Myocardial Ischaemia National Audit Project - University College ...

Part 4: Research use of MINAP data1. OverviewProf Adam Timmis – Chairman of MINAP AcademicGroup & Professor of Clinical Cardiology, Barts and theLondon School of Medicine and DentistryLucia Gavalova – MINAP Project ManagerMINAP now has over 1 million records with almost 100%hospital participation since 2003, making it the largestcollection of ACS data in the world covering most of thepatient population in England and Wales. As such it is aninvaluable research resource for observational studies.The MINAP Academic Group was delegated responsibility bythe Health Quality Improvement Partnership (HQIP) to releaseits audit data to external researchers. Research applicationsare considered by the MINAP Academic Group, and if approvalis given the data fields required for the research are madeavailable. Some preference is given to those researcherswith a track record and experience in working with large andcomplex datasets. More recently, the NICOR Research Grouphas been set up to oversee research strategy across all thedatasets under its custodianship.When NICOR was established in 2011, it facilitated the linkageof the national cardiovascular audits providing researcherswith a unique resource for tracking patients through theircardiovascular journey. MINAP has also been linked withCPRD (Clinical Practice Research Database) to explore patientcare before and after a heart attack..Vital status is updated annually by the Office of NationalStatistics. Researchers only have access to anonymised data.This is in compliance with the strict governance rules thatensure patient confidentiality.The MINAP Academic Group welcomes applications fromMINAP hospitals that are interested in regional or nationalanalyses that seek answers to valid research questions,and are able to facilitate collaborations with experiencedacademics and statisticians.To date, over 35 publications have resulted from the useof MINAP data and more projects are currently on-goingfollowing an approval by the MINAP Academic Group. Thefollowing sections highlight just a few that were published inthe last year or so.2. Evaluation of a composite performanceindicator in the assessment of hospitals care forpatients after a heart attack, MINAP 2008 to 2009.Dr Alex Simms - Cardiology Specialist RegistrarDr Chris Gale - Consultant CardiologistCentre for Epidemiology and Biostatistics, University of LeedsMINAP reports hospital performance – the care providedat each hospital to patients admitted there – in terms of anumber of different indicators of good quality care. Each ofthese indicators identifies one intervention, among many,that has been shown to improve the outcome for patientsexperiencing heart attack. We used data from MINAP to designand study a summary or composite score of how hospitalsprovided a number of these previously described singlemeasures. We advocate summary scores rather than singleindicators of care (such as “did all patients receive aspirin ondischarge”) because they measure achievements across awider range of care. Our indicator was an opportunity-basedcomposite score (OBCS) designed to be incorporate data frompatients discharged from hospital following a heart attack.The score measured all the fulfilled opportunities a hospitalhad to provide a care process, expressed as a percent. Thecare processes we used were the prescription of aspirin,thienopyridine inhibitors, β-blocker, ACE inhibitor and statin,as well as referral for cardiac rehabilitation.We found that, overall, 95% of opportunities to provide carewere achieved. This varied between hospitals in Englandand Wales – ranging from 76% to 100% across 199 acutehospitals. A funnel plot of hospital OBCS allowed visualisationof this variation between hospital (Figure 29). We also foundthat the OBCS more readily highlighted hospitals (24%)that needed to improve their performance, than using theindividual components of the OBCS, and that it showed greaterconsistency in identifying lower performing hospitals.Importantly, our study demonstrated that the OBCS had asignificant inverse relationship with death at 30-days and at6-months. It showed that better performing hospitals hadlower mortality rates. This effect persisted despite adjustmentfor differences in patient characteristics and the performanceof coronary artery catheterisation. Each percentage increasein hospital OBCS was associated with, on average, a 3% and2% decline in 30-day and 6-month death rate, respectively.In conclusion, our study found that the OBCS offered a summaryof hospital care for patients with heart attack, discriminatedhospital performance and was linked with longer-termoutcomes. The OBCS may therefore be suitable for inclusion inhospital quality-improvement strategies and for the comparisonof hospital performance in England and Wales.96 MINAP How the NHS cares for patients with heart attack