Analysis Of National Administrative Data Research Articles

Intervention Pathways following a Social Work Assessment: An Analysis of National Administrative Data for Children’s Social Care in England

Abstract The majority of children referred to social care services in England go on to receive a statutory assessment by a social worker. Research has identified consistent categories of demand based on the needs identified in assessments. However, little is known about the relationship between children’s assessed needs and their subsequent intervention pathways. To explore this relationship, secondary analysis was undertaken of a national administrative data-set including all children who received a social work assessment in England from 2015 to 2020 (n = 3.6 m). Children’s characteristics, assessed needs and intervention pathways were compared for each episode of CSC involvement. Regression analysis then explored how the proportion of children receiving different types of provision varied according to their needs as well as intersections of gender, age and ethnicity. The findings showed significant differences across twelve categories of demand, pointing to variation in the assessment and response to similar types of presenting needs. Implications are discussed for the planning and design of services.

Osteoporotic fracture admissions compared to other major medical admissions in Irish public hospitals.

Recent multinational reports suggest Ireland has one of the greatest illness burdens related to osteoporosis, manifesting clinically as fragility fractures (FF). International reports show that FF incidence, rate of hospital admission and cost are similar or greater than those for breast cancer, myocardial infarction and stroke. Studies addressing the illness burden of osteoporosis in Ireland are few, and none compares fragility fractures to other common chronic diseases. A retrospective analysis of national administrative data for all public hospital admissions was performed on adults aged 50years and older from January 2008 to December 2017. In 2017, public hospital bed days for FF totalled 249,887 outnumbering Chronic Obstructive Pulmonary Disease (COPD): 131,897; 6 solid cancers (CA): 118,098; myocardial infarction (MI): 83,477; and diabetes mellitus (DM): 31,044. Bed days for FF increased by 43% between 2008 and 2017, in contrast to a 32%, 28% and 31% reduction for CA, MI and DM, respectively, and a 12% increase for COPD. Public hospital bed days for FF in 2016 were greater than MI, stroke, atrial fibrillation and chest pain combined but less than a combination of COPD, pneumonia and lower respiratory tract infection. Osteoporotic fractures represent a large and rapidly increasing illness burden amongst older Irish adults, with substantial care requirements and the resulting onus on our healthcare system. Urgent action is needed to address this public health issue and the services for those at risk of fracture.

Estimating local need for mental healthcare to inform fair resource allocation in the NHS in England: cross-sectional analysis of national administrative data linked at person level.

Equitable access to mental healthcare is a priority for many countries. The National Health Service in England uses a weighted capitation formula to ensure that the geographical distribution of resources reflects need. To produce a revised formula for estimating local need for secondary mental health, learning disability (intellectual disability) and psychological therapies services for adults in England. We used demographic records for 43 751 535 adults registered with a primary care practitioner in England linked with service use, ethnicity, physical health diagnoses and type of household, from multiple data-sets. Using linear regression, we estimated the individual cost of care in 2015 as a function of individual- and area-level need and supply variables in 2013 and 2014. We sterilised the effects of the supply variables to obtain individual-need estimates. We aggregated these by general practitioner practice, age and gender to derive weights for the national capitation formula. Higher costs were associated with: being 30-50 years old, compared with 20-24; being Irish, Black African, Black Caribbean or of mixed ethnicity, compared with White British; having been admitted for specific physical health conditions, including drug poisoning; living alone, in a care home or in a communal environment; and living in areas with a higher percentage of out-of-work benefit recipients and higher prevalence of severe mental illness. Longer distance from a provider was associated with lower cost. The resulting needs weights were higher in more deprived areas and informed the distribution of some 12% (£9 bn in 2019/20) of the health budget allocated to local organisations for 2019/20 to 2023/24.

Exploring the impacts of the 2012 Health and Social Care Act reforms to commissioning on clinical activity in the English NHS: a mixed methods study of cervical screening

ObjectivesExplore the impact of changes to commissioning introduced in England by the Health and Social Care Act 2012 (HSCA) on cervical screening activity in areas identified empirically as particularly affected...

