BEST outcomes & benchmarking data: a suggested menu agreed by BACCH
Data type(& quality domain) / no / Name / Data availability / Comments / Suggested level
Green is immediate! / Availability for your service
A. Financial data
(efficiency) / 1 / Reference costs for statutory and non-statutory work / Mandatory
Check your trust data / See attached extract
Unavoidable! / I
B. Activity data
(access) / 2 / Numbers of
Each type of contact: eg attended, telephone,dna, single , multi-professional , new, follow up / Mandatory
Check your trust data in the reference costs publication / Comparingdna rates is very important as services are being asked to cut these down to 5% / I
3 / Further contact plans review (clinic, telephone, mdt), discharge / Mandatory in theory / May not be readily available / II
4 / Onward referrals (to specified professionals / Mandatory in theory / May not be readily available / II
C. Clinical “load” data / 5 / Number of cases on current caseload (being seen) / Mandatory recording of nhs number / From nhs numbers / I
6 / Number of cases per medical WTE
(adjust for trainees) / From staff numbers / Important as correct skill mix essential and permanent doctors carry ultimate responsibility / I
7 / Number of cases per total clinical WTE / From staff numbers in MDTS / Important for ADHD/ASD/specialist nurses. Ideally should include therapists? In which case their activity needs including too. / II if nurses
III if full MDT
8 / Caseload composition by pathway and or % of relevant key conditions / Requires coding of pathway and of at least key diagnoses / See proposed tool for key diagnoses
See proposed pathway list / I if coding diagnoses if not:
II for key diagnoses
III for pathways but sample would suffice
9 / Caseload persistence: numbers on the caseload for over 3 financial(= at least 24 months)years and diagnostic breakdown by key conditions / Number of cases can be obtained with help from IMT using NHS number; important to fight unvalidatednew:follow up ratios being imposed / See proposed tool for key diagnoses / II for numbers
III for key diagnoses
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Fawzia Rahman, Cliona Ni Bhrolchain & Ben Ko December 2013
BEST outcomes & benchmarking data: a suggested menu agreed by BACCH
Data type(& quality domain) / no / Name / Data availability / Comments / Suggested level
Green is immediate! / Availability for your service
D. Population weighted data / 10 / Referrals rates per population covered for the service / Only needs population numbers as referrals numbers should be available / Very important comparative measure, overlooked / I
11 / Referrals rates per population covered for the service by main pathway / Requires pathway coding / Essential for meaningful comparisons / III but sample over 3 months would be acceptable
12 / % of population on caseload / Only needs population numbers as referrals numbers should be available / Essential;estimated to be around 3.5% (Bristol), depends upon ADHD rates (up to 2.5%) / I
(Equity) / 13 / % of population on caseload by deprivation quintile / Uses NHS number to derive quintile / Useful for deprived areas
More disability in deprived quintiles / I
(Equity) / 14 / Ethnicity breakdown of background population vz caseload population / Ethnicity recording is mandatory / Useful for mixed ethnicity areas / I at least sample for ethnicity
15 / % of population on caseload with key conditions e.g. ADHD on medication, ASD, Cerebral palsy, Downs, epilepsy, sensory impairment / Requires coding of key conditions / I if coding diagnoses
II if not coding routinely ,for key diagnoses only
E. Clinical improvement data
(technical effectiveness) / 16 / Condition status: Clinically estimated by clinician from clinical consultation:same/ stable/ improved/ worse / Requires specific coding; can be attacked as biased but it is very simple, can be used for all the caseload and takes into account the patient/ family view / Only done in Derby routinely; worse coded cases have been audited; no problems reported; about half show improvement/ stability. Included here for discussion / ?
