Quarterly HES Extract - Health Policy HES projects

Imperial College London · Academic

Expired The latest version ended on 31 May 2025. The September 2026 register still lists the agreement, but its term has passed.

Reference: DARS-NIC-315716-L0F4M
Latest version: v7.10
Term of latest version: 16 June 2023 to 31 May 2025
Start date: Before 2 August 2018
Data controller: Sole Data Controller
Commercial purposes: No
Sublicensing: No
Files released to date: 0

Why the data was released

Objective for processing

The purpose of this amendment is to extend the territory of use to European Economic Area (EEA) and allow the lead investigator to access the data currently held by Imperial College London (ICL) through to completion of project 2 (as listed below).

Imperial College London has used the pseudonymised Hospital Episode Statistics (HES) data supplied under previous iterations of this Agreement, in the following research projects:

Project 1 - Patient safety alerts study: (PROJECT COMPLETED)

This was an evaluation of the effectiveness and economic efficiency of system-level interventions. The national reporting and learning system (NRLS) and selected patient safety ‘alerts’ that have been produced for the National Health Service (NHS) during its existence will be evaluated retrospectively to inform the configuration of the system in future. The study investigated whether there were reductions in patient safety incidents after the publication of an alert, which is expected to reduce health service resource use and indicates that the intervention is successful. The evidence from this study supported decisions about the types of incident reporting activities the system should prioritise in future. This was vital given the important role of incident reporting in the NHS and the economic constraints within which these systems must function.

This project used the following pseudonymised data: HES Admitted Patient Care (HES APC) 2003/4-2013/14; HES Outpatients (HES OP) 2003/4-2013/14; HES Accident & Emergency (HES A&E) 2007/8-2013/14 and HES Critical Care (HES CC) 2008/9-2013/14. The 11-year period was specified for this evaluation in order to capture sufficient baseline trends before and after any alert is published. Safety alerts take a general form i.e. the interventions they recommend may have implications for any number of clinical settings, which is why all HES setting-specific data was requested.

The aims for project 1 were not met because HES was not appropriate for this work for both methodological and practical reasons thus no outputs were produced.

Project 2 - Quality of care for elderly patients with chronic conditions study: (PUBLICATION AND REPORTING ONGOING)

The aim of the research is to evaluate risk factors that lead to functional health decline in elderly population with chronic conditions. There is no strong evidence on the pattern, sequence and interaction of risk factors that lead to functional health decline. The research question is: “Is there any pattern and sequence of occurrence of risk factors that lead to functional health decline? If there is any geographic variation in risk factors due to variation in quality of care provided to elderly population?” This project can use Hospital Episode Statistics (HES) data to answer these questions by identifying patients with chronic conditions and assessing their care use patterns in comparison to the population without these conditions across England.

Further, Imperial College London will use the existing data to investigate the impact of government policies for improving quality and patient safety for frail patients.

Frailty bears close relation with chronic conditions in the sense that both are crucial drivers of a person’s health trajectory in later life. In England, different policies were introduced to improve the quality of care for patients in general, for example: payment by results (PbR) reform and freedom of choice of healthcare providers. However, there has been limited existing evidence in research literature of how these government policies would specifically affect frail patients and this invokes concern that frail patients are less likely to benefit from such policies.

This project uses the pseudonymised data: Hospital Episode Statistics (HES) Admitted Patient Care (APC) for years 2003/04 to 2015/16. This project will include all the patients over the age of 55 years that are diagnosed with Chronic obstructive pulmonary disease (COPD), Stroke and dementia for the first time. The project uses 10-year inpatient data to understand risk factors that lead to long-term functional health decline, which was not assessed by previous clinical studies.

Project 3 - Hospital-acquired infections study: (PROJECT COMPLETED)

The objective of the project was to assess the magnitude and nature of the discrepancies between incident rates as implied by frequency in the National Reporting and Learning System (NRLS) - derived both from the NRLS metadata and analyses of the textual description of incidents - and the frequency in HES.

This project used the following data: HES APC 2003/4-2015/16; HES A&E 2007/8-2015/16, to correlate with the live updates from the NRLS.

The aims for project 3 were not met as work on project 3 was closed due to the departure of the primary researcher. No dataset or outputs were produced for this project.

Project 4 - Health information exchange evaluation: (PROJECT COMPLETED)

The project evaluated the impact of the implementation of a patient-accessible personal health record, provided by the Imperial College NHS Trusts to patients and their other carers (GPs, community and social care, relatives) through a website. This Health Information Exchange (HIE) was piloted in the autumn of 2015 and the Institute for Global Health Innovation evaluated the impact of the HIE in this pilot population.

This project used the following data: HES APC, HES OP, HES A&E for 2013/14 to 2015/16.

The data provided under previous iterations of this Agreement were used for the 4 projects listed above. Under this Agreement, Imperial College London, will complete Project 2. Projects 1, 3 and 4 have been completed. In the event that other purposes are envisioned, a new request or amendment will be submitted to NHS England to obtain appropriate authorisation for these additional projects.

Imperial College London is solely responsible for decisions made to determine how and why the data is used for this study, hence is the sole Controller who also process the data.

The Secure Enclaves is an isolated environment within the Imperial College London network, physically located at a datacentre operated by Virtus SDC Ltd. The servers at Virtus SDC Ltd are owned and managed by Imperial College London in a dedicated area of the Virtus SDC Ltd data centre. Virtus SDC Ltd do not have access to the data and will not process the data. As such Virtus SDC Ltd are not considered to be processors.

The data have been used and will be used to support academic research only. None of the specific projects mentioned in this Agreement requires ethical approval.

A researcher conducting data analysis for project 2 holds an honorary contract with Imperial College London.

Under UK GDPR, the lawful basis for Imperial College London to process the NHS Digital data for the purpose of this study are Articles 6(1)(e) and 9(2)(j) namely that processing is necessary for the performance of a task carried out in the exercise of official authority, such authority to make provision for research being vested in the University by virtue of the Royal Charter establishing the University dated 1907, and, that in respect of special category personal data, processing is necessary for research purposes carried out in accordance with Article 89(1) of the GDPR. Imperial College London are a public authority, and the outcome of this research is for the benefit of public interest because the objective of this study is to evaluate risk factors that lead to functional health decline in the elderly population within the general population, who suffer with chronic conditions.

Processing activities

Pseudonymised HES data disseminated from NHS England and currently held by Imperial College London under previous iterations of this Agreement:

• HES Admitted Patient Care (HES APC) 2003/4-2015/16

Under this Agreement there will be no further flows of data.

All the data used for projects 1, 3 and 4 have been destroyed. Only HES APC data for the periods 2003/4 to 2015/16 is retained to allow ongoing access to data until publication and reporting of project 2 completes.

All data is stored in Imperial College London’s Big Data and Analytical Unit Secure Environment (BDAU SE). All network infrastructure is owned and managed by Imperial College London staff in space dedicated to Imperial. The Secure Enclaves is an isolated environment within the Imperial College London network, physically located at a datacentre operated by Virtus SDC Ltd. The servers at Virtus SDC are owned and managed by Imperial College London in a dedicated area of the Virtus SDC data centre. Imperial do not have any shared racks with other organisations and operate their own switches. Access into the Imperial College London area is via swipe cards, CCTV covers the area and is monitored by Imperial College London and Virtus staff (24 hour). Access to the servers is controlled by Imperial ICT staff and heavily restricted. Virtus staff cannot enter the Imperial Cages without first seeking permission from Imperial. Permission is granted based on the need to enter and is not “ongoing” access (with the exception of “emergency” access, such as fire prevention). All access logs are recorded and made available to Imperial College London.

Data access is strictly controlled by the BDAU through a robust user and dataset registration process. No one other than BDAU staff can authorise access to the data. The BDAU SE is a secure research environment, providing a standard operating/access model, secure data storage and processing environment, and analysis software. It is ISO 27001 certified and is compliant with NHS England Data Security and Protection Toolkit. The BDAU SE is located in Imperial College London’s Data Centre and can be accessed remotely (via a screen view). Data will only be provided once the appropriate dataset registration process is completed. All data files and directories are encrypted using (ZFS) AES-256 encryption. Only the sysadmin (IT staff) has access to the filesystem encryption keys.

To access the data in the BDAU SE, researchers will require approval from the study chief investigator (in their role as Asset Owner). Once approval is given, researchers are required to: 1) pass the Imperial Data Protection Awareness, including GDPR, and Information Security Awareness training 2) agree, with possible disciplinary action for noncompliance, to BDAU ISO 27001 certified standard operating procedures by signing the BDAU SE User and Dataset Registration forms. All training and forms are required to be renewed on an annual basis. Users who do not pass the annual renewal of training and forms will be automatically removed from access. Since the BDAU SE can be accessed remotely (via a screen view) from any geographical location, a specific BDAU SE document was created to emphasise the geographical location restrictions where NHS England can be accessed/viewed from. Any BDAU SE user who is to access NHS England data within the BDAU SE is required to confirm they are only accessing the data from within the territory of use as stated in their relevant data sharing agreement. This is relevant to anyone accessing NHS England data in the BDAU Secure Environment, whether honorary or substantive employee of Imperial. Because the BDAU SE can be accessed remotely from any geographical location, this policy is in place to emphasise that users can only access their data from within the territory of use as stated in their agreement with NHS England. User access patterns and locations are also monitored regularly by the BDAU SE team to ensure user compliance. The lead investigator's substantive employer is the University of Southern Denmark and holds an honorary contact with Imperial College London. They will access the data remotely from Portugal, Denmark and France in addition to the UK. All access to the data provided under this agreement, including access from outside the UK, is remote access as described above.

