NHS Digital Data Release Register

NHS Digital Data Release Register - reformatted

The University of Manchester

Opt outs honoured: N

Basis: Informed Patient consent to permit the receipt, processing and release of data by the HSCIC

Format: Identifiable Non Sensitive

How often: Ongoing

When: unknown — 11/2016

HSCIC Id: DARS-NIC-147811-YTH88-v0.0

Data: MRIS - Cohort Event Notification Report

Data: MRIS - Cause of Death Report

Data: MRIS - Flagging Current Status Report

Data: MRIS - Cause of Death Report

Data: MRIS - Cohort Event Notification Report

Data: MRIS - Scottish NHS / Registration

Data: MRIS - Cause of Death Report

Data: MRIS - Cohort Event Notification Report

Data: MRIS - Cause of Death Report

Data: MRIS - Scottish NHS / Registration

Data: MRIS - Cohort Event Notification Report

Data: MRIS - Flagging Current Status Report

Data: MRIS - Cause of Death Report

Data: MRIS - Cohort Event Notification Report

Data: MRIS - Scottish NHS / Registration

Data: MRIS - Cohort Event Notification Report

Data: MRIS - Members and Postings Report

Data: MRIS - Personal Demographics Service

Data: MRIS - Cohort Event Notification Report

Data: Hospital Episode Statistics Admitted Patient Care

Data: MRIS - List Cleaning Report

Data: Hospital Episode Statistics Accident and Emergency

Data: Hospital Episode Statistics Admitted Patient Care

Data: Hospital Episode Statistics Outpatients

Data: MRIS - Scottish NHS / Registration

Data: Patient Reported Outcome Measures (Linkable to HES)

Data: Hospital Episode Statistics Accident and Emergency

Data: Hospital Episode Statistics Outpatients

Data: Hospital Episode Statistics Admitted Patient Care

Data: Office for National Statistics Mortality Data (linkable to HES)

Data: MRIS - Flagging Current Status Report

Data: MRIS - Scottish NHS / Registration

Data: MRIS - Cause of Death Report

Data: MRIS - Cohort Event Notification Report

Data: Office for National Statistics Mortality Data

Data: Hospital Episode Statistics Accident and Emergency

Data: Hospital Episode Statistics Admitted Patient Care

Data: Hospital Episode Statistics Outpatients

Output: In summary, the research output from all projects will be used for academic research papers that will be submitted to peer reviewed academic journals in health policy, economics, health economics and health services organisation and delivery. In addition, the research will be included in PhD projects (project 2,3 and 4), and for reports made as part of work undertaken for the Department of Health (project 2) work funded by the NIHR HS & DR programme (project 4). Please see specific details in each project.

All outputs will consist of aggregate data only with small numbers suppressed in line with HES analysis guide.

Project 1: The effects of non-payment for performance

The project outcome is expected to be 2 publications in peer reviewed academic journals in the fields of health economics and health policy.
• A first version of the paper on the readmission policy will be presented at the Royal Economic Society conference in March 2016. The target submission date is 1st August 2016, target journal American Economic Journal: Economic Policy or similar,
• Paper on Never Events, target submission date 1st December 2016, target journal Health Economics or similar

Project 2: The effects of the ‘payment by results for drug recovery’

• A report was submitted to the Department of Health on the evaluation of the policy; initially submitted Autumn 2015 - currently awaiting peer review; further changes and use of the data may be required after peer review.
• A chapter for the PhD thesis of a PhD student which will be submitted to The University of Manchester, with a target submission date of January 2017.

Project 3: An economic evaluation of the Advancing Quality pay-for-performance scheme

The specific outputs expected are two publications in peer-reviewed academic journals in the field of health economics and health policy, and a PhD thesis, which will contain one of these papers. This will follow three previous peer-reviewed publications which have already been produced as a result of the project, making significant contributions to the literature on the effects of P4P on patient health outcomes:
• Sutton et al. (2012). Reduced mortality with hospital pay for performance in England. New England Journal of Medicine, 367, 1821-1828.
• Meacock et al. (2014). Paying for improvements in quality: a recent experience in the NHS in England. Health Economics, 23, 1-13.
• Kristensen et al. (2014). Long-term effect of hospital pay for performance on mortality in England. New England Journal of Medicine, 371, 540-548.
One paper, which assesses the impact of AQ on mortality for patients affected by the policy, has already been submitted to Medical Decision Making and is currently being revised for resubmission to the journal.

Project 4: The future of 24/7 care: investigating the links between staffing levels, patient access and inequalities in health outcomes

The specific outputs expected are four publications in peer-reviewed academic journals in the fields of health economics and health policy, and an overall project report to be submitted to the National Institute for Health Research (NIHR). These will follow one previous peer-reviewed publication which has already been produced as a result of the project, making significant contributions to the literature on the costs and benefits of extending weekend hospital services:
• Meacock et al. (2015). What are the costs and benefits of providing comprehensive seven-day services for emergency hospital admissions? Health Economics, 24, 907-912.
Papers will investigate the following questions:
1. What is the impact of changes to fully operational hours on access to services for different population groups?
2. How do service re-configurations affect quality of care and patient outcomes, and their

Activities: The data will be stored within an access restricted data share on the University’s network storage infrastructure which is the recommended location for storing sensitive or critical University data. The storage infrastructure is hosted across two data centres (Kilburn Building and Reynolds House (approx. 2KM apart)) for resilience and disaster recovery purposes.

