Slide 1
Welcome to this short video demonstration. This video is part of a series of videos to help you understand measures built from the Maternity Services Dataset, often referred to as MSDS
Slide 2
Today we will look at data quality thresholds that support the measure for the Percentage of women receiving continuity of carer (ongoing). This is published with measure ID (COC_receiving_ongoing)
Slide 3
Let’s look at why data quality thresholds are used. Measures built from the Maternity Services Dataset (MSDS) are published at various breakdowns, most commonly:
Provider, National, NHS England (Region), Local Maternity System, MBRRACE Grouping
To try and reduce the impact of poor data quality at provider level on national and sub national breakdowns, we sometimes apply one or more data quality thresholds to measures. Providers have to pass these thresholds for their data for the measure they support to be published and contribute to national and sub national breakdowns.
Provider level data for each data quality thresholds will be published alongside a result of pass or fail. If a provider fails the data quality threshold, no data will be published for the measure that the data quality threshold were supporting and so data for that provider will not be used in any national and sub national breakdowns.
This video will look at the thresholds for COC_receiving_ongoing and show some examples of how these are currently displayed in the published data.
Slide 4
There are four data quality thresholds that support COC_receiving_ongoing. The first is referred to as COC_DQ06 and calculates the Percentage of women who reached 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway and who were discharged from maternity services after being placed on a continuity of carer pathway.
The second is referred to as COC_DQ07 and calculates the Percentage of women who reached 29 weeks gestation 4 months prior to the chosen month, and were placed on a continuity of carer pathway with at least 3 care contacts recorded since their care plan date.
Slide 5
The third DQ measure is referred to as COC_DQ08 and calculates Percentage of care contacts attended and where care professional information was recorded, for women who reached 29 weeks gestation 4 months prior to the chosen month and were placed on a continuity of carer pathway.
The fourth one is referred to as COC_DQ09 and calculates the Percentage of women who reached 29 weeks gestation 4 months prior and were placed on a continuity of carer pathway and had a labour recorded, where the labour had care professional information recorded.
Providers have to pass all of these four measures at greater than 5% for data for COC_receiving_ongoing to be published and included in national and sub national figures.
Slide 6
We will look at the data items in MSDS that contribute to these measures. All of these data items can be found in the technical output specification version 2.0.25 available from the top link. There is also published meta data to explain how the measures are built. This is available following the bottom link. Data items used in these data quality thresholds also exist in the measure they are supporting COC_receiving_ongoing.
Please note, all links in this video are referenced in the transcript for this video.
Slide 7
We will look at each MSDS table in turn. Some data items are derived from several items sent by providers, this is identified in the source field in each table shown in the next few slides. We will start with looking at the table MSD000 Header. We use this table to establish the reporting month and the organisation who submitted the data.
Slide 8
We want to be able to uniquely identify each woman, we do this through data submitted to MSD001 mother’s demographics. From the data submitted by all providers, NHS Digital creates a field called PERSON ID (MOTHER). This is primarily generated from the NHS Number.
Slide 9
We use the table MSD101 pregnancy and booking details to get 4 pieces of information.
- UNIQUE PREGNANCY ID, NHS Digital gives each pregnancy a unique identifier derived through items submitted by all providers. This is used to uniquely identify each pregnancy
- APPOINTMENT DATE (FORMAL ANTENATAL BOOKING), which is used to mark the start of the booking and to calculate gestational age
- GESTATIONAL AGE AT BOOKING, NHS Digital derives this information from the APPOINTMENT DATE (FORMAL ANTENATAL BOOKING) and either the ESTIMATED DATE OF DELIVERY or the LAST MENSTRUAL PERIOD DATE
- DISCHARGE DATE this is used to check if a woman is still in maternity services at 29 weeks gestation, but this is also used to check 4 months later that the woman has been discharged from maternity services
Slide 10
We use MSD102 Maternity Care plan to get care plan details. We need 5 pieces of information
- MATERNITY CARE PLAN DATE to determine date the care plan was put in place
- MATERNITY CARE PLAN TYPE to determine if the care plan was an antenatal care plan, identified by 05
- CONTINUITY OF CARER PATHWAY INDICATOR to determine if there is an indication as to whether this care plan is on the continuity of carer pathway, and we need to see 'Y' here to indicate yes.
- CARE PROFESSIONAL LOCAL IDENTIFIER to determine if a lead midwife has been assigned to the care
- CARE PROFESSIONAL TEAM LOCAL IDENTIFIER to determine if a team has been assigned to the women’s care
Slide 11
We use MSD201 Care Contact (Pregnancy) to get the details of all antenatal and postnatal care contacts during the pregnancy. We need 3 pieces of information
- We take the ‘CARE CONTACT IDENTIFIER’ to uniquely identify each care contact from the care plan date to discharge.