Only summary research outputs that are aggregated with small numbers suppressed in line with the HES Analysis Guide, can be transferred outside of the BDAU SE. BDAU SE users, whether substantive or honorary employees, are bound to the BDAU ISO 27001 certified standard operating procedures, with possible disciplinary action for noncompliance, by signing the BDAU SE User and Dataset Registration forms.

All researchers, including those with honorary association with Imperial College London, are trained in Data Protection including GDPR and Information Security Awareness before they can access and analyse the data.

Two senior members of the Imperial College London Big Data & Analytical Unit (BDAU) created and made available the customised extract specific to the needs of each project.

The specific processing activities for each project will be as follows:

Project 2: Quality of care for elderly patients with chronic conditions study: (PUBLICATION AND REPORTING ONGOING)

• This project will include all the patients over the age of 55 years that will be diagnosed with COPD, Stroke and dementia for the first time. Imperial College London will select patients for the years 2007/2008 who had been diagnosed with stroke, dementia or COPD. In order to check that it was their first time diagnosed, Imperial College London will check in the preceding five years (until year 2003/2004) their secondary diagnosis and any previous diagnosis of stroke, dementia and COPD. The patients will be followed up until 2013/2014

• Imperial College London will use HES inpatient data to check for the following information:

i. Annual and overall all-cause readmission rate

ii. Annual and overall cause-specific readmission rate (common causes of readmission every year will be identified)

iii. Annual and risk adjusted overall mortality rate

iv. Annual cumulative LOS

v. Annual discharge destination (that is discharged to nursing home, residential care)

vi. Annual rate of recurrent falls (use data from HES inpatient)

• Imperial College London plan to publish these same metrics in future publications as a result of this research in the form of small numbers suppressed aggregate data.

Imperial College London will use pseudonymised patient level data to flag admissions where adverse outcomes occur and use analytical modelling to estimate the impact of government policies on quality of care for frail patients compared to non-frail patients. Frailty will be defined in line with the literature, for example patients with related diagnoses, e.g. anxiety and depression (F320), senility (R54X), dementia (F000), delirium (F050), dependence (Z741), falls and fracture (R55X), incontinence (R15X), mobility problems (R260), and pressure ulcers (L890). The list of clinical codes, known as International Classification of Diseases [ICD] codes, for these frailty related diagnoses is referenced from a paper Developing and validating a risk prediction model for acute care based on frailty syndromes. In addition to the listed outcomes we will also analyse information relating to patient demographics, hospital service utilization, and hospital types.

Data required for project 2 was extracted from the master dataset for DARS-NIC-315716-L0F4M which is only accessible to substantive employees and one honorary employee of Imperial College London who are trained in Data Protection including GDPR and Information Security Awareness before they can access the data. This data will be made accessible in a ring-fenced dataset (in the same method that all datasets are provided in the BDAU SE) which will only be accessible by researchers assigned to the approved update.

It has been agreed with all academic supervisors that any further work going forward will require a new HES application. Once project 2 has completed (expected 2024) all data under this Agreement will be securely destroyed.

The following projects are now closed, and their associated data have been securely destroyed.

For the historic projects, processing activities were as follows:

Project 1: Patient safety alerts study: (PROJECT COMPLETED)

The effectiveness and economic efficiency of system-level interventions were evaluated using multi-level modelling of patient safety incidents before and after intervention(s) are disseminated. HES endpoints of interest are diagnostic and procedural codes, which was used to measure health service utilisation and associated resource use in order to create an economic model justifying investment in a national reporting system for patient safety. To achieve this Imperial College London manipulated the data, as follows:

• The HES record was used to generate patient and/or hospital trust level panel data.

• The monthly rates of safety incident related diagnoses were calculated

• Hospital resources used at either patient or hospital level were estimated (unit cost data was derived from secondary sources)

• In all publications, monthly and annual safety incident rates, resource use, and associated costs were published at an aggregate (national) level.

Work on project 1 was assigned to DS002 within the BDAU SE. Access for DS002 was restricted to BDAU staff only after its completion. All data stored under DS002 has been securely destroyed in November 2021. There are no further yielded benefits on this work as there has been no further analysis or publications since the last renewal.

Project 3: Hospital-acquired infections study: (PROJECT COMPLETED)

Analysis of historic trends in patient safety events, comparing the reported incidence of Clostridium difficile (C.diff) and Methicillin-Resistant Staphylococcus Aureus (MRSA) infections in the National Reporting and Learning System (NRLS) with the calculable counts in HES and official counts from Public Health England Department of Surgery & Cancer used HES to calculate time trends for rates of

• Clostridium difficile infection

• MRSA infection/bacteraemia

• ICD10:T80-88 range of medical/surgical complications.

Work on project 3 was closed due to departure of primary researcher. No dataset was produced for this project and only theoretical benefits of linking HES and NRLS were outlined as described in previous yielded benefits. No further analysis will be undertaken for this project and no further data will be disseminated.

Project 4: Health information exchange evaluation: (PROJECT COMPLETED)

• GP practice populations were analysed (except where small numbers are present) to build a baseline of system performance which may be affected by an implementation of a health information exchange and their participation in the pilot.

• These populations were analysed for a change in clinical outcomes (e.g. readmissions, avoidable admissions, emergency admission, length of stay) before and after the implementation of a health information exchange.

Work on project 4 has completed and no further analysis will be undertaken. This dataset has been destroyed.

There will be no data linkage undertaken with NHS England data provided under this agreement.

Expected output

These studies have led to 3 theses submitted in fulfilment of the requirements for the degree Doctor of Philosophy at Imperial College London (“PhD theses”), 10 articles in peer-reviewed journals (“published academic papers”), and 6 policy papers for public consumption (“white papers”).

PROJECT 1 - PATIENT SAFETY ALERTS STUDY: (PROJECT COMPLETED)

The aims for project 1 were not met because HES was not appropriate for this work for both methodological and practical reasons thus no outputs were produced.

PROJECT 2 - QUALITY OF CARE FOR ELDERLY PATIENTS WITH CHRONIC CONDITIONS STUDY: (PUBLICATION AND REPORTING ONGOING)

• A PhD thesis (Submitted November 2021)

• An academic paper on quantifying the costs of care for frail patients. Draft paper presented at the iHEA ((International Health Economics Association) conference in Basel in July 2019 and EuHEA (European Health Economics Association) conference in Porto, August 2019 (The paper was submitted to an academic journal in May 2022, and is currently being prepared for resubmission to another journal).

• An academic paper on the association of frailty syndromes and patient safety incidents (Expected 2023).

• A study on the factors affecting change of frailty status over time (Expected 2023)

• The applicant aims to have all papers published in journals within Health Services Research, Health Policy and Health Economics.

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide.

PROJECT 3 - HOSPITAL-ACQUIRED INFECTIONS STUDY: (PROJECT COMPLETED)

The aims for project 3 were not met as work on project 3 was closed due to the departure of the primary researcher. No dataset or outputs were produced for this project.

PROJECT 4 - HEALTH INFORMATION EXCHANGE EVALUATION (PROJECT COMPLETED)

• White paper "Economics evaluation building a business case for CIE programme", findings presented at annual Sowerby Symposiums to health leaders.

• A white paper on the evaluation methodology and baseline data used for the evaluation (Spring 2017)

• A white paper on the results of the evaluation (Spring 2017).

White papers are available on the Institute of Global Health Innovation webpage (https://www.imperial.ac.uk/global-health-innovation/what-we-do/our-publications/our-reports/), and actively distributed to other Trusts and interested parties through the Sowerby Annual Forum and personal contacts of the centre. A recoding of the Sowerby Forum presentations can be accessed here: https://www.imperial.ac.uk/news/166759/using-nhs-records-save-lives-sowerby/

Expected measurable benefits

The benefits to health and/or social care from the expanded knowledge base of academic research are by their nature not specifically measurable. Besides these intangible benefits, laid out below are a number of additional potential benefits which could result from the four studies described above.

PROJECT 1 - PATIENT SAFETY ALERTS STUDY: (PROJECT COMPLETED)

The aims for project 1 were not met because HES was not appropriate for this work for both methodological and practical reasons thus no outputs were produced.

PROJECT 2 - QUALITY OF CARE FOR ELDERLY PATIENTS WITH CHRONIC CONDITIONS STUDY: (PUBLICATION AND REPORTING ONGOING)

a. The publication on quantifying the costs of care for frail patients detailed in the outputs section is targeted at epidemiologists and public health commissioners. By publishing in journals read by these stakeholders, they can use the newly developed techniques to estimate functional impairment burden in the population and assess various factors affecting it in different settings.

The study found that patients with frailty syndromes were older, more likely to be female, living in more deprived areas, and more likely to have higher annual admission costs, more emergency hospital admissions and longer length of stay. All frailty syndromes were associated with increased healthcare costs. Patients with one or more frailty syndrome were associated with having substantially higher healthcare costs (ranging from £2,960 to £5,009 annually), corresponding to 52% to 157% higher costs than the average non-frail patient.

b. The publication on the association of frailty syndromes and patient safety incidents and the white paper suggests various outcome measures based on hospital administrative data that can be used to identify risk. Presentation at different conferences and engagement of primary care policymakers will help spread information about patterns of preventable risk factors leading to functional health decline to front-line primary care stakeholders. This aims to identify the elderly population at high risk of functional health decline, and allow for preventative actions to be taken.

The study found that patients with a higher number of frailty syndromes were more likely to have Inter-hospital-transfers (IHT) compared to those with lower or no frailty syndrome. For frail patients, IHTs were associated with lower in-hospital mortality, longer length of stay, higher probability of readmission, and higher probability of discharge to home.

c. A study on the factors affecting change of frailty status over time (Expected 2023).

