ukrr – hes linkage james fotheringham sheffield kidney institute
TRANSCRIPT
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UKRR – HES linkage
James FotheringhamSheffield Kidney Institute
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Why do this at all?
2002 2003 2004 2005 2006 2007 2008 20090
10
20
30
40
50
60
70
80
90
100
49.362 66.4
52.160.1
5446.8 44.4
Year of data collection
Perc
enta
ge D
ata
Com
plet
enes
s fo
r Com
orbi
dity
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USRDS
Period prevalent dialysis patients age 20 & older. At the end of 1998 a new ICD-9-CM code was added for infections due to internal devices in peritoneal dialysis patients; data prior to this date are omitted. Infections in this category include those related to vascular access devices or peritoneal dialysis catheters. Dialysis patients, 2005, used as reference cohort. Rates adjusted for gender, race, & primary diagnosis.
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Potential avenues it opens up
• Hospitalisation• Procedures• Location• Diagnosis• Superior position to USRDS in that we can
describe events preRRT in < 65 year olds– Centre attributable outcomes
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Linkage & Dataset & Fields
21,268 Incident RRT Patients
2002 - 2006
Hospitalisations, Procedures & Outpatient
Episodes1998 to Date
Cause of Death & Location
HES
ANONYMISED
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Comprehensive timelineDEATH
FRACTURE
PARATHYROIDECTOMY
START
OF RRT
AVF
FORMATION
MI
DIABETES
HESHospital Episode Statistics
CaPhosPTHHb
CHANGE IN
MODALITY
TENCKHOFF
INSERTION
L741X411
M809B142
E119I21
0 1 2 3 4
CABG X3
K423
-1-2 YEARS
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DHSMR / SHMI-D
95%
95%99.8%
99.8%
0 100 200 300 400 500 600 700 800 900 1000
Expected Number of Deaths
0.00
0.25
0.50
0.75
1.00
1.25
1.50
Sta
ndar
dise
d M
orta
lity
Rat
io
Transplant Centre
On Site Renal Services
Visiting Renal Cover> 95% CI> 99.8% CI
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Length of Stay & Frequency of Admission
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Location of Admission
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Better adjusted incident survival & practice characteristics influence it
HES I21 - Myocardial Infarction
HES E10 - Diabetes
HES I71 - Peripheral Vasc. Dis.
HES I50 – Cong. Cardiac FailureNoneCOPDMIPVDDMCCF
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Underpinning all this
• Comorbidity adjustment• Insights into individual units own practice with
relation to hospitalisation and how this differs from national practice
• Begin understanding if HES offers the answers to missing data
• Intuitive way of displaying centre specific data• Demonstrating the utility of HES-linkage
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Recognised pitfalls
• Undercoding and inaccuracies– Early focus will be describing robust endpoints
• Hospitalisation Location• 30 Day Mortality• Length of stay
– Learn what the data can allow us to do
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Progress to date
• Funding and authorisations are in place• HRSS has the HES data• UKRR will shortly be sending their data• Combined dataset should arrive early August
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Thank you