- We need ‘CARE CONTACT DATE’ to identify which care contacts take place between Continuity of Carer care plan date and discharge
- And then we need ‘ATTENDED OR DID NOT ATTEND CODE’ to identify only those care contacts which were attended, we will look for 5 and 6 in this field.
Slide 12
We use MSD202 Care Activity (Pregnancy) to get the details of the activities for the contacts we identified in the previous table MSD201 Care Contact (pregnancy). We need 3 pieces of information from this table.
- The ‘CARE CONTACT IDENTIFIER’ so we can link to the contacts we identified in 201
- The ‘CARE PROFESSIONAL LOCAL IDENTIFIER’ to see whether the woman was seen by their lead midwife during the care contacts
- And the ‘CARE PROFESSIONAL TEAM LOCAL IDENTIFIER’ to identify the team who performed the care activity during the pregnancy.
Slide 13
We use MSD301 Labour and Delivery and MSD302 Care Activity (Labour and Delivery) to get the details of intrapartum care.
- From MSD301 Labour and Delivery, we take ' LABOUR AND DELIVERY IDENTIFIER’ to uniquely identify a labour or delivery
- From MSD302 Care Activity (Labour and Delivery) we take ‘CARE PROFESSIONAL LOCAL IDENTIFIER’ to establish the care professional information is recorded
Slide 14
We use MSD901 Staff Details to get details of the care professionals we have identified in the previous tables we've looked at. We need 2 pieces of information from this table.
- ‘CARE PROFESSIONAL LOCAL IDENTIFIER’ to locate the care professionals named as providing care, and to assess consistency of the woman’s contact with her lead midwife during pregnancy and labour
- We take ' CARE PROFESSIONAL STAFF GROUP (MATERNITY)’ to establish whether the care professional information at a care contact is recorded.
Slide 15
We will start by looking COC_DQ06. This data quality threshold measure is assessing, of all the women who reach 29 weeks gestation 4 months prior to the chosen month how many were discharged from maternity services after being placed on a continuity of carer pathway.
Slide 16
We will start with the denominator: All women who reached 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway.
Slide 17
We use both PERSON ID (MOTHER) and UNIQUE PREGNANCY ID to count unique pregnant women. Both of these are derived as we have seen previously.
Next, we consider only those who reached 29 weeks gestation 4 months prior to the chosen month. We will count this in days, and 29 weeks gestation is 203 days. To calculate this, we take the Gestational age at Booking then add on the number of days between the antenatal appointment date, which is when the gestational age was estimated, and the start of the reporting month, Reporting Period Start Date.
We will do the same calculation but for the reporting period end.
We are interested in only those who reach 203 days gestation between the start and end of the month.
We then consider only women who have been placed on a continuity of carer pathway, who are identified through having an ‘05’ Care Plan Type, a ‘Y’ in the Continuity of Carer Pathway Indicator, and both Care Professional and Team Local Identifiers are populated.
We then look to use the Discharge Date from maternity services to check the woman has not been discharged, or if she has, it was after she reached 203 days gestation.
This is the denominator, all the women who reach 29 weeks gestation 4 months prior to the chosen month who have been placed on a continuity of carer pathway.
Slide 18
We will now look at how the numerator is calculated. We will be looking for women who reach 29 weeks gestation 4 months prior who have been placed onto a continuity of carer pathway by 29 weeks gestation, this is from the denominator. Then we retain only women discharged from Maternity services at some point in the following 4 months.
Slide 19
We use the cohort of women we found for the denominator
We include only those from this group who were discharged from Maternity services at sometime within the next 4 months.
Slide 20
The final step is to take the numerator and the denominator and to create the measure as a percentage. we simply divide the numerator by the denominator and multiply by 100 to get a percentage.
Slide 21
Next, we will look at COC_DQ07. This data quality threshold measure is assessing, of women who reached 29 weeks gestation 4 months prior and were placed on a continuity of carer pathway, how many have at least 3 care contacts recorded since their care plan date.
Slide 22
We will start with the denominator: All women who reached 29 weeks gestation 4 months prior to the chosen month who were placed on a continuity of carer pathway.
Slide 23
The denominator for COC_DQ07 has same build as the denominator for COC_DQ06, i.e., all the women who reach 29 weeks gestation 4 months prior to the chosen month who were placed on a continuity of carer pathway
Slide 24
Next, we will look at the build of the numerator.
Slide 25
For the numerator, we will be looking for women who reach 29 weeks gestation 4 months prior and who were placed on a continuity of carer pathway, this is from the denominator. Then we retain only women with at least 3 care contacts recorded after their continuity of carer plan date.
Slide 26
The final step is to take the numerator and the denominator and to create the measure as a percentage. we simply divide the numerator by the denominator and multiply by 100 to get a percentage.
Slide 27
Next, we will look at the third DQ measure COC_DQ08. This data quality threshold measure is assessing for women who reach 29 weeks gestation 4 months prior and were placed on a continuity of carer pathway, of all the care contacts since their care plan date, the number of those care contacts which were attended and included care professional identity and staff group information.