Frailty was found to be a dynamic process with heterogenous transition probabilities between frailty states. Age, gender, source of admission, and deprivation were found to be associated with changes in the frailty states.

The potential change that could happen as a result of these findings are a) an attempt to prevent patients developing frailty or b) an attempt to find more a cost-effective ways of treating patients with frailty. The cost estimates indicate that an upper bound of the potential savings are £2,960 to £5,009 per frail patient annual, but realised savings are likely to be lower, as it is unlikely that all frailty syndromes can be prevented or dealt with in a more cost-effective manner.

The project aims to assess cost and quality of care for frail patients in the NHS including how patients transition between frailty states. Better knowledge about this patient group aims to benefit Health and Social Care by allowing better planning of future spending needs and efficient budget allocations for policy interventions related to frail elderly patients. Lastly it is hoped to provide information which can be used to assess future programmes for quality and safety improvement taking into account this vulnerable patient group.

PROJECT 4 - HEALTH INFORMATION EXCHANGE EVALUATION (PROJECT COMPLETED)

Although the project has ended it is hoped that this study will allow the Trust to evaluate the implementation and use of electronic health records. If clinical improvements are observed for patients, the project can be expanded and the benefits extended to a larger population.

By making the findings widely available to Trusts considering investment in similar technologies (4B, 4C), Department of Surgery & Cancer will provide guidance regarding investment in health information exchanges in line with benefits discovered. This aim to ensure better targeted IT investment, and effective use of electronic health records to improve the quality of care and patient outcomes.

Benefits reported so far

PROJECT 1 - PATIENT SAFETY ALERTS STUDY: (PROJECT COMPLETED)

No yielded benefits have been identified following the end of the study. The aims for project 1 were not met because HES was not appropriate for this work for both methodological and practical reasons thus no outputs were produced.

This study is now closed, any further work in this area will require a new application

PROJECT 2 - QUALITY OF CARE FOR ELDERLY PATIENTS WITH CHRONIC CONDITIONS STUDY: (PUBLICATION AND REPORTING ONGOING)

A completed PhD thesis, passed with minor corrections in May 2022 (Unpublished)

PROJECT 3 - HOSPITAL-ACQUIRED INFECTIONS STUDY: (PROJECT COMPLETED)

Department of Surgery & Cancer hope to provide findings to Patient Safety Collaborative through Department of Surgery & Cancer‘s existing collaboration with the NIHR Patient Safety Translational Research Centre hosted at Imperial to improve the reporting of incidents and Department of Surgery & Cancer‘s knowledge of patient safety and hospital-acquired infections.

Department of Surgery & Cancer will provide findings to a large range of patient safety policymakers at the National Reporting and Learning System (NRLS) day for which the theme is “Improving safety of care through better use of reporting and healthcare data”, to increase the understanding of the accuracy of reported infection rates, and to ultimately reduce levels of hospital-acquired infections. By cross-validating different indicators of patient-safety-related incidents, it is hoped to be able to publish guidance for clinicians on which measures of patient safety are likely to be the most reliable, possibly feeding into alterations to reporting regimes and best practices. This work is also likely to be of potential interest to NPSA (National Patient Safety Agency), NRLS, and Public Health England, whose data will be, where possible, juxtaposed against that derived from HES.

The benefits of being able to link HES data to NRLS were outlined in the NRLS report (2016) http://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/IMPJ4219-NRLS-report_010316-INTS-WEB.pdf

Study discontinued due to primary researcher leaving therefore the aims for project 3 were not met. No dataset or outputs were produced for this project.

This study is now closed, any further work in this area will require a new application.

PROJECT 4 - HEALTH INFORMATION EXCHANGE EVALUATION (PROJECT COMPLETED)

Using the provided HES data, GP practice populations were analysed to build a baseline of system performance which may be affected by the implementation of a health information exchange (HIE) and their participation in the pilot. Again using HES data, these populations were analysed for a change in clinical outcomes (e.g. readmissions, avoidable admissions, emergency admission, length of stay) before and after the implementation of a health information exchange. These findings were presented as peer-reviewed podiums at the national Digital Health and Care Congress, Kings Fund 2016 and the Sowerby E-Health Forum Symposium, Institute of Global Health Innovation,2016.

The above analysis, presented to leads at Imperial College NHS Healthcare Trust, provided the baseline to enable the development of the North-West London Care-information Exchange (CIE) evaluation, which was co-designed and co-produced, with interim findings presented through the Care Information Exchange Evaluation Steering Group Quarterly Meetings. The Care Information Exchange involves health and social care organisations across North West London.

Users can permit any health or care professional, who needs to see it, access to their record on the Care Information Exchange. Users can also manage their healthcare from the comfort of their own home including accessing laboratory results and appointments.

Delivery of findings to Imperial Healthcare NHS Trust who have commissioned the project and for whom the findings will potentially justify an on-going business case for implementing and expanding the health information exchange programme.

This study is now closed, any further work in this area will require a new application.

Datasets on the latest version

Legal basis for provision: Health and Social Care Act 2012 – s261(2)(a)

Datasets approved under DARS-NIC-315716-L0F4M-v7.10
Dataset	Type of data	Sensitivity	Frequency	Confidential data
Hospital Episode Statistics Admitted Patient Care (HES APC)	Anonymised - ICO Code Compliant	Non-Sensitive	One-Off	Does not include the flow of confidential data

Files released

Files released counts only files released externally by DARS. Access granted in NHS England's own systems, such as its Secure Data Environment, is not included.

No files recorded as released under this agreement.

Version history

The register lists each renewal of this agreement as a separate row. This site has 5 versions — earlier versions existed before this site's records begin.

DARS-NIC-315716-L0F4M-v7.10 16 June 2023 to 31 May 2025

Title: Quarterly HES Extract - Health Policy HES projects
Commercial: No
Sublicensing: No
Datasets: 1
Files released: 0

Datasets: Hospital Episode Statistics Admitted Patient Care (HES APC)

What changed from DARS-NIC-315716-L0F4M-v6.3

Text removed is ~~struck through~~; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Fields changed from DARS-NIC-315716-L0F4M-v6.3
Field	Was	Became
Start date	~~2021-08-23~~	2023-06-16
End date	~~2022-08-22~~	2025-05-31
Hospital Episode Statistics Admitted Patient Care (HES APC): legal basis	~~Health and Social Care Act 2012 - s261 - 'Other dissemination of information'~~	Health and Social Care Act 2012 – s261(2)(a)

Datasets: ~~− Hospital Episode Statistics Accident and Emergency (HES A and E)~~; ~~− Hospital Episode Statistics Critical Care (HES Critical Care)~~; ~~− Hospital Episode Statistics Outpatients (HES OP)~~

