Audits and registries team

The aim is to enable quality improvement to take place where it will be most helpful and will improve outcomes for patients. Registries collect data about the health status of patients and the health care they receive over varying periods of time.

We work with the Healthcare Quality Improvement Partnership (HQIP) and other ALBs (arm's length bodies) to deliver 15 audits, each with their own information governance arrangements, that link data across complex care pathways. We host the data landing platform for these audits, the Clinical Audit Platform, and co-ordinate the analysis of data with other stakeholders to produce regular publications for each audit. National audits are vital to understand the trends of current disease management across the NHS, and to inform national policy. Good models of care can be identified, and unwarranted variation can be addressed. 

Clinical audits and registries are developed and delivered by the Clinical Audits and Registries Management Service (CARMS), working collaboratively with clinical specialists, patient representatives and universities. Audits are commissioned by various organisations including NHS England, the Healthcare Quality Improvement Partnership, DHSC and Royal Colleges.

The content of collected data is determined by:

• commissioners
• government
• charities
• academia
• professional bodies
• medical royal colleges
• patient groups

The audits and registries collected are:

• National Diabetes Audit
• National Bowel Cancer Audit
• National Oesophago-Gastric Cancer Audit
• Female Genital Mutilation (FGM) Enhanced Data Set
• National Audit of Pulmonary Hypertension
• Breast and Cosmetic Implant Registry
• National Diabetes Foot Care Audit
• National Pregnancy in Diabetes Audit
• National Diabetes Inpatient Audit
• National Diabetes Transition Audit
• National Audit of Cardiac Rehabilitation
• National Third Molar Audit
• National Orthognathic Audit
• Out of Area Placements
• Diabetes Prevention Programme (Pilot Study) 

Each audit and registry has its own information governance arrangements, which can impact on its data collection. For example, when the National Diabetes Audit (NDA) changed from a system in which GP practices had to opt in rather than opt out, participation fell from 71% in 2012/13 to 57% in 2013/14. However, since the introduction of a direction from NHS England to NHS Digital to collect the NDA data in April 2017, practices and specialist services are required to collect the data by law, provided that the patient has not opted out. Participation is currently at 95%.

Other challenges to the submission of data include:

• lack of patient understanding of the benefit of participating in audit
• uncertainty about consent
• workforce pressure
• clarity and ease of submission processes for providers
• lack of electronic patient record systems for some specialties

Data is assembled on the clinical audit platform. This is a secure tool where providers can use data entry screens or upload csv files. The clinical audit platform also has a data landing platform.

Work is often carried out in partnership with other organisations when assembling data, including the Healthcare Quality Improvement Partnership (HQIP), Royal College of Surgeons, the British Heart Foundation and various other organisations.
 

The clinical audit platform provides instant feedback on data quality. Validation is carried out in-house. Analysis varies considerably between audits.

Linking of audits and data sets can be carried out and has enormous potential.

Example

The National Diabetes Transition Audit linked the National Paediatrics Diabetes Audit (commissioned by HQIP and run by the Royal College of Paediatrics and Child Health) with the data from the National Diabetes Audit.

A working group was formed that consisted of clinical leads and audit managers for both audits, along with analysts from our organisation and Diabetes UK.

Their analysis discovered that the hba1c target (which indicates good blood sugar control) is more likely to be reached before transition from paediatric care to adult care than after transition, and that cholesterol and blood pressure targets were also more likely to be reached before transition. The analysis included patients undergoing transition at any age between 12 and 24, and proved that transition is most effective between 16 and 19 years. 

Linkage also enables the size of the audit data sets to be minimised by re-using existing data sources where possible.

Audit and registry reports and raw aggregate data can be accessed through our publications system:

• National Diabetes Audit publication
• National Bowel Cancer Audit publication
• National Oesophago-Gastric Cancer Audit publication
• Female Genital Mutilation (FGM) Enhanced Data Set publication
• National Audit of Pulmonary Hypertension publication
• Breast and Cosmetic Implant Registry publication
• National Diabetes Foot Care Audit publication 
• National Pregnancy in Diabetes Audit publication
• National Diabetes Inpatient Audit publication 
• National Diabetes Transition Audit publication 
• National Audit of Cardiac Rehabilitation publication
• National Third Molar Audit publication 
• National Orthognathic Audit publication 
• Out of Area Placements publication 
• Diabetes Prevention Programme (Pilot Study) publication

Customers can commission us to produce bespoke reports, such as management reports and user reports comparing local data against national data.

Health and care organisations who submit data to the audits can use it to monitor how they are doing and look at areas for improvement in care. Researchers, charities, central government, commissioners and others use audit data to improve care for patients. Audits and registries have an important part to play in improving care by:

• identifying and promoting good practice (positive deviance) through benchmarking
• highlighting the gap between actual care and recommended best practice
• identifying inequitable provision of care
• monitoring the effectiveness of a service or intervention
• identifying problems and monitoring progress or trends to inform local or national policy
• identifying at risk groups and enabling product recalls