Doug West SCTS Thoracic Audit Lead 2014 LCCOP slides courtesy Richard Page SCTSLiverpool Heart and Chest Ian Woolhouse NLCAQEH Birmingham and Arthur Yelland HSCIC Leeds Overview Long term trends from the SCTS registry ID: 585986
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Slide1
National data in thoracic surgery
Doug WestSCTS Thoracic Audit Lead
2014 LCCOP slides courtesy Richard Page (SCTS/Liverpool Heart and Chest)
Ian
Woolhouse
(NLCA/QEH Birmingham) and Arthur
Yelland
(HSCIC Leeds)Slide2
Overview
Long term trends from the SCTS registryNew structures: the COPInsights from the 2014 COP
Future development and challengesSlide3
The SCTS thoracic registrySlide4
Long term trendsSlide5Slide6Slide7Slide8Slide9
Current situation: SCTS returnsSlide10
Pneumonectomy
as percentage of all lung cancer resections
ProvisionalSlide11
Pneumonectomy
as a percentage of all lung cancer resections by unit 2013-14Slide12
Pneumonectomy
as a percentage of all lung cancer resections 2013-14
N=341 open, 3 VATSSlide13Slide14
Sleeve lobectomy as a percentage of all lung cancer resectionsSlide15
VATS as a percentage of lobectomies for lung cancer
2013-14: n=1271 VATS, 3140 openSlide16
VATS as a percentage of all lobectomies for lung cancerSlide17
The Lung Cancer Surgery Consultant Outcomes Publication (LCCOP)
Public facingOnline at
mynhs (england.nhs.uk) and SCTS.org
Searchable at unit and consultant levelSlide18
HQIP COP in Thoracic Surgery
SCTS / NLCA supported2012 NLCA data
Validated locally by SCTS audit leadsOutcomes: 30 and 90 mortality after any lung resection for primary lung cancer, resection ratesMDT and surgeon unit-level results, not individualSlide19
Transparency agenda
Individual clinician based
Risk adjusted
Publicly reportable
Positive and negative outliers identified from 2015Slide20
COP via
SCTS.orgSlide21
2014 COP: other specialties
Adult cardiac surgery
NACSA (NICOR)
Bariatric surgery
National
Bariatric Surgery Register
Colorectal surgery
National Bowel Cancer Audit
Programme
Head and Neck
DAHNO
Interventional
Cardiology
NICOR
Orthopaedic
surgery
National Joint Registry
Thyroid and Endocrine
BAETS
Upper GI Surgery
National
oesophago
-gastric audit
Urology
BAUS
Vascular
surgery
National Vascular Registry
Neurosurgery
National Neurosurgery Audit
Programme
Urogynaecology
BSUG Audit Slide22
Wider Context
NLCA re-commissioned
late 2014NLCA moving from NHSCIC Leeds to RCP/NottinghamTightening of regulations on Section 251 applicationsSlide23
Lung Cancer Surgery COP
2014 LCCOP slides courtesy Richard Page (SCTS/Liverpool Heart and Chest)
Ian
Woolhouse
(NLCA/QEH Birmingham) and Arthur
Yelland
(HSCIC Leeds)Slide24
Numbers of Operations per Unit
2014 LCCOP slides courtesy Richard Page (SCTS/Liverpool Heart and Chest)
Ian
Woolhouse
(NLCA/QEH Birmingham) and Arthur
Yelland
(HSCIC Leeds)Slide25
NLCA + SCTS Surgery 2012
Primary lung cancer resections
2014 LCCOP slides courtesy Richard Page (SCTS/Liverpool Heart and Chest)
Ian
Woolhouse
(NLCA/QEH Birmingham) and Arthur
Yelland
(HSCIC Leeds)Slide26
MDT Resection Rate
vs MDT VolumeSlide27
Central vs
Peripheral MDTs
2014 LCCOP slides courtesy Richard Page (SCTS/Liverpool Heart and Chest)
Ian
Woolhouse
(NLCA/QEH Birmingham) and Arthur
Yelland
(HSCIC Leeds)Slide28
Resection Rate by Unit
2014 LCCOP slides courtesy Richard Page (SCTS/Liverpool Heart and Chest)
Ian
Woolhouse
(NLCA/QEH Birmingham) and Arthur
Yelland
(HSCIC Leeds)Slide29
30-day Mortality By TrustSlide30
Numbers of procedures per surgeon
Mean = 34
Median = 30
Slide: Richard Page
4
th
quartileSlide31
Number of operations per surgeonSlide32
Future of the LCCOP: short term
NLCA re-commissioning limits change2015 same outputs as 2014
30 and 90 day mortalityResection rateNot risk adjustedUnit / MDT based reporting
Units will validate all dataSlide33
Can we assess thoracic surgeons by mortality after lung resection?Slide34Slide35
Challenges-long term
Risk adjustmentEssentialMay need new adjustment tool
Thoracoscore AOC 0.6-0.68 (Barua 2012,
Badley
2012)
ESOS 0.7-0.8 (
Poullis
2013,
Barua
2012)
Devolved nations
Data sharing vs. separate systems
SCTS audit representation from NI and ScotlandSlide36
What happens to outliers?
“Measurement is the first step that leads to control and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it.”
H Walter HarrisonIBMSlide37
(Likely!) outliers protocol
Letter to unit lead and medical director jointly from NLCA/SCTS (MDT Lead also for resection rate alert)
Local review advised / expectedAll surgeons (+MDT lead if relevant) plus Trust managementRetrospective risk stratification-
Thoracoscore
or other
Assessment of other local evidence- peer review, internal audit, appraisal/revalidation
Involvement of Royal College advised (alert) or expected (alarm)
SCTS support outlinedSlide38
Linking alerts and alarms to Quality Improvement
Report and action to NLCA, commissioners. Reported to next peer review
Included in next appraisalTargeted audit within NLCANatural outcome for alerts / alarms
Might also be self-referred, or from peer review
Nature TBCSlide39
Outcome measures: what is right?
Mortalityeasily defined
fixed periods best
Isolated use may encourage “gaming” and risk avoidance
Longer term outcomes in cancer surgery
Quality of life
Patient involvement
?Cost
Patient defined
Surgeon definedSlide40
COP 2.0- is resection for primary lung cancer enough?
Lung cancer resection about a quarter of all non-endoscopy activitySlide41
Only 32% of deaths occur after resection of lung cancer (2012-3)
COP 2.0- is resection for primary lung cancer enough?Slide42
The (ideal) future
Routine public reporting of cancer and non-cancer activityTeam based reporting (?some role for rolling summed individual data)
Process and outcome endpointsRisk adjustment, model updating over timeReduced burden on reporting units
Immediate link to Quality Improvement at alert and alarm levelsSlide43
Acknowledgements
NLCA
Ian WoolhouseRichard Hubbard
Mick
Peake
Rhona
Buckingham
Roy Castle
Jesme
Fox
Lorraine Dallas
SCTS
Richard Page
Simon Kendall
Joel Dunning
Eric Lim
Carol Tan
David Jenkins