Objective for processing

The Department of Surgery and Cancer, based at Imperial College London, requires Hospital Episode Statistics data, which was supplied under a previous version of this Agreement, for use in the following research projects: The purpose of this amendment is to extend the territory of use to European Economic Area (EEA) and allow the lead investigator to access the data currently held by Imperial College London (ICL) through to completion of project 2 (as listed below). Imperial College London has used the pseudonymised Hospital Episode Statistics (HES) data supplied under previous iterations of this Agreement, in the following research projects: [1 paragraph unchanged] This was an evaluation of the effectiveness and economic efficiency of system-level [7 words unchanged] (NRLS) and selected patient safety ‘alerts’ that have been produced for the ~~NHS~~ National Health Service (NHS) during its existence will be evaluated retrospectively to inform the configuration of [47 words unchanged] of incident reporting activities the system should prioritise in future. This was ~~important~~ vital given the important role of incident reporting in the NHS and the economic constraints within which these systems must function. This project used the following pseudonymised data: HES ~~APC~~ Admitted Patient Care (HES APC) 2003/4-2013/14; HES OP Outpatients (HES OP) 2003/4-2013/14; HES ~~A&E~~ Accident & Emergency (HES A&E) 2007/8-2013/14 and HES Critical Care (HES CC) 2008/9-2013/14. The 11-year period was specified for this evaluation in order to [28 words unchanged] of clinical settings, which is why all HES setting-specific data was requested. ~~Project 2 - Quality of care for elderly patients with chronic conditions study: (ONGOING)~~ The aims for project 1 were not met because HES was not appropriate for this work for both methodological and practical reasons thus no outputs were produced. The aim of the research is to evaluate risk factors that lead to functional health decline in elderly population with chronic conditions. There is no strong evidence on the pattern, sequence and interaction of risk factors that lead to functional health decline. The research question is: “Is there any pattern and sequence of occurrence of risk factors that lead to functional health decline? If there is any geographic variation in risk factors due to variation in quality of care provided to elderly population?” This project can use HES to answer these questions. Project 2 - Quality of care for elderly patients with chronic conditions study: (PUBLICATION AND REPORTING ONGOING) ~~Further, Imperial College London would like to use the existing data to investigate the impact of government policies for improving quality and patient safety for frail patients.~~ The aim of the research is to evaluate risk factors that lead to functional health decline in elderly population with chronic conditions. There is no strong evidence on the pattern, sequence and interaction of risk factors that lead to functional health decline. The research question is: “Is there any pattern and sequence of occurrence of risk factors that lead to functional health decline? If there is any geographic variation in risk factors due to variation in quality of care provided to elderly population?” This project can use Hospital Episode Statistics (HES) data to answer these questions by identifying patients with chronic conditions and assessing their care use patterns in comparison to the population without these conditions across England. Frailty bears close relation with chronic conditions in the sense that both are crucial drivers of a person’s health trajectory in later life. In England, different policies were introduced to improve the quality of care for patients in general, for example: payment by results (PbR) reform (see Department of Health’s Payment by results – Guidance for 2012-13, Emergency readmissions section) and freedom of choice of healthcare providers (see Martin Gaynor’s Death by market power: Reform, competition and patient outcomes in the national health service). However, there has been limited existing evidence in research literature of how these government policies would specifically affect frail patients and this invokes concern that frail patients are less likely to benefit from such policies. Further, Imperial College London will use the existing data to investigate the impact of government policies for improving quality and patient safety for frail patients. This project uses the following pseudonymised data: HES APC 2003-2014 and HES A&E 2007-2014. The project uses 10-year inpatient data to understand risk factors that lead to long-term functional health decline, which was not assessed by previous clinical studies. Frailty bears close relation with chronic conditions in the sense that both are crucial drivers of a person’s health trajectory in later life. In England, different policies were introduced to improve the quality of care for patients in general, for example: payment by results (PbR) reform and freedom of choice of healthcare providers. However, there has been limited existing evidence in research literature of how these government policies would specifically affect frail patients and this invokes concern that frail patients are less likely to benefit from such policies. This project uses the pseudonymised data: Hospital Episode Statistics (HES) Admitted Patient Care (APC) for years 2003/04 to 2015/16. This project will include all the patients over the age of 55 years that are diagnosed with Chronic obstructive pulmonary disease (COPD), Stroke and dementia for the first time. The project uses 10-year inpatient data to understand risk factors that lead to long-term functional health decline, which was not assessed by previous clinical studies. [2 paragraphs unchanged] This project used the following data: HES APC ~~2003-most recent;~~ 2003/4-2015/16; HES A&E ~~2007-most recent,~~ 2007/8-2015/16, to correlate with the live updates from the NRLS. ~~Project 4 - Health information exchange evaluation:~~ The aims for project 3 were not met as work on project 3 was closed due to the departure of the primary researcher. No dataset or outputs were produced for this project. ~~(PROJECT COMPLETED)~~ Project 4 - Health information exchange evaluation: (PROJECT COMPLETED) [1 paragraph unchanged] This project used the following data: HES ~~APC 2013/14 and going forward;~~ APC, HES ~~OP 2013/14 and going forward; and~~ OP, HES A&E for 2013/14 ~~and going forward.~~ to 2015/16. The data provided under previous iterations of this Agreement were used for the 4 projects listed above. Under this Agreement, Imperial College London, will complete Project 2. Projects 1, 3 and 4 have been completed. In the event that other purposes are envisioned, a new request or amendment will be submitted to NHS ~~Digital~~ England to obtain appropriate authorisation for these additional projects. ~~The Department of Surgery and Cancer confirms that the data under this Agreement will only be used for the 4 projects listed in this Data Sharing Agreement.~~ Imperial College London is solely responsible for decisions made to determine how and why the data is used for this study, hence is the sole Controller who also process the data. Under this Agreement, Imperial College London, the data controller, will complete Project 2. Projects 1, 3 and 4 have been completed. Any additional project using the data provided under this Agreement has been separately approved by NHS Digital and is subject to a valid Data Sharing Agreement with NHS Digital. The Secure Enclaves is an isolated environment within the Imperial College London network, physically located at a datacentre operated by Virtus SDC Ltd. The servers at Virtus SDC Ltd are owned and managed by Imperial College London in a dedicated area of the Virtus SDC Ltd data centre. Virtus SDC Ltd do not have access to the data and will not process the data. As such Virtus SDC Ltd are not considered to be processors. Individuals working on each project will only be permitted to access the data relating to that project, as identified within this application. Access is granted for each project only to the named individuals associated with that project under authorised user names. Such access is password controlled (with a password reset required on a regular refresh). The data have been used and will be used to support academic research only. None of the specific projects mentioned in this Agreement requires ethical approval. The controls enable a single copy of the data to be held, reducing security risk associated with multiple copies being provided per project. This model is aligned with similar arrangements for other sizeable research institutions. A researcher conducting data analysis for project 2 holds an honorary contract with Imperial College London. ~~The data will be handled only within the Department of Surgery, to support academic research. None of the specific projects mentioned in this Agreement requires ethical approval.~~ Under UK GDPR, the lawful basis for Imperial College London to process the NHS Digital data for the purpose of this study are Articles 6(1)(e) and 9(2)(j) namely that processing is necessary for the performance of a task carried out in the exercise of official authority, such authority to make provision for research being vested in the University by virtue of the Royal Charter establishing the University dated 1907, and, that in respect of special category personal data, processing is necessary for research purposes carried out in accordance with Article 89(1) of the GDPR. Imperial College London are a public authority, and the outcome of this research is for the benefit of public interest because the objective of this study is to evaluate risk factors that lead to functional health decline in the elderly population within the general population, who suffer with chronic conditions. The HES data will be used alongside the National Inpatient Survey, which will be available from 2003 going forward, and the National Reporting and Learning System (NRLS), which is housed at IGHI and contains data going back to 2003 and is continuously updated. ~~GDPR Legal Basis:~~ ~~Article 6(1)(e): processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller;~~ Article 9(2)(j): processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject.

