Post on 29-Mar-2015
3rd April 2001Birmingham
PRIMISFirst National Conference
3rd April 2001Birmingham
PRIMISFirst National Conference
MIQUEST Unravelling the Mysteries
3rd April 2001Birmingham
PRIMISFirst National Conference
MIQUEST Unravelling the Mysteries
Lynne WrightPRIMIS Information Manager
Dr Andrew PerryMIQUEST Consultant
Sue TrinderClinical Audit Facilitator, Oxfordshire MAAG
3rd April 2001Birmingham
PRIMISFirst National Conference
Outline
• Introduction• Setting the scene: Sue Trinder• Preparing to write queries: Andrew
Perry• Feedback software: Lynne Wright• Practice feedback: Sue Trinder• Questions
3rd April 2001Birmingham
PRIMISFirst National Conference
Setting the Scene
Sue TrinderClinical Audit Facilitator,
Oxfordshire MAAG
3rd April 2001Birmingham
PRIMISFirst National Conference
Why a CHD Audit
• National Service Framework for CHD• MAAG priority• Each of the 6 PCGs had made CHD a
priority for their clinical governance agenda
• An annual MAAG audit• CHD SQA and Health Promotion
requirements are satisfied by participation in MAAG audits
3rd April 2001Birmingham
PRIMISFirst National Conference
CHD AuditFrom the Beginning
• Agree the team• Find the Evidence• Agree the audit criteria• Decide which Read codes to use• Write the queries• Put queries through Query Manager• Send out to the 62/88 Oxfordshire
practices with MIQUEST software installed
PRIMISFirst National Conference3rd April 2001Birmingham
Audit Criteria Target group A
CHD patients
35-74 years
Target group B
TIA/Strokepatients
35-74 years
Target group C
PVD patients
35-74 years
Numbers in targetage bands
consultation in past15 months
CHD review orpreventionappointment in past15 months
Smoking status inpast 15 months
Current smokerslast record in past15 months
Smoking advicegiven in past 15months
BP measured inpast 15 months
Diastolic BP 89 orless in past 15months (anyrecord)
Systolic BP 149 orless in past 15months (anyrecord)
3rd April 2001Birmingham
PRIMISFirst National Conference
CHD Audit – Next Time!
• We intend to consult far more widely about:– Clinical criteria– Read codes used– Format of feedback
• We will document our decisions and give clearly written and precisely described instructions to Query writers
• We will be careful to avoid making assumptions
3rd April 2001Birmingham
PRIMISFirst National Conference
MIQUEST Unravelling the mysteries
• What can and cannot be done with MIQUEST – Can do almost everything we ask of it
in terms of collecting clinical data– Cannot tell us how or what to ask
• Planning, consulting, checking and then checking again absolutely vital
3rd April 2001Birmingham
PRIMISFirst National Conference
Setting the Scene
Sue TrinderClinical Audit Facilitator,
Oxfordshire MAAG
3rd April 2001Birmingham
PRIMISFirst National Conference
3rd April 2001Birmingham
PRIMISFirst National Conference
Preparing to Write Queries
Dr Andrew PerryMIQUEST Consultant to
PRIMISClinical Information
Consultancy
3rd April 2001Birmingham
PRIMISFirst National Conference
Writing MIQUEST queries
It’s really not difficult…… it’s just the software…
…. that’s confounding
3rd April 2001Birmingham
PRIMISFirst National Conference
All you need• Wonder woman
• Super hero
• Team work
3rd April 2001Birmingham
PRIMISFirst National Conference
All you need
• Knowledge of clinical systems• Audit experience• Read code knowledge • Medical backup
3rd April 2001Birmingham
PRIMISFirst National Conference
Process
• Specify requirements• Create query definitions• Write queries
3rd April 2001Birmingham
PRIMISFirst National Conference
Specify requirements
3rd April 2001Birmingham
PRIMISFirst National Conference
Specify requirements
• Iterative process• Start with existing audit• Reduce to set of questions
– How many patients have …?– Of these how many also have …?– Do they have a record of …?– When was the last …?– How many have a raised …?