Assessment of Guideline Discordance With Antimicrobial Prophylaxis Best Practices for Common Urologic Procedures

The American Urological Association guidelines recommend 24 or fewer hours of antimicrobial prophylaxis for most urologic procedures. Continuing antimicrobial therapy beyond 24 hours may carry more risks than advantages. To assess guideline discordance of antimicrobial prophylaxis for common urologic endoscopic procedures, and to identify opportunities for improving antimicrobial prescribing through future stewardship interventions. This multicenter cohort study conducted manual audits of medical records of 375 patients who underwent 1 of 3 urologic procedures (transurethral resection of bladder tumor [TURBT], transurethral resection of the prostate [TURP], and ureteroscopy [URS]) at 5 Veterans Health Administration facilities from January 1, 2016, to June 30, 2017. Antimicrobial prescribing practices across the national Veterans Health Administration system were assessed using the administrative data for 29 530 records. Guideline discordance was assessed in the medical record review. Excessive postprocedural antimicrobial use was measured in the national administrative data analysis. The medical records of a total of 375 patients were manually reviewed. Among the 375 patients, 366 (97.6%) were male and 9 (2.4%) were female, with a mean (SD) age of 64.2 (10.9) years and a predominantly white race/ethnicity (289 [77.1%]). In addition, 29 530 patient records in the national administrative database were assessed. Among the patient records, 28 938 (98.0%) were male and 592 (2.0%) were female with a mean (SD) age of 69.1 (10.2) years and a predominantly white race/ethnicity (23 297 [78.9%]). Among the manually reviewed medical records, periprocedural or postprocedural antimicrobial prescribing was guideline discordant in 217 patients (57.9%). Postprocedural antimicrobial agents were continued beyond 24 hours in 211 patients (56.3%) and were guideline discordant in 177 patients (83.9%), with a median (interquartile range) duration of 3 (3-5) days of unnecessary antimicrobial therapy. In the analysis of national administrative data, excessive postprocedural antimicrobial agents were prescribed in 10 988 of 29 350 patient records (37.2%), with a median (interquartile range) of 3 (2-6) excess days. For any given facility, a statistically significant correlation was observed in the frequency of postprocedural antimicrobial prescribing between any 2 procedures, indicating that facilities with higher rates of excessive use for 1 procedure also had higher rates for another procedure: TURP and TURBT (ρ = 0.719; 95% CI, 0.603-0.803; P < .001), TURP and URS (ρ = 0.629; 95% CI, 0.476-0.741; P < .001), and TURBT and URS (ρ = 0.813; 95% CI, 0.724-0.873; P < .001). In this study of patients who underwent common urologic procedures, the rate of guideline-discordant antimicrobial use was high mostly because of overprescribing of postprocedural antimicrobial agents; future antimicrobial stewardship interventions should target the postprocedural period.

Grommet Surgery in Children With Orofacial Clefts in England.

To assess grommet insertion practice in the first 5 years of life among children with an orofacial cleft in England. Analysis of national administrative data of hospital admissions. National Health Service hospitals, England. Patients born between 1997 and 2005 who underwent surgical cleft repair. Children receiving grommets before the age of 5 years. The proportion of children receiving grommets before the age of 5 years, the timing of the first grommet insertion, and the proportion of children having repeat grommet insertions were examined according to cleft type, the absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. The study included 8,269 children. Before the age of 5 years, 3,015 (36.5%) children received grommets. Of these, 33.2% received their first grommets at primary cleft repair and 33.3% underwent multiple grommet insertion procedures. The most common age for the first procedure was between 6 and 12 months. Children with a cleft affecting the palate were more likely to receive grommets than children with a cleft lip alone (45.5% versus 4.5%). Grommet insertion practice also varied according to year of birth, absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. Grommets practice in children with a cleft appears to vary according to their clinical characteristics. The differences in practice observed according to deprivation and region of residence need to be further explored.

The Impact of Transferring Stroke Patients: An Analysis of National Administrative Data.

