skin cancer network group audit of clinical performance indicators: data quality and treatment...
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Skin Cancer Network Group
Audit of Clinical Performance Indicators:
Data quality and treatment quality
Anna Murray BSc
Cancer Information Analyst
Standards for Better Health• Clinical performance indicators
• Measurable and comparative data
• Progress assessment locally and at network level
• Merseyside and Cheshire CNG:
Access to services
Consistency of service provision
Compliance with national targets
Clinical Performance Indicators
I. The number of newly diagnosed patients referred by trust and ICD-10 code:
i. 31 day first definitive treatment
ii. 62 day standard
i. Number of patients being treated
ii. Waiting times for treatment
II. Performance of radiotherapy:
Clinical Performance Indicators
III. Clinical trial activity
i. Accrual by MDT in to clinical trials
IV. Sentinel lymph node biopsy
i. Number of patients referred by Breslow score
ii. Number of procedures performed
V. Primary care excisions
i. Number of primary care excisions taking place
I. The number of newly diagnosed patients referred by trust and ICD-10 code:
31 day first definitive treatment: Total number of patients by tumour type for Merseyside and Cheshire (January to December 2008)
367
773
1140367
772
1139
0
1
1
0
500
1000
1500
2000
2500
C43 - Malignant melanoma of the skin C44 - Other malignant neoplasms of the skin(except basal cell carcinoma)
Combined
Nu
mb
er o
f p
atie
nts
Treated after 31 days
Treated on or within 31 days
Total treated
I. The number of newly diagnosed patients referred by trust and ICD-10 code:
62 day standard: Total number of patients by tumour type for Merseyside and Cheshire (January to December 2008)
255 289
544
255
287
542
0
2
2
0
200
400
600
800
1000
1200
C43 - Malignant melanoma of the skin C44 - Other malignant neoplasms of the skin(except basal cell carcinoma)
Combined
Nu
mb
er o
f p
atie
nts
Treated after 62 days
Treated on or within 62 days
Total treated
Data discrepancies• Apparent between CWT data and local trust data• Suggests issues across the network for data uploads• Are performance figures inaccurate?• Somerset Cancer Register should address this• Must make sure that trusts are uploading all of their data• Good quality data is the key
Trust Cancer waiting times data Local trust data
Southport and Ormskirk 43 30
Warrington & Halton 12 15
Arrowe park 57 52
St Helens and Knowsley 40 93
Aintree 6 Awaiting data
Countess of Chester 70 Awaiting data
RLBUHT 91 90
Total 319 298
Comparison of total numbers of patients first seen for Malignant Melanoma in Merseyside and Cheshire Cancer network by trust (January to December 2008)
V. Primary care excisions
Research and audit:
‘…the planned treatment of low-risk BCCs should be restricted to approved doctors…, usually a GPwSI…or the LSMDT/SSMDT. All other skin cancers should be referred to the LSMDT in the first instance (National Institute for Clinical Excellence, 2006).’
•If the lesion is not a BCC, then the patient should be urgently referred (National Institute for Health and Clinical Excellence, 2006)
• Abnormal growths/inflammations to be treated by GPs unless there is doubt with regards to diagnosis (National Institute for Health and Clinical Excellence, 2006)
V. Primary care excisions
TrustC43 - Malignant
melanoma of the skin
C44 - Other malignant neoplasms of the skin (except
basal cell carcinoma)Combined
RLBUHT 9 23 32
WUTH 2 20 22
St. Helens & Knowsley 6 13 19
Southport & Ormskirk Awaiting data Awaiting data Awaiting data
Countess of Chester Awaiting data Awaiting data Awaiting data
Network 17 56 73
• Malignant melanoma – 4.6%
• Squamous cell carcinoma – 7.2%
• Combined – 6.4%
V. Primary care excisions
Findings:
• Not all patients diagnosed with either malignant melanoma or squamous cell carcinoma are urgently referred via 2 week wait
• What are the reasons for this?
• Can such cases be avoided in the future?
• Poorer patient experience?
What next?
• Clinical Performance Indicators
• Audit of excision completeness in primary care
• Monitoring uptake in to clinical trials
• Audit of patients referred for SLNB
• Breach analysis in CWT data