Processing activities

The data was received from NHS Digital and is stored on a secure server hosted at Imperial College. Access to data on this server is restricted to authorised individuals only. The data is accessed and processed by researchers in the Department of Surgery & Cancer at Imperial College. This access is password-based and permitted solely to registered users logging on via permitted IP addresses. Record level data will not be distributed to different parts of the organisation. The data will not be made available to third party individuals, institutions or companies. Pseudonymised HES data disseminated from NHS England and currently held by Imperial College London under previous iterations of this Agreement: The data will be processed as part of the above-mentioned research project within the Department of Surgery & Cancer. It will be queried using data analysis tools such as SPSS, STATA, SAS, macros and pivot tables in Microsoft Excel, Microsoft Access etc. to aid in answering specific research questions. Data visualisations will be done to present insights gained using suitable tools including Tableau, Inkscape, NodeXL, Qlikview and others. • HES Admitted Patient Care (HES APC) 2003/4-2015/16 Two senior members of the Big Data & Analytical Unit (BDAU) create and make available (via the secure server or very occasionally on an encrypted data storage device) the customised extract specific to the needs of each project. Under this Agreement there will be no further flows of data. All the data used for projects 1, 3 and 4 have been destroyed. Only HES APC data for the periods 2003/4 to 2015/16 is retained to allow ongoing access to data until publication and reporting of project 2 completes. All data is stored in Imperial College London’s Big Data and Analytical Unit Secure Environment (BDAU SE). All network infrastructure is owned and managed by Imperial College London staff in space dedicated to Imperial. The Secure Enclaves is an isolated environment within the Imperial College London network, physically located at a datacentre operated by Virtus SDC Ltd. The servers at Virtus SDC are owned and managed by Imperial College London in a dedicated area of the Virtus SDC data centre. Imperial do not have any shared racks with other organisations and operate their own switches. Access into the Imperial College London area is via swipe cards, CCTV covers the area and is monitored by Imperial College London and Virtus staff (24 hour). Access to the servers is controlled by Imperial ICT staff and heavily restricted. Virtus staff cannot enter the Imperial Cages without first seeking permission from Imperial. Permission is granted based on the need to enter and is not “ongoing” access (with the exception of “emergency” access, such as fire prevention). All access logs are recorded and made available to Imperial College London. Data access is strictly controlled by the BDAU through a robust user and dataset registration process. No one other than BDAU staff can authorise access to the data. The BDAU SE is a secure research environment, providing a standard operating/access model, secure data storage and processing environment, and analysis software. It is ISO 27001 certified and is compliant with NHS England Data Security and Protection Toolkit. The BDAU SE is located in Imperial College London’s Data Centre and can be accessed remotely (via a screen view). Data will only be provided once the appropriate dataset registration process is completed. All data files and directories are encrypted using (ZFS) AES-256 encryption. Only the sysadmin (IT staff) has access to the filesystem encryption keys. To access the data in the BDAU SE, researchers will require approval from the study chief investigator (in their role as Asset Owner). Once approval is given, researchers are required to: 1) pass the Imperial Data Protection Awareness, including GDPR, and Information Security Awareness training 2) agree, with possible disciplinary action for noncompliance, to BDAU ISO 27001 certified standard operating procedures by signing the BDAU SE User and Dataset Registration forms. All training and forms are required to be renewed on an annual basis. Users who do not pass the annual renewal of training and forms will be automatically removed from access. Since the BDAU SE can be accessed remotely (via a screen view) from any geographical location, a specific BDAU SE document was created to emphasise the geographical location restrictions where NHS England can be accessed/viewed from. Any BDAU SE user who is to access NHS England data within the BDAU SE is required to confirm they are only accessing the data from within the territory of use as stated in their relevant data sharing agreement. This is relevant to anyone accessing NHS England data in the BDAU Secure Environment, whether honorary or substantive employee of Imperial. Because the BDAU SE can be accessed remotely from any geographical location, this policy is in place to emphasise that users can only access their data from within the territory of use as stated in their agreement with NHS England. User access patterns and locations are also monitored regularly by the BDAU SE team to ensure user compliance. The lead investigator's substantive employer is the University of Southern Denmark and holds an honorary contact with Imperial College London. They will access the data remotely from Portugal, Denmark and France in addition to the UK. All access to the data provided under this agreement, including access from outside the UK, is remote access as described above. Only summary research outputs that are aggregated with small numbers suppressed in line with the HES Analysis Guide, can be transferred outside of the BDAU SE. BDAU SE users, whether substantive or honorary employees, are bound to the BDAU ISO 27001 certified standard operating procedures, with possible disciplinary action for noncompliance, by signing the BDAU SE User and Dataset Registration forms. All researchers, including those with honorary association with Imperial College London, are trained in Data Protection including GDPR and Information Security Awareness before they can access and analyse the data. Two senior members of the Imperial College London Big Data & Analytical Unit (BDAU) created and made available the customised extract specific to the needs of each project. [1 paragraph unchanged] Project 2: Quality of care for elderly patients with chronic conditions study: ~~This project is ongoing.~~ (PUBLICATION AND REPORTING ONGOING) • This project will include all the patients over the age of 55 years that will be diagnosed with COPD, Stroke and dementia for the first time. ~~Department of Surgery & Cancer~~ Imperial College London will select patients for the years 2007/2008 who had been diagnosed with stroke, dementia or COPD. In order to check that it was their first time diagnosed, ~~Department of Surgery & Cancer~~ Imperial College London will check in the preceding five years ~~(till~~ (until year 2003/2004) their secondary diagnosis and any previous diagnosis of stroke, dementia and COPD. The patients will be followed up until 2013/2014 • ~~Department of Surgery & Cancer~~ Imperial College London will use HES inpatient ~~data and HES A&E~~ data to check for the following information: [4 paragraphs unchanged] v. Annual discharge destination (that is ~~discharge~~ discharged to nursing home, residential care) vi. Annual rate of recurrent falls (use data from HES ~~A&E and HES~~ inpatient) • ~~Department of Surgery & Cancer~~ Imperial College London plan to publish these same metrics in future publications as a result of this ~~research.~~ research in the form of small numbers suppressed aggregate data. Imperial College London will use pseudonymised patient level data to flag admissions where adverse outcomes occur and use ~~econometric methods such as multivariate regression models~~ analytical modelling to estimate the impact of government policies on quality of care for [38 words unchanged] incontinence (R15X), mobility problems (R260), and pressure ulcers (L890). The list of ~~ICD codes~~ clinical codes, known as International Classification of Diseases [ICD] codes, for these frailty related diagnoses is referenced from a paper Developing and [21 words unchanged] analyse information relating to patient demographics, hospital service utilization, and hospital types. Data required for project 2 was extracted from the master dataset for ~~315716-L0F4M~~ DARS-NIC-315716-L0F4M which is only accessible to substantive ~~BDAU staff.~~ employees and one honorary employee of Imperial College London who are trained in Data Protection including GDPR and Information Security Awareness before they can access the data. This data will be made accessible in a ring-fenced dataset (in the same method that all datasets are provided in the ~~BDAU)~~ BDAU SE) which will only be accessible by researchers assigned to the approved update. It has been agreed with all academic supervisors that any further work going forward will require a new HES application. Once project 2 has completed (expected 2024) all data under this Agreement will be securely destroyed. Controls related to point 2 are handled through a robust security mechanism within the BDAU secure environment which is ISO 27001 certified and compliant with the Data Security Protection Toolkit (DSPT). This includes restriction of access to data to only researchers who require access with yearly renewal and accompanying robust audits. The following projects are now closed, and their associated data have been securely destroyed. ~~The following projects are now closed, data will be retained in the event of any queries or challenge related to the research findings.~~ For the historic projects, processing activities were as follows: ~~Under this Agreement there will be no further flows of data. Data is only held from previous versions.~~ Project 1: Patient safety alerts study: (PROJECT COMPLETED) ~~For the historic projects, processing activities are as follows:~~ The effectiveness and economic efficiency of system-level interventions were evaluated using multi-level modelling of patient safety incidents before and after intervention(s) are disseminated. HES endpoints of interest are diagnostic and procedural codes, which was used to measure health service utilisation and associated resource use in order to create an economic model justifying investment in a national reporting system for patient safety. To achieve this Imperial College London manipulated the data, as follows: ~~Project 1: Patient safety alerts study:~~ The effectiveness and economic efficiency of system-level interventions were evaluated using multi-level modelling of patient safety incidents before and after intervention(s) are disseminated. HES endpoints of interest are diagnostic and procedural codes, which was used to measure health service utilisation and associated resource use in order to create an economic model justifying investment in a national reporting system for patient safety. To achieve this ICL will manipulate the data, as follows: [4 paragraphs unchanged] Work on project 1 was assigned to DS002 within the ~~BDAU.~~ BDAU SE. Access for DS002 ~~is currently~~ was restricted to BDAU staff ~~only.~~ only after its completion. All data stored under DS002 has been securely destroyed in November 2021. There are no further yielded benefits on this work as there has been no ~~new work done~~ further analysis or publications since the last renewal. Project 3: Hospital-acquired infections study: (PROJECT COMPLETED) Analysis of historic trends in patient safety events, comparing the reported incidence of ~~C.diff~~ Clostridium difficile (C.diff) and ~~MRSA~~ Methicillin-Resistant Staphylococcus Aureus (MRSA) infections in the National Reporting and Learning System (NRLS) with the calculable counts in HES and official counts from Public Health England Department of Surgery & Cancer used HES to calculate time trends for rates of [3 paragraphs unchanged] Work on project 3 was closed due to departure of primary researcher. [14 words unchanged] and NRLS were outlined as described in previous yielded benefits. No further ~~work~~ analysis will be ~~done~~ undertaken for this project and no further data will be ~~extracted.~~ disseminated. Project 4: Health information exchange evaluation: (PROJECT COMPLETED) [2 paragraphs unchanged] Work on project 4 has completed and no ~~new work~~ further analysis will be ~~done using the existing dataset.~~ undertaken. This dataset has been destroyed. All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract - i.e. employees, agents and contractors of the Data Recipient who may have access to that data). There will be no data linkage undertaken with NHS England data provided under this agreement. ~~There will be no data linkage undertaken with NHS Digital data provided under this agreement.~~ ~~Data will only be accessed and processed by substantive employees of Imperial College London who have been appropriately trained in data protection and confidentiality.~~

Expected output

~~It is expected that these~~ These studies ~~will lead~~ have led to 3 theses submitted in fulfilment of the requirements for the degree [14 words unchanged] (“published academic papers”), and 6 policy papers for public consumption (“white papers”). ~~All outputs will contain only aggregated data with small numbers suppressed in line with the HES Analysis Guide.~~ PROJECT 1 - PATIENT SAFETY ALERTS STUDY: (PROJECT COMPLETED) ~~Project 2 - Quality of care for elderly patients with chronic conditions study:~~ The aims for project 1 were not met because HES was not appropriate for this work for both methodological and practical reasons thus no outputs were produced. ~~a. A PhD thesis (October 2017)~~ PROJECT 2 - QUALITY OF CARE FOR ELDERLY PATIENTS WITH CHRONIC CONDITIONS STUDY: (PUBLICATION AND REPORTING ONGOING) b. A published academic paper on the novel methods used to analyse deterioration (December 2016). This will be submitted for publication in the Journal of Clinical Epidemiology, read by epidemiologists and other healthcare planners. • A PhD thesis (Submitted November 2021) c. A published academic paper on factors contributing to deterioration (May 2017). The applicant hopes to publish this in the BMJ (British Medical Journal), and will request any journals to have open access to the articles. These journals have wider audience and are read by health policy makers, epidemiologists, and primary care teams. • An academic paper on quantifying the costs of care for frail patients. Draft paper presented at the iHEA ((International Health Economics Association) conference in Basel in July 2019 and EuHEA (European Health Economics Association) conference in Porto, August 2019 (The paper was submitted to an academic journal in May 2022, and is currently being prepared for resubmission to another journal). d. The Department of Surgery & Cancer aim to present the findings at international conferences and health policy meetings such as such as the UK Faculty of Public Health annual conference and the National Health Policy conference held by Academy Health, and GP conferences organised by the Royal College of General Practitioners and the BMA. • An academic paper on the association of frailty syndromes and patient safety incidents (Expected 2023). ~~e. A white paper publication evaluating pattern and variation in preventable risk factors that leads to functional health decline in elderly population with chronic conditions.~~ • A study on the factors affecting change of frailty status over time (Expected 2023) ~~Update 2020:~~ • The applicant aims to have all papers published in journals within Health Services Research, Health Policy and Health Economics. ~~a. A PhD thesis (December 2020)~~ All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide. b. An academic paper on quantifying the costs of care for frail patients. Draft paper presented at the iHEA conference in Basel in July 2019 and EuHEA conference in Porto, August 2019 (Expected submission July 2020). PROJECT 3 - HOSPITAL-ACQUIRED INFECTIONS STUDY: (PROJECT COMPLETED) ~~c. An academic paper on the association of frailty syndromes and patient safety incidents (Expected submission October 2020).~~ The aims for project 3 were not met as work on project 3 was closed due to the departure of the primary researcher. No dataset or outputs were produced for this project. ~~d. A study on the factors affecting change of frailty status over time.~~ PROJECT 4 - HEALTH INFORMATION EXCHANGE EVALUATION (PROJECT COMPLETED) ~~e. An academic paper on the reliability of using penalty as an incentive to reduce hospital readmission rates for frail patients (Expected submission December 2020).~~ • White paper "Economics evaluation building a business case for CIE programme", findings presented at annual Sowerby Symposiums to health leaders. ~~f. The applicant aims to have all four papers published in the Journal of Health Economics.~~ • A white paper on the evaluation methodology and baseline data used for the evaluation (Spring 2017) ~~All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide~~ • A white paper on the results of the evaluation (Spring 2017). White papers are available on the Institute of Global Health Innovation webpage (https://www.imperial.ac.uk/global-health-innovation/what-we-do/our-publications/our-reports/), and actively distributed to other Trusts and interested parties through the Sowerby Annual Forum and personal contacts of the centre. A recoding of the Sowerby Forum presentations can be accessed here: https://www.imperial.ac.uk/news/166759/using-nhs-records-save-lives-sowerby/