Interhospital transfer is an important but resource-intensive pattern of care. The use for stroke patients is highly dependent upon health system structure. We examined the impact of hospital transfers for stroke care in Canada. We analyzed hospital administrative data within the Canadian Institute for Health Information (CIHI) Database for the 3 fiscal years 2011/12, 2012/13 and 2013/14. Patients with clinical stroke syndrome (ischemic or hemorrhagic) were identified using International Classification of Diseases. Stroke centers were defined by Heart & Stroke Foundation of Canada stroke report. During the 3-year period,397 patients in Canada (excluding Quebec) were admitted to hospital for clinical stroke syndrome. Median age was 75 (interquartile range [IQR] 64-84) years; 50.6 % were male. Less than 5% (n=4030) of patients were transferred. Patients transferred to stroke centers were younger (p<0.001) and had shorter median length of stay (p<0.001). The highest probability of discharge home was associated with sole care at stroke center (43.8%). Transfer to stroke center from community hospital had the highest probability for discharge to rehabilitation facility (25%) and lowest to either long-term (2.1%) or complex community care (2.0%). Transferred patients had lower mortality at discharge. Younger patients were transferred more frequently to stroke centers; older patients were more likely treated in community hospitals. Sole stroke center care was associated with high discharge rate to home; transfer to a stroke center was associated with high discharge rate to rehabilitation and lower mortality rates.

OP44 A framework for monitoring nhs equity performance – small area analysis of national administrative data from 2004/5 to 2011/12

Background In 2003, tackling health inequalities was made a priority for the NHS as part of a cross-governmental strategy, and in 2012 a duty was placed on those commissioning NHS services to consider reducing inequality in healthcare access and outcomes. We assess progress between 2004/5 and 2011/12, with the aim of developing the first systematic approach to monitoring socioeconomic inequalities in NHS access and outcomes. Methods Indicators of healthcare access and outcomes at different stages of the patient pathway were constructed for all English small areas (2001 LSOAs) from 2004/5 to 2011/12 using GMS, QOF, HES and ONS mortality and population data – (1) GP supply: full time equivalent (FTE) GPs per 100,000 population, excluding registrars and retainers, need-weighted using the Carr-Hill workload adjustment, (2) primary care quality: quality and outcomes framework clinical performance, weighted by public health impact, (3) hospital waiting time: days from referral-to-treatment, allowing for patient-level casemix, (4) amenable hospitalisation: unplanned hospitalisation per 100,000 population for conditions amenable to healthcare, indirectly age-sex-standardised, (5) excess hospital stays: proportion of inpatients with excess length of stay, allowing for patient-level casemix, (6) post-hospital mortality: 12-month mortality after discharge, allowing for patient-level casemix and comorbidity, (7) amenable mortality: deaths from causes amenable to health care per 100,000 population, indirectly age-sex-standardised. Slope and relative indices of inequality were calculated through small-area-level regression using all 32,482 Index of Multiple Deprivation 2010 ranks, with regression-based tests of change over time. Equity “dashboards” were developed to communicate findings to decision makers in a concise form. Results Nationally, all unadjusted relative indices of inequality fell from 2004/5 to 2011/12 (with 95% CIs in brackets, where negative indices represent “pro-poor” inequality): (1) for GP supply from –2.2% [–2.9% to –1.6%] to –9.5% [–10.2% to –8.8%], (2) for primary care quality from 4.1% [3.6% to 4.6%] to 1.1% [0.6% to 1.6%], (3) for hospital waiting time from 3.2% [2% to 4.4%] to 2.7% [1.5% to 3.8%], (5) for excess hospital stays from 13.8% [14.7% to 12.9%] to 8% [9% to 7.1%], (6) for post-hospital mortality from 0.6% [2.3% to –1.2%] to –4.5% [–2.6% to –6.4%], and (7) for amenable mortality from 34% [36.5% to 31.4%] to 11.9% [14.6% to 9.2%]. Conclusion Socioeconomic inequality in healthcare access and outcomes in the English NHS reduced between 2004/5 and 2011/12 in both relative and absolute terms on all our indicators (unadjusted), though all indicators except GP supply and post-hospital mortality continued to exhibit “pro-rich” inequality. The main study limitations are imperfect adjustments for need and risk and measurement of socioeconomic status using neighbourhood deprivation.

Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

BackgroundThe UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice...