NHS Hospital Episode Statistics Research Articles

A national review of mandibular orthognathic surgery activity in the National Health Service in England over a nine year period: Part 1 - Service factors

We aimed to investigate the changing provision of mandibular orthognathic surgery in England for the period 1 April 1997–30 March 2006. Data on hospital inpatient activity were extracted from the NHS Hospital Episode Statistics (HES) database for all mandibular orthognathic surgical procedures between these dates. We investigated provider factors (in which units providing services were classified as undertaking either high or low volumes of activity) and temporal changes. There was a steady increase in the number of procedures over time, and a decrease in the mean time spent in hospital ( p < 0.001). Provider units with high volumes of activity had shorter inpatient stays than those that provided low volume ( p < 0.001) and exhibited a greater reduction in the duration of inpatient stays ( p = 0.02). Patterns of care are changing, and increasing numbers of treatments are being done as day-cases ( p < 0.001). Units with high volumes seem to be more efficient in terms of duration of hospital stay than low volume units. However, our data do not allow an insight into the quality of care provided, and further research is needed to address this issue.

A national review of mandibular orthognathic surgery activity in the National Health Service in England over a nine year period: Part 2 - patient factors

We aimed to investigate patients who had mandibular orthognathic surgery in England for the period 1 April 1997–30 March 2006. Data on hospital inpatient activity were extracted from the NHS Hospital Episode Statistics (HES) database for all mandibular orthognathic surgical procedures between these dates. Details of patients were investigated in relation to clinical details, socioeconomic status, other diagnoses, and clinical outcomes. Mandibular orthognathic operations were done for 8941 patients in England over the 9-year period, and the ratio of women: men was 1.7:1. The mean (SD) age at operation was 24 (9) years with no difference between sexes. There was a socioeconomic gradient in patients requesting treatment, most of whom lived in relatively affluent areas. The most common other diagnosis was “additional dentofacial anomalies” (8% of episodes). Mental or behavioural diagnoses were recorded in 41 patients (<1%). One patient died in hospital. Our results confirmed the differences in sex in patients receiving orthognathic care and highlighted socioeconomic inequalities in the treated patients. A number of coexisting diagnoses were also identified.

Hospital Episode Statistics and changing trends in glaucoma surgery

A number of authors have documented the decrease in the rate of glaucoma drainage surgery, felt to be owing to increased medical therapy options. There has also been an increase in cataract extraction. The aim of this study was, using the NHS Hospital Episode Statistics (HES), to attempt to confirm these trends and to examine the possibility that these trends are not necessarily independent. The HES was accessed for the main glaucoma procedures between 1998 and 2004 and for cataract operations performed over the same time period. Diagnostic data were also extracted from the HES data for glaucoma. Figures for the changes in glaucoma medications were obtained from pharmaceutical data. Over the period that the data are available, trabeculectomy numbers have reduced by 51%, laser trabeculoplasty by 60%, and laser peripheral iridectomy (PI) by 30%. Cataract extractions have increased by 52%. Medical treatments, especially prostaglandin use, have increased. The number of admissions for acute glaucoma did not increase. The figures indicated a decrease in glaucoma drainage surgery and an increase in cataract extraction-consistent with other studies. More surprisingly, there was no increase in diagnosis of angle closure glaucoma or laser PIs within the figures and we suggest this may in part be related to the increase in cataract extraction. We speculate that this may also partly be responsible for the reduction in trabeculectomies. Although the HES data are a potentially rich source of information, there are potential inaccuracies in the data, which means interpretations must be made with caution.

Identifying ‘unknown diabetics’ using geodemographics and social marketing

This paper reports on a pilot study of the use of geodemographic segmentation and social marketing to identify people at risk of the disease Type II diabetes within a primary care trust (PCT). Geodemographic segmentation data for all GB households were overlaid with UK NHS hospital episode statistics (2001–2002) to predict population groups at risk of Type II diabetes. ‘At-risk’ populations were then profiled within Slough and a targeted social marketing campaign was instigated to encourage those likely to be at risk of the disease but unaware of their symptoms to be screened. The marketing campaign focused on the predominant community most at risk, those South Asians within the Slough, PCT. Health professional and government attempts to date have been largely reactive to managing population disease burden. Chronic disease management has tended to concentrate on case management of only the very sickest patients. The debate is now shifting to a proactive stance: on earlier ‘upstream’ interventions with at-risk populations (those who are not yet sick and those who are sick but receive no treatment) to reduce long-term disease complications and improve health. This pilot study showed geodemographic data can be successfully overlaid with routine NHS data to identify people at risk of Type II diabetes. Coupled with social marketing techniques, a cost-effective and successful screening programme for Type II diabetes is achievable. Referral rates increased critically among those in the early stages of the disease, understanding of the condition was raised within the community and links between the local Asian community and the PCT were strengthened. Such frontloading of NHS resources into targeted interventions has potentially far-reaching repercussions for improving the quality of life of diabetes sufferers. The model has considerable potential for replication among other communities and for different medical conditions.

Trends in number of hysterectomies performed in England for menorrhagia: examination of health episode statistics, 1989 to 2002-3

Twenty years ago 60% of patients with menorrhagia who were referred to a gynaecologist had a hysterectomy as treatment.1 Endometrial ablation was firstdescribed in the United Kingdom in 1989 and...

Assessment of the reproducibility of clinical coding in routinely collected hospital activity data: a study in two hospitals.

The aim of the study was to assess the reproducibility of clinical coding in two National Health Service hospitals within North West Thames region. A retrospective audit was carried out, of clinical coding in hospital episode statistics, involving comparison of the codes assigned by local staff with those assigned by members of an external team unaware of the locally assigned codes. Where local and external coders disagreed, the records were reviewed for a third time by a further independent coder. The subjects were a random sample of 1607 non-maternity, non-psychiatric admissions occurring between 1991 and 1993, stratified for year and type of disease (asthma, diabetes, appendicitis, fractured femur and 'general'--a random selection of any diagnoses). The main outcome measures were the levels of exact agreement between local and external teams over codes for main diagnosis and procedure, and the level of approximate agreement (over the first three characters of the ICD-9 code for diagnosis and the letter and first two digits of the OPCS-4 code for procedure). For disagreements, the outcome measure was the level of agreement between the 'third' coder and the local and external coders. For the main diagnosis in the 'general' group at hospital A, internal and external coders agreed exactly in 43 per cent of the admissions examined and agreed 'approximately' in 55 per cent (kappa = 0.54). For hospital B the corresponding figures were 60 per cent and 72 per cent (kappa = 0.72). Approximate agreement was higher for the specific diseases considered, particularly for asthma (A: 86 per cent; B: 91 per cent) and fractured femur (A: 84 per cent; B: 89 per cent). For the main procedure at hospital A, there was exact agreement for 58 per cent and approximate agreement for 70 per cent (kappa = 0.66). For hospital B, the corresponding figures were 76 per cent and 83 per cent (kappa = 0.80). In cases of disagreement over the first three digits of the ICD-9 code for main diagnosis, the third coder disagreed with both local and external coders in 53 per cent at hospital A and 38 per cent at hospital B. Agreement was slightly better for discharges in 1992-1993 than in 1991-1992. The full clinical codes in NHS hospital episode statistics (HES) data should be treated with caution. The first three characters of ICD-9 codes for diagnoses and the OPCS-4 codes for procedures were more reliable. For some specific conditions such as asthma and fractured femur, reliability of the first three characters is much higher (for example, 86 per cent and 91 per cent for asthma in the two hospitals), but for the full codes can be worse. Secondary diagnoses or comorbidities may be significantly undercoded. A higher level of agreement in 1992-1993 than in 1991-1992 suggests that coding may be improving.