joint strategic needs assessment foundation profile - JSNA

Interative Hull Atlas: www.hullpublichealth.org/Pages/hull_atlas.htm More information: www.jsnaonline.org and www.hullpublichealth.org
difference between the model and the register estimates can be examined further and
considered in relation to patient characteristics using local knowledge. Differences
might just reflect that the model is not a very good fit for Hull. For reference, the mean
age of practice patients (Table 28) and mean deprivation scores (Table 49) for each
practice may be examined.
The Doncaster model uses estimated prevalence for men and women combined for
different age groups (18-39, 40-59, 60-69 and 70+ years) which are applied to estimated
age-specific population figures for each practice to obtain an estimate of the total
number of people with CKD aged over 18 years. No adjustments were made for
ethnicity, deprivation or other factors. The original research used to estimate the
prevalence was from a US study undertaken by Coresh (Coresh, Astor et al. 2003)
involved a nationally representative sample of over 15,000 adults. Serum creatinine
assay provided a basis for estimating the prevalence of CKD using standardised criteria
based on estimating glomerular filtration rate. Kidney function (GFR), kidney damage
(albuminuria) and CKD (GFR and albuminuria) were estimated from calibrated serum
creatinine level, spot urine albumin level, age, sex, and race. GFR was estimated using
the simplified Modification of Diet in Renal Disease Study equation and compared with
the Cockcroft-Gault equation for creatinine clearance. Therefore, the estimated
prevalence is based on a model, and furthermore on the US population where obesity
levels, and hence type 2 diabetes prevalence, are relatively high. The National Services
Framework for Renal Services (Department of Health 2005) claims the US study will
slightly over-estimate prevalence. As the model is based on serum creatinine levels,
and albeit modelled data, it appears that the prevalence estimates may include
undiagnosed case of CKD as well as diagnosed CKD. Table 287 gives the results of
the modelling and the actual diagnosed numbers of patients with CKD. Due to the
limitations mentioned above, the model does not necessarily represent the actual
number of people who should be diagnosed with CKD for each practice; it is only a
guide. Furthermore, the characteristics of each practice differ and need to be
considered.
The prevalence on the disease registers used to form the official QOF information is
extracted from the Quality Management and Analysis System (QMAS) at the end of
March. However, this information can be extracted at any time point from the local
QMAS system and the information in Table 287 gives this information as at September
2010.
Joint Strategic Needs Assessment Foundation Profile – Hull Health Profile: Release 3. March 2011. 596