The research group are based in offices on the 4th floor of the Jean McFarlane Building and the data will be hosted on a strictly controlled data share within the University’s network storage infrastructure to which only six designated members of research group staff will have access permissions.

The data will only be used for the purpose listed in the four projects above and not for any additional projects without further permission. All five projects are addressing the same theme but there will be no cross-project sharing of data. Only the University of Manchester will have access to the data provided and no data will be shared with a third party or used for commercial purposes.

Project 1: The effects of non-payment for performance

The effect of the policies on patients’ health outcomes and resource use will be assessed using difference in differences analysis and duration analysis using advanced econometric methods appropriate for linear and nonlinear multilevel data. The outcomes analysed will be readmission rates within 30 and 90 days, time to readmission, resource use in the inpatient, outpatient and A&E setting, and the probability of experiencing a never event. All analysis will include controls for patient and provider characteristics.

Project 2: The effects of the ‘payment by results for drug recovery’

The effect of the policy will be assessed using difference-in-differences regression analysis, comparing risk-adjusted emergency admission rates between pilot and non-pilot areas over time.

Project 3: An economic evaluation of the Advancing Quality pay-for-performance scheme

The effect of the policy on the three outcomes listed above will be assessed using difference-in-differences regression analysis. Survival analysis will also be performed on the mortality data.

Project 4: The future of 24/7 care: investigating the links between staffing levels, patient access and inequalities in health outcomes

The effect of the policy on the three outcomes listed in the objective for processing will be assessed using difference-in-differences regression analysis.

Objective: The purpose of this application is to obtain data to be used in specific academic research projects evaluating the impact of financial and organisational reforms of the English National Health Service.

Over the past 10 years, multiple reforms have aimed at creating incentives for performance improvements amongst providers, and higher quality of care for patients. The aim of this research is to assess the extent to which the structure and design of these reforms has led to the intended improvements in productivity and outcomes. The data will be used in regression analysis using advanced econometric modelling (including linear and non-linear regressions models, multilevel models and difference-in-differences designs) to generate causal inferences on the impact on health policy and service structure and design on health outcomes. The data will only be used for the following projects:

Project 1: The effects of non-payment for performance

Since 2011 the English National Health Service (NHS) has aimed at reducing readmission rates by not paying for individual readmissions occurring within 30 days of discharge from hospital (Department of Health, 2011). In a similar spirit, the “never events” policy framework withholds payment for hospitalisations leading to undesired patient outcomes e.g. pressure ulcers during hospitalisation and wrong side surgery. The objective of this project is to conduct academic research on the effect of the non-payment policies on patients’ health outcomes directly and indirectly affected by those policies.

Project 2: The effects of the ‘payment by results for drug recovery’

The aim of this project is to evaluate the effects of the effect of the Payment by Results for Drug Recovery (PbRDR) Pilot Programme on patient health and hospital outcomes. Providers of services for substance misusers have their payments linked to the ‘national outcomes framework’. PbRDR was introduced to ‘facilitate better care leading to better outcomes for service users’ (DH 2010: 7) including patients’ health and wellbeing. The project will examine whether the introduction of PbRDR pilots led to changes in emergency hospital admissions and associated costs for conditions that indicate complications of drugs misuse.

Project 3: An economic evaluation of the Advancing Quality pay-for-performance scheme

Pay-for-performance (P4P) programmes link financial payments by purchasers to the quality of care supplied by health care providers, and have grown in popularity over recent years. Advancing Quality (AQ) was the first hospital-based P4P scheme to be introduced in England in October 2008. The objective of processing this data is to conduct academic research to investigate the effects of AQ on health outcomes of importance to patients: mortality, length of stay, and readmissions rates. This will be compared to the costs of the programme to the NHS to evaluate whether the AQ P4P programme represents a cost-effective use of NHS resources. No data will be made available to third parties.

Project 4: The future of 24/7 care: investigating the links between staffing levels, patient access and inequalities in health outcomes

There are long-standing concerns that patients admitted to hospital at night and at weekends, when staffing levels are lower and some services are not available, suffer higher complication and mortality rates that patients admitted at times when the hospital is fully operational. Salford Royal Foundation Trust (SRFT) has been gradually extending fully-operational service provision since 2007. The objective of processing this data is to conduct academic research to investigate outcomes for patients admitted to SRFT at the weekend and compare with those admitted to other hospitals in England that have not yet extended service provision. Outcomes of interest are length of stay, mortality, complications and readmissions. Analysis will estimate the effect of fully-operational hours on the quality of care provided to patients, and any improvements in outcomes as a result of increased quality. Data will not be made available to any third parties.

