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How accurate are Scottish Morbidity Record (SMR01) data for elective AAA procedures?

How accurate are Scottish Morbidity Record (SMR01) data for elective AAA procedures? Sarah Couper SpR in Public Health Medicine John Connor Principal Information Analyst, ISD Donna Nicholson Senior Information Analyst, ISD

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How accurate are Scottish Morbidity Record (SMR01) data for elective AAA procedures?

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  1. How accurate are Scottish Morbidity Record (SMR01) data for elective AAA procedures? Sarah Couper SpR in Public Health Medicine John Connor Principal Information Analyst, ISD Donna Nicholson Senior Information Analyst, ISD Jennifer Armstrong Senior Medical Officer, Scottish Government

  2. Background • Scottish screening programme for AAA due for phased roll-out 2011/2012 • Some evidence exists which shows that the outcome of AAA surgery is dependent on the number of interventions per unit • NHS QIS has produced clinical standards which refer to units undertaking a minimum of 20 elective interventions each year. (Level B) • We wanted to answer the question of how many interventions were happening in Scottish units

  3. SMR PATIENT DATA FLOWS Sources SecondaryCare ISD SMR DATA RECORDING RULES VALIDATION RULES REFERENCE FILES HOSPITAL PAS/PMS Data Processing & Data Users M Patient Types New SMR? D S D Monitoring A A M & I I T R S COMPLETENESS FLAT FILES N OUTPATIENTS SPECIALTY A C C OF DATA D L H RECORD LINKAGE H V I A A TIMELINESS OF O E N T Elective referrals R DATA DATA MARTS S R A I Submission G P I C of SMRs E DATA QUALITY INFORMATION I F DAY CASES SIGNIFICANT A V / REQUESTS T I FACILITY L A T DERIVED DATA A C L R ITEMS PQs L A C I A T O D N CORRECTING PUBLICATIONS I D A S ERRORS O INPATIENTS CONSULTANT/HCP I T Emergency F A/E N N I E G O R N SMR submission process

  4. What we asked for • date of discharge between 1st April 2007 to 31st March 2010 • elective cases only, emergencies and transfers excluded • case attributed to main consultant • specific ICD10/OPCS4 code combinations (supplied by Julie Brittenden)

  5. Diagnosis and procedure codes Diagnosis Code I71.4 Abdominal aortic aneurysm, without mention of rupture Procedure Codes Open Repair L19.4 Replacement of aneurysmal segment of infrarenal abdominal aorta by anastomosis of aorta to aorta NEC L19.5 Replacement of aneurysmal segment of abdominal aorta by anastomosis of aorta to aorta NEC L19.6 Replacement of aneurysmal bifurcation of aorta by anastomosis of aorta to iliac artery NEC L19.8 Other specified other replacement of aneurysmal segment of aorta. L19.9 Unspecified other replacement of aneurysmal segment of aorta. L21  Other bypass of segment of aorta EVAR L27.1 Endovascular insertion of stent graft for infrarenal abdominal aortic aneurysm. L27.5 Endovascular insertion of stent graft for aortic aneurysm of bifurcation. L28.1 Endovascular stenting for infrarenal abdominal aortic aneurysm. L28.8 Other specified transluminal operations on aneurysmal segment of aorta. L28.9 Unspecified transluminal operations on aneurysmal segment of aorta. 

  6. Outline of data collection process

  7. Why did we ask for patient identifiers? • Investigate the discrepancies in the data and correct the system for future use • Avoid double counting of cases • Clarify cases fit the case definition

  8. Method Number of interventions from SMR01 data + Number of additional cases reported by those consultants who responded = Total number of interventions

  9. Level of discrepancy* only refers to those consultants who responded to exercise

  10. Analysis of the discrepancies for one Health Board Different codes Emergency/transfer Out with date range Agreement with SMR01 data 87%

  11. Conclusions • Selecting search criteria and ensuring these are adhered to is a complex exercise • Cross-checking data with consultants was challenging due to workloads and data confidentiality/disclosure issues • Data collection process could perhaps have been streamlined by asking consultants to provide patient level case details direct to ISD for verification • Clinicians sometimes query the accuracy of nationally collected data • Provisional analysis of the discrepancies show that many seem to be due to data extraction rather than inherent inaccuracy within the SMR01 records • Further work cross-checking clinicians’ records to discuss the discrepancies with them would have been useful but out with the scope of this exercise

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