Sampling would be adequate
17 / Condition status measured by clinician using defined scales e.g. Conners/ SDQ/GMFS ( cerebral palsy)/ sleep / growth / Information may be
in record but difficult to extract / More objective but can only be used for a few specified conditions; CAHMS are expected to use these at start 3 months 6 months and discharge / Probably best done as part of condition specific audits until full electronic patient record but services should incorporate this into the E H R templates
18 / Quality of life measures
a. Measured using scales such as Peds QL / Information may be in record but difficult to extract / Debate over which measure to use; Derby using generic paeds QL but CP QL available / III sampling would be adequate; should be incorporated in EHR
19 / Quality of life measures
b. Measured using a reporting system on barriers to home life/ Participation/school / Coding and tool in development / Suggested by BACD informatics lead with suitable codes and supported by heath outcomes forum / Await suitable tool development
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Fawzia Rahman, Cliona Ni Bhrolchain & Ben Ko December 2013
BEST outcomes & benchmarking data: a suggested menu agreed by BACCH
Data type(& quality domain) / no / Name / Data availability / Comments / Suggested level
Green is immediate! / Availability for your service
F.”Performance” measures
effectiveness / 20 / Time from referral to diagnosis for sentinel conditions (ASD ADHD, cerebral palsy, significant LD)- / Requires coding for key conditions at least
(median with spread) / Being proposed by health outcomes forum J / I if coding diagnoses
III if not , for key conditions
Effectiveness / 21 / Time from referral to treatment (as defined) 18 week RTT / Mandated in theory for all cases; requires RTT coding / All services should be coding for RTT at least for sentinel conditions / I if coding RTT
III if not coding &need to use paper tool for index conditions
Efficiency / 22 / Number of appointments to diagnosis for sentinel conditions / Requires diagnostic coding but simple IT calculation / Important for ASD & ADHD as affects new:follow up ratio / I if coding diagnoses
III if not
Efficiency / 23 / Number of appointments to discharge / Simple IT calculation / Derby data showed that this took 3 appointments & 4 if dna included for children not discharged on first contact / ? I in theory
Yields per year and per pathway efficiency& effectiveness / 24 / ASD/ADHD:
i. Numbers diagnosed each year with ASD/ADHD/LD
ii. Number where diagnosis of ASD/ ADHD was excluded
iii. Number of referrals falling into each of above categories (pathway yield)
iv. Comparison with expected numbers and already known in background population / i & ii require diagnostic coding but simple IT calculation
iii requires pathway coding / If there is an ASD/ADHD lead they would be expected to keep data on numbers diagnosed! / I if coding diagnoses
?if not
Yields per year & per pathway (efficiency& effectiveness / 25 / Other Developmental problems pathway
i.Number where diagnosis of developmental problem confirmed and type , eggeneralised LD
ii.Number where developmental problem excluded
iii .No of referrals falling into each of above categories
iv. Comparison with expected & already known numbers from background population / i& ii require diagnostic coding but simple IT calculation
iii requires pathway coding / Yields per pathway will depend upon how each local pathway is set up; however after the first screening stages similar yields would be expected; this needs analyzing in conjunction with referral rates per pathway and known numbers in population. / I if coding diagnoses
1
Fawzia Rahman, Cliona Ni Bhrolchain & Ben Ko December 2013
BEST outcomes & benchmarking data: a suggested menu agreed by BACCH
Data type(& quality domain) / no / Name / Data availability / Comments / Suggested level
Green is immediate! / Availability for your service
F.”performance measuresctd
Yields per year & pathways (efficiency& effectiveness / 26 / Other pathways as relevant to service eg epilepsy
i. Number where diagnosis confirmed
ii.Number where problem excluded
iii. No of referrals falling into each of above categories
iv.Comparison with expected numbers from background population / i & ii require diagnostic coding but simple IT calculation
iii requires pathway coding / See BACCH prospectus & calculator / I if coding diagnoses
G. Clinical audit data / 27 / List of reports from specific audits / variable / Should reflect clinical services provided / BACCH will develop an audit compendium
H. Feedback data from CYPs parents and carers
(Interpersonal effectiveness) / 28 / Spontaneous e.g. compliments and complaints / mandatory / Difficult to collect compliments. Safeguarding work attracts more complaints / I for complaints
Interpersonal effectiveness / 29 / Anonymised e.g. RCPCH CCF form, service surveys (ESQ), MPOC / Mandatory yearly for services
Mandatory 5 yearly for revalidation / RCPCH has been asked if they can merge CCFdata from drs in the same service / I for service, usually coordinated by trust.
Interpersonal effectiveness / 30 / Service Area specific eg child protection work.& LAC work / Done in Derby for both csa and nai examination and LAC reviews / Very positive feedback for very stressful work / ?
H. Child heath surveillance data / For services still providing these but should be reported by all CGGS
31 / Age at orchidopexy for undescended testis & proportion operated by recommended age / Should be available from already coded inpatient data / Why is it not being reported already?
32 / Age at operation for congenital cataract & proportion operated by recommended age / Should be available from already coded inpatient data / Why is it not being reported already?
33 / Proportion of children with developmental dysplasia of the hip requiring operative treatment / Should be available from already coded inpatient data / Why is it not being reported already?
Neonatal hearing screening / 34 / Age at detection of congenital sensorineural deafness / Already reported but not by CCG/ geographic area
Neonatal biochemical screening / 35 / Various congenital errors of metabolism / Already reported and audited; included for completeness.
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Fawzia Rahman, Cliona Ni Bhrolchain & Ben Ko December 2013