Benefits: Please see the individual project descriptions for details. The results from the research projects described above are expected to be published by 2018 and will shed important new light on how the framing and design of organisational performance incentives affect the outcome of such reforms. In addition to its academic value, the research will thus inform policy makers on efficient design of health care service organisation and performance incentives and how to best allocate scarce health care resources in the English NHS for the benefit of patients.

Project 1: The effects of non-payment for performance

The non-payment policies analysed in this project represent a genuine novelty in the approach to incentivising higher quality care in the English NHS. Where previous initiatives to improve health care quality has relied on paying a bonus for improved care quality – so called Pay for performance (for example Best Practice Tariffs) - the reimbursement policies analysed in this project relies on financial penalties for “poor performance” – the occurrence of ‘never events’ and high readmission rate – to improve quality.
England first introduced a non-payment policy for so-called ‘Never Events’ in 2009. A Never Event has been defined by the National Patient Safety Agency (NPSA) as “[a] serious, largely preventable patient safety incident that should not occur if the available preventative measures have been implemented by healthcare providers.” (NPSA, 2009). The list of Never Events is updated regularly, and for 2012/13 contained 25 events including wrong site surgery, severe scalding of patients, and unintended retention of a foreign object in a patient after surgical intervention (Department of Health, 2012a). If a Never Event occurs, providers must initiate an investigation into the causes of the event. In addition, the provider is not reimbursed for both the episode of care that involved the event, and for the costs of consequential treatment (Department of Health, 2012b).
In April 2011, England introduced a policy (Department of Health, 2011) according to which hospitals would no longer be reimbursed for emergency readmissions occurring within 30 days of discharge from an elective admission. Around 40% of all readmissions, including those for children under four years of age, maternity, childbirth and cancer patients, and those who self-discharge against clinical advice, were however excluded from these non-payment rules.
The policy was expanded after its first year of operation, and now mandatorily applies to both emergency and elective first admissions (Department of Health, 2012c). Any savings made by commissioners due to non-payment for readmissions must be reinvested in post-discharge reablement services which support rehabilitation, reablement, and the prevention of future readmissions.
Nonpayment policies are potentially more cost effective than pay for performance because there is no cost in terms of bonus payments.
However, although these policies that apply to all hospital in-patients have been a part of the Department of Health’s hospital reimbursement policies for years, the intended and unintended effects of the policies on patients’ health outcomes and on hospital performance is hitherto unknown.
The research outcome of this project will thus shed important light on the effect of non-payment policies on the intended and unintended effects of NP4P on patients’ health outcomes, and assess whether non-payment are effective in improving hospital performance on the targeted areas.
In addition to publishing the findings in academic research journals that are also read by policymakers, the findings from the project will be disseminated at conferences such as the UK Health Economic Study Group and the International Health Economics Association. These conferences are regularly attended by representatives from the Department of Health and NHS England, and the relevant actors in NHS policy making can learn about the results through these channels. In addition, when publishing research findings that are thought to be of importance to the public and policy makers, the University of Manchester generally issues press releases to ensure a wider dissemination of research findings.
If the findings are positive, policy makers in NHS England and the Department of Health involved in the design of payment policies for health care may consider applying non-payment policies to other areas of the health service or expand to other outcomes than readmission rates and never events. If the results indicate unintended consequences for patients’ health outcomes, or hospital gaming of the policies, policymakers may consider changing the design of the non-payment policies to avoid adverse consequences and gaming. The results have thus potentially important impact on both the patients using the health care service and the future design of health care reimbursement policies.
References:
Department of Health, 2011. Payment by Results Guidance for 2011-12. Leeds.
Department of Health, 2012a. The “Never Events” list 2012/13. London.
Department of Health, 2012b. The Never Events Policy Framework: an update to the never events
policy. London.
Department of Health, 2012c. Payment by Results Guidance for 2012-13. Leeds.
NPSA, 2009. Never Events Framework 2009/10. National Reporting and Learning Service -
National Patient Safety Agency.

Project 2: The effects of the ‘payment by results for drug recovery’

It is an important requirement of projects funded by the NIHR and the DH that applicants make a convincing case for the expected benefits of the research. This is assessed by expert reviewers and the funding panels at the award stage. Projects that do not offer benefits to health and social care are not funded by NIHR and the DH.

Project 3: An economic evaluation of the Advancing Quality pay-for-performance scheme

It is an important requirement of projects funded by the NIHR and the DH that applicants make a convincing case for the expected benefits of the research. This is assessed by expert reviewers and the funding panels at the award stage. Projects that do not offer benefits to health and social care are not funded by NIHR and the DH.

Project 4: The future of 24/7 care: investigating the links between staffing levels, patient access and inequalities in health outcomes

The research will provide evidence on how best to allocate scare NHS resources in order to obtain the maximum benefits in terms of patient health. This will inform policy makers on the costs and benefits of extending fully-operational hours for hospital services in England, and aid the efficient organization of NHS hospital services.

Source: NHS Digital.