1. Using routine data to plan and assess
service performance: Outputs from the
NWC Connected Health Cities Programme
Tony Marson
Professor of Neurology

2. Project Partners

3. Data ark and trusted researcher environment

4. Identifying cohorts and demand
Professor Tony Marson; Clinical Lead NWC CHC 21.06.2017

5. Standard approach: ARLD-Primary
Clinical approach: ARLD-Algorithm
5,101
9,728
= ARLD-Primary x 191%
Cheshire, Lancashire and Merseyside
Emergency Admissions 2014/15-2016/17

6. Acute Beds

9. Patient pathways
Professor Tony Marson; Clinical Lead NWC CHC 21.06.2017

10. • 9000 attendances
• Wide variability across sites
• <50% first seizures referred to a
seizure clinic
• < 50% of ‘known epilepsy’ under
active follow up
• Inadequate assessments in
emergency departments
National Audit of Seizure Management in Hospitals 2011 & 2013

11. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
30 60 90 120 150 180 210 240 270 300 330 361
%receivingoutpatientappointment
Days to clinic
Days to Outpatient Appointment
Aintree Known
Aintree not Known
Chester Known
Chester not Known
East Cheshire Known
East Cheshire not Known
Mid Cheshire Known
Mid Cheshire not Known
RLBUHT Known
RLBUHT not Known
Southport Known
Southport not Known
Warrington Known
Warrington not Known
Whiston Known
Whiston not Known
Wirral Known
Wirral not Known
Known to neurology service
Not known to neurology service

12. Implement a simple pathway….....

13. Time to neurology appointment
Comparisons for unknown and known patient status

15. Proportion with appointment within 3 months
With nurse support Without nurse support

17. Conclusions
• NWC CHC Data ark up and running with administrative data
• Algorithms developed to reliably identify cohorts
• Must have clinical credibility
• Service performance can be assessed with 3 month data lag
• Geographical mapping can help focus services
• This work is scalable nationally
• Analysis of linked datasets planned and will add considerable
depth

18. Flow of pseudonymised commissioning datasets
Healthcare Data Laboratory NWC CHC Data Ark – (Trusted Research Environment) Pan-NWC DSCRO Data
(inc all APC, A& E and OPD admissions for NWC all providers)

21. Time to neurology appointment (within one year)
Data for financial years: 2014/15 – 2016/17

23. Using these analyses to improve services
• Cheshire & Merseyside Seizure Pathway implemented by local SCN,
following results of NASH and experience from Ireland
• Alongside this the Care After Presenting with Seizures (CAPS) project
funded by NIHR CLAHRC NWC; looking at the effect of employing
nurses to facilitate the referral process
• CAPS also collects Patient Reported Outcome Measures and Patient
Reported Experience Measures
• In addition, analyses presented above being conducted on a quarterly
basis, and hospitals being sent update reports to allow them to see
their progress. Work undertaken in collaboration with the Walton
Centre Vanguard