009/10 and ONS 2008

C2.2 – Readmissions within 30d to secondary care where COPD is the primary diagnosis by PCT 14 Data Table 1b: Observed values Data obtained from HES 2008/09, 2009/10

C2.2 – Readmissions within 30d to secondary care where COPD is the primary diagnosis by PCT 15 Chart 1: Time series (directly standardised rate per 100,000 population Data obtained from HES 2008/09, 2009/10 and ONS 2008

C2.2 – Readmissions within 30d to secondary care where COPD is the primary diagnosis by PCT (age-sex standardised to England population) 16 Chart 2: Funnel Plot (directly standardised rate per 100,000 population) Data obtained from HES 2009/10 and ONS 2008

C3.1 – Median length of stay for admissions to secondary care where COPD exacerbations are the primary diagnosis by acute trust 17 Data obtained from HES 2008/09, 2009/10 Data Table 1: Median length of stay (days) for admissions to secondary care where COPD exacerbations are the primary diagnosis by acute trust

C3.2 – Median length of stay for admissions to secondary care where COPD exacerbations are the primary diagnosis by PCT 18 Data obtained from HES 2008/09, 2009/10 Data Table 1: Median length of stay (days) for admissions to secondary care where COPD exacerbations are the primary diagnosis by PCT

C4.1 – Current prevalence for COPD by PCT vs. Predicted by PCT 19 Data obtained from NHS Comparators 2005/06, 2006/07, 2007/08, 2008/09 and ERPHO modelled estimates of prevalence Data Table 1: Ratio of reported vs expected COPD (Current / Predicted)

C4.1 – Current prevalence for COPD by PCT vs. Predicted by PCT 20 Data obtained from NHS Comparators 2005/06, 2006/07, 2007/08, 2008/09 and ERPHO modelled estimates of prevalence Chart 1: Ratio of reported vs expected COPD (Current / Predicted)

C4.2 – Current prevalence for COPD by GP practice vs. Predicted by PCT 21 Data obtained from NHS Comparators 2008/09 Data Table 1: Ratio of reported vs expected COPD (Current / Predicted) Please see excel supplement for data table by GP practice

C4.2 – Current prevalence for COPD by GP practice vs. Predicted by PCT 22 Data obtained from NHS Comparators 2008/09 Chart 1: Ratio of reported vs expected COPD (Current / Predicted)

C5.1 – In-hospital mortality for admissions where COPD is the primary diagnosis by acute trust 23 Data Table 1: Indirectly standardised ratio Data obtained from HES 2008/09, 2009/10 Data Table 1b: Observed values

C5.1 – In-hospital mortality for admissions where COPD is the primary diagnosis by acute trust 24 Chart 1: Time series (indirectly standardised ratio) Data obtained from HES 2008/09, 2009/10

C5.1 – In-hospital mortality for admissions where COPD is the primary diagnosis by acute trust 25 Chart 2: Funnel Plot (indirectly standardised ratio) Data obtained from HES 2009/10

C5.2 – In-hospital mortality for admissions where COPD is the primary diagnosis by PCT 26 Data Table 1: Directly standardised rate per 100,000 population Data obtained from HES 2008/09, 2009/10 and ONS 2008

C5.2 – In-hospital mortality for admissions where COPD is the primary diagnosis by PCT 27 Data Table 1b: Observed values Data obtained from HES 2008/09, 2009/10

C5.2 – In-hospital mortality for admissions where COPD is the primary diagnosis by PCT 28 Chart 1: Time series (directly standardised rate per 100,000 population) Data obtained from HES 2008/09, 2009/10 and ONS 2008

C5.2 – In-hospital mortality for admissions where COPD is the primary diagnosis by PCT 29 Chart 2: Funnel Plot (directly standardised rate per 100,000 population) Data obtained from HES 2008/09, 2009/10 and ONS 2008