Expected measurable benefits

[1 paragraph unchanged] ~~Project 2 - Quality of care for elderly patients with chronic conditions study:~~ PROJECT 1 - PATIENT SAFETY ALERTS STUDY: (PROJECT COMPLETED) a. The publication (see output 2B) was targeted at epidemiologists and public health commissioners. By publishing in journals read by these stakeholders, they can use the newly developed techniques to estimate functional impairment burden in the population and assess various factors affecting it in different settings. The aims for project 1 were not met because HES was not appropriate for this work for both methodological and practical reasons thus no outputs were produced. b. The publication (2C) and the white paper (2E) will suggest various outcome measures based on hospital administrative data that will can be used to identify risk. Presentation at different conferences and engagement of primary care policymakers will help spread information about pattern of preventable risk factors leading to functional health decline to front-line primary care stakeholders. This will identify elderly population at high risk of functional health decline, and allow for preventative actions to be taken. PROJECT 2 - QUALITY OF CARE FOR ELDERLY PATIENTS WITH CHRONIC CONDITIONS STUDY: (PUBLICATION AND REPORTING ONGOING) ~~2020 Update:~~ a. The publication on quantifying the costs of care for frail patients detailed in the outputs section is targeted at epidemiologists and public health commissioners. By publishing in journals read by these stakeholders, they can use the newly developed techniques to estimate functional impairment burden in the population and assess various factors affecting it in different settings. Since it is unclear if the recent NHS policies targeting quality and safety of care are equally effective for different patient groups, or whether vulnerable groups such as frail patients miss out on quality improvements for example due to gaming of quality indicators, the project will assess the performance of these policies e.g. penalties for readmissions and hospital competitions on frail patients. This will benefit Health and Social Care by providing validation of efficacy for such policies both retrospectively and going forward. This could also lead to more efficient budget allocations for policy interventions related to frail elderly patient. Lastly it will provide information which can be used to assess future programmes for quality and safety improvement taking into account this vulnerable patient group. The study found that patients with frailty syndromes were older, more likely to be female, living in more deprived areas, and more likely to have higher annual admission costs, more emergency hospital admissions and longer length of stay. All frailty syndromes were associated with increased healthcare costs. Patients with one or more frailty syndrome were associated with having substantially higher healthcare costs (ranging from £2,960 to £5,009 annually), corresponding to 52% to 157% higher costs than the average non-frail patient. At this point in the process it would be not be appropriate to attach specific improvement goals or commit to expected savings figures, as the size of the potential impact on the health and/or social care system is a portion of what Department of Surgery & Cancer are seeking to discover in the various projects. b. The publication on the association of frailty syndromes and patient safety incidents and the white paper suggests various outcome measures based on hospital administrative data that can be used to identify risk. Presentation at different conferences and engagement of primary care policymakers will help spread information about patterns of preventable risk factors leading to functional health decline to front-line primary care stakeholders. This aims to identify the elderly population at high risk of functional health decline, and allow for preventative actions to be taken. The study found that patients with a higher number of frailty syndromes were more likely to have Inter-hospital-transfers (IHT) compared to those with lower or no frailty syndrome. For frail patients, IHTs were associated with lower in-hospital mortality, longer length of stay, higher probability of readmission, and higher probability of discharge to home. c. A study on the factors affecting change of frailty status over time (Expected 2023). Frailty was found to be a dynamic process with heterogenous transition probabilities between frailty states. Age, gender, source of admission, and deprivation were found to be associated with changes in the frailty states. The potential change that could happen as a result of these findings are a) an attempt to prevent patients developing frailty or b) an attempt to find more a cost-effective ways of treating patients with frailty. The cost estimates indicate that an upper bound of the potential savings are £2,960 to £5,009 per frail patient annual, but realised savings are likely to be lower, as it is unlikely that all frailty syndromes can be prevented or dealt with in a more cost-effective manner. The project aims to assess cost and quality of care for frail patients in the NHS including how patients transition between frailty states. Better knowledge about this patient group aims to benefit Health and Social Care by allowing better planning of future spending needs and efficient budget allocations for policy interventions related to frail elderly patients. Lastly it is hoped to provide information which can be used to assess future programmes for quality and safety improvement taking into account this vulnerable patient group. PROJECT 4 - HEALTH INFORMATION EXCHANGE EVALUATION (PROJECT COMPLETED) Although the project has ended it is hoped that this study will allow the Trust to evaluate the implementation and use of electronic health records. If clinical improvements are observed for patients, the project can be expanded and the benefits extended to a larger population. By making the findings widely available to Trusts considering investment in similar technologies (4B, 4C), Department of Surgery & Cancer will provide guidance regarding investment in health information exchanges in line with benefits discovered. This aim to ensure better targeted IT investment, and effective use of electronic health records to improve the quality of care and patient outcomes.

Benefits reported

~~Project 1 - Patient safety alerts study:~~ PROJECT 1 - PATIENT SAFETY ALERTS STUDY: (PROJECT COMPLETED) ~~a. A PhD thesis, which was be published online (January 2018)~~ No yielded benefits have been identified following the end of the study. The aims for project 1 were not met because HES was not appropriate for this work for both methodological and practical reasons thus no outputs were produced. ~~b. A published academic paper on the methodology for identifying patient safety incidents and measuring impact of system-wide interventions using HES (Sep 16)~~ ~~c. A published academic paper on the relationship between patient safety alerts and the rate of patient safety incidents (May 2017).~~ d. Promulgation of findings to a conference of relevant commissioners and policymakers, for instance the annual NRLS summit that includes delegates from across healthcare, including NHS England, who are sponsoring the NRLS R&D programme at Imperial College and have requested this study as an important deliverable of that programme e. Promulgation of findings to the International Health Economics Association (iHEA), which attracts an NHS and global audience of economists, clinicians and health financers. The applicant seeks to share the work at the annual iHEA conference. f. A lay summary of research findings, intended for public consumption, which may take the form of a non-technical white-paper. This will be publicised using social media and the Imperial College London website. Our links to the London School of Economics and Political Science will also be exploited to share the findings of the project as widely as possible. g. Guidance about improving patient safety and overall clinical standards using incident reporting systems will be disseminated locally via links to NHS trusts. Specifically, guidance will be issued to Imperial College Healthcare NHS Trust in London. Attempts will be made to liaise with other London based NHS trusts, including Chelsea and Westminster Hospital NHS Trust and the Royal Brompton & Harefield NHS Foundation Trust. The evidence produced will be communicated to the decision makers in NHS England and the wider health care community, as described in outputs 1A-1G. Findings will be supplemented with essential evidence from other projects in the NRLS R & D program. In conjunction with this research the expected benefits of the evidence derived using HES is the technically efficient allocation of (limited) resources for the development of the NRLS system and other patient safety tools in England. In this way the NRLS will be configured to generate implementable and effective alerts and interventions that reduce the rate of safety incidents in the NHS and potentially reduce overall service delivery costs. The development of methods for measuring patient safety incidents in HES should improve accuracy of measurement and/or reduce analysis time. The benefit of potential improvements in safety incident monitoring is the hastened deployment of resources to reduce the occurrence of costly incidents in the NHS. The benefits of being able to link HES data to NRLS (not possible at the moment) were outlined in the NRLS report (2016) http://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/IMPJ4219-NRLS-report_010316-INTS-WEB.pdf ~~b. A paper was published on a patient safety indicator for obstetrics http://dx.doi.org/10.1136/bmjopen-2016-015463~~ [1 paragraph unchanged] ~~Project 2 - Quality of care for elderly patients with chronic conditions study:~~ PROJECT 2 - QUALITY OF CARE FOR ELDERLY PATIENTS WITH CHRONIC CONDITIONS STUDY: (PUBLICATION AND REPORTING ONGOING) ~~Study not yet complete~~ A completed PhD thesis, passed with minor corrections in May 2022 (Unpublished) ~~Project 3 - Hospital-acquired infections study:~~ PROJECT 3 - HOSPITAL-ACQUIRED INFECTIONS STUDY: (PROJECT COMPLETED) a. Department of Surgery & Cancer ~~will~~ hope to provide findings ~~(3A, 3C)~~ to Patient Safety Collaborative through Department of Surgery & Cancer‘s existing collaboration [18 words unchanged] Department of Surgery & Cancer‘s knowledge of patient safety and hospital-acquired infections. b. Department of Surgery & Cancer will provide findings to a large range of patient safety policymakers at the ~~NRLS~~ National Reporting and Learning System (NRLS) day ~~(3B)~~ for which the theme is “Improving safety of care through better use [19 words unchanged] reduce levels of hospital-acquired infections. By cross-validating different indicators of patient-safety-related incidents, ~~we hope~~ it is hoped to be able to publish guidance for clinicians on which measures of [18 words unchanged] practices. This work is also likely to be of potential interest to ~~NPSA,~~ NPSA (National Patient Safety Agency), NRLS, and Public Health England, whose data will be, where possible, juxtaposed against that derived from HES. ~~Study discontinued due to primary researcher leaving~~ The benefits of being able to link HES data to NRLS were outlined in the NRLS report (2016) http://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/IMPJ4219-NRLS-report_010316-INTS-WEB.pdf b. The benefits of being able to link HES data to NRLS (not possible at the moment) were outlined in the NRLS report (2016) http://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/IMPJ4219-NRLS-report_010316-INTS-WEB.pdf Study discontinued due to primary researcher leaving therefore the aims for project 3 were not met. No dataset or outputs were produced for this project. [1 paragraph unchanged] ~~Project 3 - Hospital-acquired infections study:~~ PROJECT 4 - HEALTH INFORMATION EXCHANGE EVALUATION (PROJECT COMPLETED) ~~a. A published academic paper on this topic (December 2016)~~ ~~b. Promulgation of findings to a conference of relevant commissioners and policymakers co-sponsored by NHS England at the NRLS summit (22nd September 2015 at the Royal Society)~~ ~~c. A white paper on the role of the National Reporting and Learning System as a resource for quantifiable metrics (December 2016)~~ ~~This study is now closed, any further work in this area will require a new application~~ ~~Project 4 - Health information exchange evaluation~~ [1 paragraph unchanged] a. The above analysis, presented to leads at Imperial College NHS Healthcare Trust, [22 words unchanged] findings presented through the Care Information Exchange Evaluation Steering Group Quarterly Meetings. The Care Information Exchange involves health and social care organisations across North West London. ~~b. White paper "Economics evaluation building a business case for CIE programme", findings presented at annual Sowerby Symposiums to health leaders.~~ Users can permit any health or care professional, who needs to see it, access to their record on the Care Information Exchange. Users can also manage their healthcare from the comfort of their own home including accessing laboratory results and appointments. c. Delivery of findings to Imperial Healthcare NHS Trust who have commissioned the [9 words unchanged] an on-going business case for implementing and expanding the health information exchange ~~programme~~ programme. ~~d. A white paper on the evaluation methodology and baseline data used for the evaluation (Spring 2017)~~ e. A white paper on the results of the evaluation (Spring 2017). Both white papers will be available on the Centre for Health Policy website, as well as actively distributed to other Trusts and interested parties through the Sowerby Annual Forum and personal contacts of the centre. f. The primary project will allow the Trust to evaluate the implementation and use of electronic health records. If clinical improvements are observed for patients, the project can be expanded and the benefits extended to a larger population. g. By making the findings widely available to Trusts considering investment in similar technologies (4B, 4C), Department of Surgery & Cancer will provide guidance regarding investment in health information exchanges in line with benefits discovered. This will ensure better targeted IT investment, and effective use of electronic health records to improve the quality of care and patient outcomes. [1 paragraph unchanged]