Slide 28
We will start with the denominator: Number of care contacts since the care plan date for women who reached 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway.
Slide 29
For the denominator, first we will identify all the women who reach 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway. For this we use the same logic used for other DQ measures as explained in the previous slides.
Then we get the number of care contacts recorded for the women since their care plan date by ensuring the care contact date is on or after the care plan date, and the discharge date is not populated or is greater than or equal to the Care Contact Date for each of the care contacts.
Slide 30
Next, we will look at the build of the numerator. Number of care contacts for women who reach 29 weeks gestation 4 months prior, where the care contacts were attended and included care professional identity and staff group information.
Slide 31
For the numerator, first we will be looking at the number of care contacts recorded since their care plan date for the women who reach 29 weeks gestation 4 months prior, this is from the denominator. Then retain only those care contacts which were attended and included care professional identity and staff group information.
We do this by only looking for care contacts where the attend code is 5 or 6 and the staff group is between 01 and 16, or 98, as shown in this slide.
Slide 32
The final step is to take the numerator and the denominator and to create the measure as a percentage. we simply divide the numerator by the denominator and multiply by 100 to get a percentage.
Slide 33
Next, we will look at the fourth and final DQ measure COC_DQ09. This data quality threshold measure is assessing, of all the women who reach 29 weeks gestation 4 months prior, who were placed on a continuity of carer pathway with a labour recorded at some point in the following 4 months, how many had care professional information recorded for labour.
Slide 34
We will start with the denominator: Number of women who reach 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway, with a labour recorded at some point in the following 4 months.
Slide 35
For the denominator, first we will identify all the women who reach 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway. For this we use the same logic used for other DQ measures as explained in the previous slides.
Then we retain only those women who had a labour recorded at some point in the following 4 months. By looking for a record for pregnancy in MSD301 Labour Delivery.
Slide 36
Next, we will look at the build of the numerator. Number of women who reach 29 weeks gestation 4 months prior, who were placed on a continuity of carer pathway, with a labour recorded at some point in the following 4 months and had care professional information recorded.
Slide 37
For the numerator, first we will be looking at the number of women who reach 29 weeks gestation 4 months prior and were placed on a continuity of carer pathway and had a labour recorded at some point in the following 4 months, this is from the denominator. Then retain only those who had care professional information recorded in MSD302 Care Activity (Labour and Delivery).
Slide 38
The final step is to take the numerator and the denominator and to create the measure as a percentage. we simply divide the numerator by the denominator and multiply by 100 to get a percentage.
Slide 39
Providers need to pass all the four data quality thresholds COC_DQ06, COC_DQ07, COC_DQ08 and COC_DQ09 at greater than 5%. We will now look at how this is showing up in published data
Slide 40
We will use data published for July 2021, the link for this available from the transcript below this video. We will look at two randomly selected organisations.
- First, we will look at R0A, we can see from this image that R0A have passed only COC_DQ07 with 85.1% of women who reached 29 weeks gestation 4 months prior has at least 3 care contacts recorded since their care plan date. However, they have not passed COC_DQ06, COC_DQ08 and COC_DQ09 as the corresponding rate is not greater than 5%.
- Next, we will look at RA2, here we see they have passed all four data quality thresholds with rate greater than 5%.
We will next look at what this means for the measure COC_receiving_ongoing that these thresholds are supporting .
Slide 41
As R0A did not pass all data quality thresholds their data is not published in the final measure of COC_receiving_ongoing and does not feature in the national or sub national figures either
As RA2 have passed all four data quality thresholds their data for COC_receiving_ongoing is published and will contribute to national and sub national figures
Slide 42
Let’s look at the overall picture. For July 2021, 124 providers submitted data to MSDS. Looking at COC_DQ06, 39 providers passed this threshold with an average pass rate of 29%. Meaning that for approximately 29% of women who reached 29 weeks gestation 4 months prior, were discharged from maternity services after being placed on a continuity of carer pathway. 85 providers have not passed this 5% threshold yet as they are not supplying required information.
Similarly looking at COC_DQ07, 112 providers passed this threshold with an average pass rate of 71%. For these providers this means that for approximately 71% of the women who reached 29 weeks gestation 4 months prior to the chosen month has at least 3 care contacts recorded since their care plan date. 12 providers have not passed this 5% threshold based on their data submitted to MSDS.
Note that the threshold of 5% could alter in future as providers start to improve data quality and providers should be aiming to pass a completion rate of much higher than 5% for both data quality thresholds
Providers can access a Data Quality Submission Summary Tool designed to help them understand the validation reports provided after a submission on SDCS cloud portal, please use the link in the transcript to access this.
Slide 43
This brings us to the end of the video.
Thank you for watching this video demonstration we hope you found this useful. This video is part of a suite of videos to help you understand key measures in MSDS.
We value your feedback, please use the email address here if you wish to get in touch: [email protected]
Thank you.