DATA SPECIFICATIONS HIGH LEVEL NOTES 30

General Notes for all Indicators – Data Details HES primary diagnosis (diag_01) in list of ICD10 codes NOTE – due to variation in coding practices and other differences amongst trusts, it is possible that the diagnosis of COPD may not be coded in the primary position although it is, in fact, the primary cause for the hospital admission. Consequently, relevant episodes may be omitted from this analysis by limiting the COPD diagnosis to the primary position. However, by expanding the selection of episodes to include those where COPD is in any position runs the risk of including episodes where the actual primary diagnosis (e.g. Fracture) has no relation to the COPD condition. Therefore, in order to include in the analyses only those episodes for which COPD was the primary cause for admission, the decision was made to limit selection of episodes only to those where COPD was coded as the primary diagnosis. 31

C1.1 – Admissions to secondary care where COPD is the primary diagnosis by acute trust Data Source: HES in-patient data 2008/09, 2009/10 Data Details: HES primary diagnosis (diag_01) in list of ICD10 codes Indicator: Number of admissions where the primary diagnosis is COPD by acute trust, standardised by age and sex Numerator = COPD admissions Denominator = All secondary care admissions Data Handling Notes: ICD10 Codes for COPD - J411, J420, J430, J431, J432, J438, J439, J440, J441, J448, J449 Indirectly standardised for age and sex 32

C1.2 –Admissions to secondary care where COPD is the primary diagnosis by PCT Data Source: HES in-patient data 2008/09, 2009/10 ONS data 2008/09 Data Details: HES primary diagnosis (diag_01) in list of ICD10 codes Indicator: Number of admissions where the primary diagnosis is COPD by PCT, standardised by age and sex Numerator = COPD admissions Denominator = PCT population Data Handling Notes: ICD10 Codes for COPD - J411, J420, J430, J431, J432, J438, J439, J440, J441, J448, J449 Referring PCT field will be used Directly standardised for age and sex per 100,000 population 33

C2.1 – Readmissions within 30d to secondary care where COPD is the primary diagnosis by acute trust Data Source: HES in-patient data 2008/09, 2009/10 Data Details: HES primary diagnosis (diag_01) in list of ICD10 codes Indicator: Number of admissions where the primary diagnosis is COPD by acute trust, standardised by age and sex Numerator = 30 day COPD readmissions Denominator = All secondary care admissions Data Handling Notes: ICD10 Codes for COPD - J411, J420, J430, J431, J432, J438, J439, J440, J441, J448, J449 Indirectly standardised for age and sex 34

C2.2 – Readmissions within 30d to secondary care where COPD is the primary diagnosis by PCT Data Source: HES in-patient data 2008/09, 2009/10 ONS data 2008/09 Data Details: HES primary diagnosis (diag_01) in list of ICD10 codes Indicator: Number of admissions where the primary diagnosis is COPD by PCT, standardised by age and sex Numerator = 30 day COPD readmissions Denominator = PCT population Data Handling Notes: ICD10 Codes for COPD - J411, J420, J430, J431, J432, J438, J439, J440, J441, J448, J449 Referring PCT field will be used Directly standardised for age and sex per 100,000 population 35

C3.1 – Median length of stay for admissions to secondary care where COPD exacerbations are the primary diagnosis by acute trust Data Source: HES in-patient data 2008/09, 2009/10 Data Details: HES primary diagnosis (diag_01) in list of ICD10 codes Indicator: Median length of stay for admissions to secondary care where the primary diagnosis is in the list of COPD exacerbations, by acute trust Data Handling Notes: ICD10 Codes for COPD - J411, J420, J430, J431, J432, J438, J439, J440, J441, J448, J449 36

C3.2 – Median length of stay for admissions to secondary care where COPD exacerbations are the primary diagnosis by PCT Data Source: HES in-patient data 2008/09, 2009/10 Data Details: HES primary diagnosis (diag_01) in list of ICD10 codes Indicator: Median length of stay for admissions to secondary care where the primary diagnosis is in the list of COPD exacerbations, by PCT Data Handling Notes: ICD10 Codes for COPD - J411, J420, J430, J431, J432, J438, J439, J440, J441, J448, J449 Referring PCT field will be used 37