DARS-NIC-315716-L0F4M-v6.3 23 August 2021 to 22 August 2022

Title: Quarterly HES Extract - Health Policy HES projects
Commercial: No
Sublicensing: No
Datasets: 4
Files released: 0

Datasets: Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)

What changed from DARS-NIC-315716-L0F4M-v5.8

Text removed is ~~struck through~~; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Fields changed from DARS-NIC-315716-L0F4M-v5.8
Field	Was	Became
Start date	~~2020-08-02~~	2021-08-23
End date	~~2021-08-01~~	2022-08-22
Hospital Episode Statistics Accident and Emergency (HES A and E): legal basis	~~Health and Social Care Act 2012 – s261(2)(b)(ii)~~	Health and Social Care Act 2012 - s261 - 'Other dissemination of information'
Hospital Episode Statistics Admitted Patient Care (HES APC): legal basis	~~Health and Social Care Act 2012 – s261(2)(b)(ii)~~	Health and Social Care Act 2012 - s261 - 'Other dissemination of information'
Hospital Episode Statistics Critical Care (HES Critical Care): legal basis	~~Health and Social Care Act 2012 – s261(2)(b)(ii)~~	Health and Social Care Act 2012 - s261 - 'Other dissemination of information'
Hospital Episode Statistics Outpatients (HES OP): legal basis	~~Health and Social Care Act 2012 – s261(2)(b)(ii)~~	Health and Social Care Act 2012 - s261 - 'Other dissemination of information'

Processing activities

[37 paragraphs unchanged] Work on project 4 has completed and no new work will be done using the existing dataset. This dataset has been ~~destroyed..~~ destroyed. [3 paragraphs unchanged]

Benefits reported

[35 paragraphs unchanged] This study is now closed, any further work in this area will require a new ~~application~~ application.

Unchanged: Objective for processing, Expected output, Expected measurable benefits.

Objective for processing

Project 1 - Patient safety alerts study: (PROJECT COMPLETED)

This was an evaluation of the effectiveness and economic efficiency of system-level interventions. The national reporting and learning system (NRLS) and selected patient safety ‘alerts’ that have been produced for the NHS during its existence will be evaluated retrospectively to inform the configuration of the system in future. The study investigated whether there were reductions in patient safety incidents after the publication of an alert, which is expected to reduce health service resource use and indicates that the intervention is successful. The evidence from this study supported decisions about the types of incident reporting activities the system should prioritise in future. This was important given the important role of incident reporting in the NHS and the economic constraints within which these systems must function.

This project used the following data: HES APC 2003/4-2013/14; HES OP 2003/4-2013/14; HES A&E 2007/8-2013/14 and HES Critical Care 2008/9-2013/14. The 11-year period was specified for this evaluation in order to capture sufficient baseline trends before and after any alert is published. Safety alerts take a general form i.e. the interventions they recommend may have implications for any number of clinical settings, which is why all HES setting-specific data was requested.

Project 2 - Quality of care for elderly patients with chronic conditions study: (ONGOING)

Further, Imperial College London would like to use the existing data to investigate the impact of government policies for improving quality and patient safety for frail patients.

Frailty bears close relation with chronic conditions in the sense that both are crucial drivers of a person’s health trajectory in later life. In England, different policies were introduced to improve the quality of care for patients in general, for example: payment by results (PbR) reform (see Department of Health’s Payment by results – Guidance for 2012-13, Emergency readmissions section) and freedom of choice of healthcare providers (see Martin Gaynor’s Death by market power: Reform, competition and patient outcomes in the national health service). However, there has been limited existing evidence in research literature of how these government policies would specifically affect frail patients and this invokes concern that frail patients are less likely to benefit from such policies.

This project uses the following pseudonymised data: HES APC 2003-2014 and HES A&E 2007-2014. The project uses 10-year inpatient data to understand risk factors that lead to long-term functional health decline, which was not assessed by previous clinical studies.

Project 3 - Hospital-acquired infections study: (PROJECT COMPLETED)

This project used the following data: HES APC 2003-most recent; HES A&E 2007-most recent, to correlate with the live updates from the NRLS.

Project 4 - Health information exchange evaluation:

(PROJECT COMPLETED)

This project used the following data: HES APC 2013/14 and going forward; HES OP 2013/14 and going forward; and HES A&E 2013/14 and going forward.

In the event that other purposes are envisioned, a new request or amendment will be submitted to NHS Digital to obtain appropriate authorisation for these additional projects.

The Department of Surgery and Cancer confirms that the data under this Agreement will only be used for the 4 projects listed in this Data Sharing Agreement.

Under this Agreement, Imperial College London, the data controller, will complete Project 2. Projects 1, 3 and 4 have been completed. Any additional project using the data provided under this Agreement has been separately approved by NHS Digital and is subject to a valid Data Sharing Agreement with NHS Digital.

Individuals working on each project will only be permitted to access the data relating to that project, as identified within this application. Access is granted for each project only to the named individuals associated with that project under authorised user names. Such access is password controlled (with a password reset required on a regular refresh).

The controls enable a single copy of the data to be held, reducing security risk associated with multiple copies being provided per project. This model is aligned with similar arrangements for other sizeable research institutions.

The data will be handled only within the Department of Surgery, to support academic research. None of the specific projects mentioned in this Agreement requires ethical approval.

The HES data will be used alongside the National Inpatient Survey, which will be available from 2003 going forward, and the National Reporting and Learning System (NRLS), which is housed at IGHI and contains data going back to 2003 and is continuously updated.

GDPR Legal Basis:

Article 6(1)(e): processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller;

Article 9(2)(j): processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject.

Expected output

It is expected that these studies will lead to 3 theses submitted in fulfilment of the requirements for the degree Doctor of Philosophy at Imperial College London (“PhD theses”), 10 articles in peer-reviewed journals (“published academic papers”), and 6 policy papers for public consumption (“white papers”).

All outputs will contain only aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Project 2 - Quality of care for elderly patients with chronic conditions study:

a. A PhD thesis (October 2017)

b. A published academic paper on the novel methods used to analyse deterioration (December 2016). This will be submitted for publication in the Journal of Clinical Epidemiology, read by epidemiologists and other healthcare planners.

c. A published academic paper on factors contributing to deterioration (May 2017). The applicant hopes to publish this in the BMJ (British Medical Journal), and will request any journals to have open access to the articles. These journals have wider audience and are read by health policy makers, epidemiologists, and primary care teams.

d. The Department of Surgery & Cancer aim to present the findings at international conferences and health policy meetings such as such as the UK Faculty of Public Health annual conference and the National Health Policy conference held by Academy Health, and GP conferences organised by the Royal College of General Practitioners and the BMA.

e. A white paper publication evaluating pattern and variation in preventable risk factors that leads to functional health decline in elderly population with chronic conditions.

Update 2020:

a. A PhD thesis (December 2020)

b. An academic paper on quantifying the costs of care for frail patients. Draft paper presented at the iHEA conference in Basel in July 2019 and EuHEA conference in Porto, August 2019 (Expected submission July 2020).

c. An academic paper on the association of frailty syndromes and patient safety incidents (Expected submission October 2020).

d. A study on the factors affecting change of frailty status over time.

e. An academic paper on the reliability of using penalty as an incentive to reduce hospital readmission rates for frail patients (Expected submission December 2020).

f. The applicant aims to have all four papers published in the Journal of Health Economics.