• Specify the Read codes• Consultation
3rd April 2001Birmingham
PRIMISFirst National Conference
Specify the Read codes
3rd April 2001Birmingham
PRIMISFirst National Conference
Specify the Read codes
• Initial specification– Start from PRIMIS query sets
• Clinical consensus– Different ways to code conditions– Different systems– PRIMIS Clinical Advisory Group
3rd April 2001Birmingham
PRIMISFirst National Conference
Specify the Read codes
• Need codes for each– diagnosis– treatment– medication
• Require codes for– each version of Read codes– any local or system specific codes
3rd April 2001Birmingham
PRIMISFirst National Conference
Create query definitions
• Identify the subsets required• Query for each type of data• Specify selection criteria• Decide on output and therefore style
– Subset– Analyse– Report
• Specify the output
3rd April 2001Birmingham
PRIMISFirst National Conference
Styles of HQL queryStyles of HQL query
• SUBSET– Selects a sub-population for future analysis or
reporting
• ANALYSE– Counts patients or records meeting selection
criteria– Can count in bands (e.g. by Age, Sex)
• REPORT– Extracts selected data about patients in a sub-
population– Allows more detailed subsequent analysis
3rd April 2001Birmingham
PRIMISFirst National Conference
Writing queries
• Create new set for each disease area
• New query for each – Subset– Condition
• Add selection criteria as specified• Add the output • Quality assurance and piloting
3rd April 2001Birmingham
PRIMISFirst National Conference
3rd April 2001Birmingham
PRIMISFirst National Conference
Feedback Software
Lynne WrightPRIMIS Information Manager
3rd April 2001Birmingham
PRIMISFirst National Conference
Creating a Rush feedback spreadsheet
3rd April 2001Birmingham
PRIMISFirst National Conference
Structure
• Rush Import directory on local hard drive– Containing:
• RushImport ini file• Response import ini file
• Rush template in the template directory of Microsoft office
• Directory of aggregated responses
3rd April 2001Birmingham
PRIMISFirst National Conference
Aggregated Responses
• Using Response Manager• Select responses to aggregate• Select Rush layout• Click the aggregate button
3rd April 2001Birmingham
PRIMISFirst National Conference
Response Manager
3rd April 2001Birmingham
PRIMISFirst National Conference
Aggregated Layout
F F F F F F F F Query name Site Date series 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 [TARGAAGE] Age Sex breakdown of target group A PIT20 01/04/01 0 0 0 0 0 0 0 0 PIT22 01/04/01 0 0 0 0 0 0 0 0 PIT23 01/04/01 0 0 0 0 0 0 0 0 PIT24 01/04/01 0 0 0 0 0 1 0 0 PIT25 01/04/01 0 0 0 0 0 0 0 1 PIT26 01/04/01 0 0 0 0 0 0 0 0 PIT27 01/04/01 0 0 0 0 0 0 0 0 PIT28 01/04/01 0 0 0 0 0 0 0 0 PIT29 01/04/01 0 0 0 0 1 0 0 2
3rd April 2001Birmingham
PRIMISFirst National Conference
Two Control (ini) files
• ‘RushImport’ – Controls the import directory
• ‘Response import’– Lists all responses to be imported– Order of the responses– Title of the responses to be shown
both on the sheet tab and in the sheet heading
3rd April 2001Birmingham
PRIMISFirst National Conference
Ini File
3rd April 2001Birmingham
PRIMISFirst National Conference
Preparing a Rush Spreadsheet
• Aggregated analyse responses in Rush format
• Control (ini) files for import• Rush import sheet• Rush Excel template
3rd April 2001Birmingham
PRIMISFirst National Conference
Rush Excel Template
• Using the Import data button to select:– Control (ini) file– Response directory
• Check the response files• Import the response files
3rd April 2001Birmingham
PRIMISFirst National Conference
Rush Template (1)
3rd April 2001Birmingham
PRIMISFirst National Conference
Rush Template (2)
3rd April 2001Birmingham
PRIMISFirst National Conference
Rush Template (3)
3rd April 2001Birmingham
PRIMISFirst National Conference
So ... let’s do it
3rd April 2001Birmingham
PRIMISFirst National Conference
Feedback Software
Lynne WrightPRIMIS Information Manager
3rd April 2001Birmingham
PRIMISFirst National Conference
3rd April 2001Birmingham
PRIMISFirst National Conference
CHD Audit Feedback
Sue TrinderClinical Audit Facilitator,
Oxfordshire MAAG
3rd April 2001Birmingham
PRIMISFirst National Conference
Individual Practice Feedback
• Individual practice report– Crude and age/sex standardised prevalence– All audit criteria reported on– List of patients with operation codes without
diagnosis codes given– List of patients with either monitoring or
relevant drug codes without a diagnosis code given
• Aim to improve CHD registers
3rd April 2001Birmingham
PRIMISFirst National Conference
Individual Practice Feedback
• Practice-based 2-hour workshop offered to all practices built around their audit results– Part of each workshop looks at data
management issues within the practice• The use of recommended Read codes• Computer templates• Protocols
• Training needs identified and training arranged– Read Code training– Creating templates– Use of clinical system search engine
3rd April 2001Birmingham
PRIMISFirst National Conference
Comparative Feedback
• PCG report– Anonymised data compared at PCG and
county level
• PCG clinical governance CHD workshops held– CHD NSF implementation plans agreed– Training needs identified
• Practice nurse / GP 20-hour CHD workshops arranged
• One PCG funded clinical system training
3rd April 2001Birmingham
PRIMISFirst National Conference
CHD Audit Feedback –Next Time
• Include a list of all of the codes used in each query in the practice reports
• 2-hour workshops – huge time commitment– Include clinical governance leads?– Commission specialists?
• Would like to have the Rush software available for MAAG use
3rd April 2001Birmingham
PRIMISFirst National Conference
Discussion Session
• MIQUEST– software questions?– query questions?– Rush questions?
3rd April 2001Birmingham
PRIMISFirst National Conference