C4.1 – Current prevalence rate for COPD by PCT vs. Predicted rate by PCT Data Source: NHS Comparators 2005/06, 2006/07, 2007/08, 2008/09 and ERPHO modelled estimates of prevalence of COPD for PCTs in England ( Data Details: The ERPHO estimates and were derived using a model developed at the Dept of Primary Care and Social Medicine, Imperial College, London. The model was developed using data from the 2001 Health Survey for England. The model takes into account age, sex, ethnicity, smoking status, rurality and deprivation score. Indicator: Numerator = Count of patients recorded by practice as having COPD as reported in QOF data summed to the PCT level Denominator = Expected count of patients by PCT 38

C4.2 – Current prevalence rate for COPD by GP practice vs. Predicted rate by PCT Data Source: NHS Comparators 2008/09 Data Details: The ERPHO rates were derived using GP Practice list data. To match with QOF populations, ERPHO prevalence rates at GP practice level for the population aged 16 and over were applied to the estimated QOF list population of the practice aged 16 and over. NB assumption of zero rate in population less than 16 Some practices in QOF have no modelled prevalence rates in the ERPHO data - including all practices that formed after March 2007 were not included in the modelled data. For these practices (138 in 2007/08 and 155 in 2008/09) the national modelled prevalence rate has been applied for both years (for COPD 3.63% of practice population aged 16 and over) Details of the COPD model used can be found at Modelled estimates are published on the APHO website. Indicator: Numerator = Count of patients recorded by practice as having COPD as reported in QOF data by GP practice Denominator = Expected count of patients by practice on the disease register by PCT (Expected prevalence data are derived using expected prevalence rates provided by ERPHO which take account of age, sex, ethnicity, smoking status and deprivation score at practice level) Data Handling Notes: This will be a high volume of data so will be delivered as raw data and summary statistics and limited to NE GP practices 39

C5.1 – In-hospital mortality for admissions where COPD is the primary diagnosis by acute trust Data Source: HES in-patient data 2008/09, 2009/10 Data Details: HES primary diagnosis (diag_01) in list of ICD10 codes HES discharge method equal to Death Indicator: Number of admissions where the primary diagnosis is COPD where patient dies by acute trust, standardised by age and sex Numerator = Number of deaths for COPD admissions Denominator = Number of COPD admissions Data Handling Notes: ICD10 Codes for COPD - J411, J420, J430, J431, J432, J438, J439, J440, J441, J448, J449 Indirectly standardised for age and sex 40

C5.2 – In-hospital mortality for admissions where COPD is the primary diagnosis by PCT Data Source: HES in-patient data 2008/09, 2009/10 ONS data 2008/09 Data Details: HES primary diagnosis (diag_01) in list of ICD10 codes HES discharge method equal to Death Indicator: Number of admissions where the primary diagnosis is COPD where patient dies by PCT, standardised by age and sex Numerator = Number of deaths for COPD admissions Denominator = PCT population Data Handling Notes: ICD10 Codes for COPD - J411, J420, J430, J431, J432, J438, J439, J440, J441, J448, J449 Referring PCT field will be used Directly standardised for age and sex per 100,000 population 41

COPD ICD10 Codes J41.1 Mucopurulent chronic bronchitis J42.0 Unspecified chronic bronchitis J43.0 Emphysema J43.1 Panlobular emphysema - Panacinar emphysema J43.2 Centrilobular emphysema J43.8 Other emphysema J43.9 Emphysema, unspecified J44.0 Other chronic obstructive pulmonary disease J44.1 Chronic obstructive pulmonary disease with acute exacerbation, unspecified J44.8 Other specified chronic obstructive pulmonary disease J44.9 Chronic obstructive pulmonary disease, unspecified 42