1. Hampshire Health Record Diabetes pathway reports

2. Overview Database Pivot tables and charts Report sections Data issues

3. Hampshire Health Record Shared primary and secondary care record Based on extracts from GP systems and Trust systems. Browsable clinical record Database for analysis

4. GP Record (Read codes) (c900,000) Hospital records (SUHT & PHT) Pathology Radiology Correspondence (c 14.4 million documents) Hampshire Health Record (HHR) OT/CN/ PT/Pod SAP Clinical view Analytical Clinical Data Repository (ACDR) IP/OP/A&E CMDS (Other data sets?) Care Pathway Reports Prevalence GP and hospital activity Clinical outcome CDR Patient Index Personal Demographic Service

5. Number of Records GP Records 102 / 210 Practices participating 117 million entries for c 900,000 patients –74% Southampton PCT –50% Hampshire PCT –30% Portsmouth PCT Hospital Records 14.4 million documents on 640,000 patients Feeds live from SUHT, PHT ( WEHT and NHHT live within 3/12)

6. Data extracted to Analysis Server (linked by encrypted NHS Number and GP practice codes anonymised) GP: Read codes Diagnoses, Laboratory results Prescriptions Radiology Clinical measurements ETC Hospital Pathology results Radiology requests Commissioning Data Sets In patient Outpatient A&E

7. Pivot tables and Charts Initial queries on Diabetes Pathway –Able to select PCT, PBC group, Practice or GP Additional tables on secondary care use –Selection of specialty, PBC group

11. Diabetes pathway reports Process of initiation of care Process of monitoring in established diabetics Events in transition from juvenile to adult services Incidence of complications Use of hospital services ( IP/OP/ A&E) Cost of hospital care

13. Summary for each section link Practice50114150157183 Clinical Measurements within 3 months 52413chart 1.1 Clinical Measurements within12 months 13542chart 1.2 Investigations within 3 months13425chart 2.1 Investigations within 12 months13452chart 2.2 Diabetes education within 3 or 12 months ----- Mean rank 22.75 4.25 3 3

14. Commentary Recording of diabetes education is poorly undertaken in GP systems, so none of the practices appear to do well in this area. Apart from clinical measurements at 3 months, practice 50 appears to perform better than the other practices in the area of initiation of diabetes care, practice 150 has the worst performance.

16. Commentary The secondary care costs for the PBC group as a whole are the highest of any PBC in Hampshire/Southampton and Portsmouth (All PBC costs) at nearly £1470 per diabetic patient/ year[1] as compared to about £1070 per diabetic patient/year in the average PBC. Over the nearly 2000 diabetic patients in the PBC, this represents an additional £800,000 of secondary care expenditure which might potentially be avoided.All PBC costs[1]

17. Summary by Practice Practice 50 has a relatively good performance in the initiation of diabetes care (apart from clinical measurements at 3 months), and monitoring of patients with diabetes is average. The incidence of complications and the costs and volumes of secondary care are low. Practice 150 had a poor performance at initiation of care, and also for monitoring. The complication rate is high and the costs of inpatient care are second highest, with high use of bed days, outpatient and A&E attendances.

18. Health Warnings Data need to be reviewed by the individual practices to check the accuracy of the results Need to understand mix of : –Age, –Ethnic group –Social deprivation –Duration of diabetes

19. Issues Clinical and analytical value greater with higher coverage New Leaflets and publicity campaign for patients in next 3 months to encourage recruitment of practices Some extraction issues uncovered and now being addressed.