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide

Benefits reported

Project 1 - Patient safety alerts study:

a. A PhD thesis, which was be published online (January 2018)

b. A published academic paper on the methodology for identifying patient safety incidents and measuring impact of system-wide interventions using HES (Sep 16)

c. A published academic paper on the relationship between patient safety alerts and the rate of patient safety incidents (May 2017).

d. Promulgation of findings to a conference of relevant commissioners and policymakers, for instance the annual NRLS summit that includes delegates from across healthcare, including NHS England, who are sponsoring the NRLS R&D programme at Imperial College and have requested this study as an important deliverable of that programme

e. Promulgation of findings to the International Health Economics Association (iHEA), which attracts an NHS and global audience of economists, clinicians and health financers. The applicant seeks to share the work at the annual iHEA conference.

f. A lay summary of research findings, intended for public consumption, which may take the form of a non-technical white-paper. This will be publicised using social media and the Imperial College London website. Our links to the London School of Economics and Political Science will also be exploited to share the findings of the project as widely as possible.

g. Guidance about improving patient safety and overall clinical standards using incident reporting systems will be disseminated locally via links to NHS trusts. Specifically, guidance will be issued to Imperial College Healthcare NHS Trust in London. Attempts will be made to liaise with other London based NHS trusts, including Chelsea and Westminster Hospital NHS Trust and the Royal Brompton & Harefield NHS Foundation Trust.

The evidence produced will be communicated to the decision makers in NHS England and the wider health care community, as described in outputs 1A-1G. Findings will be supplemented with essential evidence from other projects in the NRLS R & D program. In conjunction with this research the expected benefits of the evidence derived using HES is the technically efficient allocation of (limited) resources for the development of the NRLS system and other patient safety tools in England. In this way the NRLS will be configured to generate implementable and effective alerts and interventions that reduce the rate of safety incidents in the NHS and potentially reduce overall service delivery costs.

The development of methods for measuring patient safety incidents in HES should improve accuracy of measurement and/or reduce analysis time. The benefit of potential improvements in safety incident monitoring is the hastened deployment of resources to reduce the occurrence of costly incidents in the NHS.

The benefits of being able to link HES data to NRLS (not possible at the moment) were outlined in the NRLS report (2016) http://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/IMPJ4219-NRLS-report_010316-INTS-WEB.pdf

b. A paper was published on a patient safety indicator for obstetrics http://dx.doi.org/10.1136/bmjopen-2016-015463

This study is now closed, any further work in this area will require a new application

Project 2 - Quality of care for elderly patients with chronic conditions study:

Study not yet complete

Project 3 - Hospital-acquired infections study:

a. Department of Surgery & Cancer will provide findings (3A, 3C) to Patient Safety Collaborative through Department of Surgery & Cancer‘s existing collaboration with the NIHR Patient Safety Translational Research Centre hosted at Imperial to improve the reporting of incidents and Department of Surgery & Cancer‘s knowledge of patient safety and hospital-acquired infections.

b. Department of Surgery & Cancer will provide findings to a large range of patient safety policymakers at the NRLS day (3B) for which the theme is “Improving safety of care through better use of reporting and healthcare data”, to increase the understanding of the accuracy of reported infection rates, and to ultimately reduce levels of hospital-acquired infections. By cross-validating different indicators of patient-safety-related incidents, we hope to be able to publish guidance for clinicians on which measures of patient safety are likely to be the most reliable, possibly feeding into alterations to reporting regimes and best practices. This work is also likely to be of potential interest to NPSA, NRLS, and Public Health England, whose data will be, where possible, juxtaposed against that derived from HES.

Study discontinued due to primary researcher leaving

b. The benefits of being able to link HES data to NRLS (not possible at the moment) were outlined in the NRLS report (2016) http://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/IMPJ4219-NRLS-report_010316-INTS-WEB.pdf

This study is now closed, any further work in this area will require a new application.

Project 3 - Hospital-acquired infections study:

a. A published academic paper on this topic (December 2016)

b. Promulgation of findings to a conference of relevant commissioners and policymakers co-sponsored by NHS England at the NRLS summit (22nd September 2015 at the Royal Society)

c. A white paper on the role of the National Reporting and Learning System as a resource for quantifiable metrics (December 2016)

This study is now closed, any further work in this area will require a new application

Project 4 - Health information exchange evaluation

a. The above analysis, presented to leads at Imperial College NHS Healthcare Trust, provided the baseline to enable the development of the North-West London Care-information Exchange (CIE) evaluation, which was co-designed and co-produced, with interim findings presented through the Care Information Exchange Evaluation Steering Group Quarterly Meetings.

b. White paper "Economics evaluation building a business case for CIE programme", findings presented at annual Sowerby Symposiums to health leaders.

c. Delivery of findings to Imperial Healthcare NHS Trust who have commissioned the project and for whom the findings will potentially justify an on-going business case for implementing and expanding the health information exchange programme

d. A white paper on the evaluation methodology and baseline data used for the evaluation (Spring 2017)

e. A white paper on the results of the evaluation (Spring 2017). Both white papers will be available on the Centre for Health Policy website, as well as actively distributed to other Trusts and interested parties through the Sowerby Annual Forum and personal contacts of the centre.

f. The primary project will allow the Trust to evaluate the implementation and use of electronic health records. If clinical improvements are observed for patients, the project can be expanded and the benefits extended to a larger population.

g. By making the findings widely available to Trusts considering investment in similar technologies (4B, 4C), Department of Surgery & Cancer will provide guidance regarding investment in health information exchanges in line with benefits discovered. This will ensure better targeted IT investment, and effective use of electronic health records to improve the quality of care and patient outcomes.

This study is now closed, any further work in this area will require a new application.

DARS-NIC-315716-L0F4M-v5.8 2 August 2020 to 1 August 2021

Title: Quarterly HES Extract - Health Policy HES projects
Commercial: No
Sublicensing: No
Datasets: 4
Files released: 0

What changed from DARS-NIC-315716-L0F4M-v4.2

Text removed is ~~struck through~~; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Fields changed from DARS-NIC-315716-L0F4M-v4.2
Field	Was	Became
Start date	~~2019-09-01~~	2020-08-02
End date	~~2020-08-01~~	2021-08-01

Objective for processing

The Department of Surgery and Cancer, based at Imperial College London, ~~is requesting to retain existing data~~ requires Hospital Episode Statistics data, which was supplied under a previous version of this Agreement, for use in the following research ~~project:~~ projects: ~~Project 2 - Quality of care for elderly patients with chronic conditions study:~~ Project 1 - Patient safety alerts study: (PROJECT COMPLETED) This was an evaluation of the effectiveness and economic efficiency of system-level interventions. The national reporting and learning system (NRLS) and selected patient safety ‘alerts’ that have been produced for the NHS during its existence will be evaluated retrospectively to inform the configuration of the system in future. The study investigated whether there were reductions in patient safety incidents after the publication of an alert, which is expected to reduce health service resource use and indicates that the intervention is successful. The evidence from this study supported decisions about the types of incident reporting activities the system should prioritise in future. This was important given the important role of incident reporting in the NHS and the economic constraints within which these systems must function. This project used the following data: HES APC 2003/4-2013/14; HES OP 2003/4-2013/14; HES A&E 2007/8-2013/14 and HES Critical Care 2008/9-2013/14. The 11-year period was specified for this evaluation in order to capture sufficient baseline trends before and after any alert is published. Safety alerts take a general form i.e. the interventions they recommend may have implications for any number of clinical settings, which is why all HES setting-specific data was requested. Project 2 - Quality of care for elderly patients with chronic conditions study: (ONGOING) [1 paragraph unchanged] 2018 Update - Imperial College London would like to amend this study, using existing data and without further release of data, to investigate the impact of government policies for improving quality and patient safety for frail patients. Frailty bears close relation with chronic conditions in the sense that both are crucial drivers of a person’s health trajectory in later life. In England, different policies were introduced to improve the quality of care for patients in general, for example: payment by results (PbR) reform (see Department of Health’s Payment by results – Guidance for 2012-13, Emergency readmissions section) and freedom of choice of healthcare providers (see Martin Gaynor’s Death by market power: Reform, competition and patient outcomes in the national health service). However, there has been limited existing evidence in research literature of how these government policies would specifically affect frail patients and this invokes concern that frail patients are less likely to benefit from such policies. Further, Imperial College London would like to use the existing data to investigate the impact of government policies for improving quality and patient safety for frail patients. This project will use the following data: HES APC 2003-2014 and HES A&E 2007-2014. The project will use 10-year inpatient data to understand risk factors that lead to long-term functional health decline, which was not assessed by previous clinical studies. Frailty bears close relation with chronic conditions in the sense that both are crucial drivers of a person’s health trajectory in later life. In England, different policies were introduced to improve the quality of care for patients in general, for example: payment by results (PbR) reform (see Department of Health’s Payment by results – Guidance for 2012-13, Emergency readmissions section) and freedom of choice of healthcare providers (see Martin Gaynor’s Death by market power: Reform, competition and patient outcomes in the national health service). However, there has been limited existing evidence in research literature of how these government policies would specifically affect frail patients and this invokes concern that frail patients are less likely to benefit from such policies. ~~Project 1 - Patient safety alerts study:~~ This project uses the following pseudonymised data: HES APC 2003-2014 and HES A&E 2007-2014. The project uses 10-year inpatient data to understand risk factors that lead to long-term functional health decline, which was not assessed by previous clinical studies. ~~Project Completed~~ Project 3 - Hospital-acquired infections study: (PROJECT COMPLETED) This is an evaluation of the effectiveness and economic efficiency of system-level interventions. The national reporting and learning system (NRLS) and selected patient safety ‘alerts’ that have been produced for the NHS during its existence will be evaluated retrospectively to inform the configuration of the system in future. The study will investigate whether there are reductions in patient safety incidents after the publication of an alert, which is expected to reduce health service resource use and indicates that the intervention is successful. The evidence from this study will support decisions about the types of incident reporting activities the system should prioritise in future. This is important given the important role of incident reporting in the NHS and the economic constraints within which these systems must function. The objective of the project was to assess the magnitude and nature of the discrepancies between incident rates as implied by frequency in the National Reporting and Learning System (NRLS) - derived both from the NRLS metadata and analyses of the textual description of incidents - and the frequency in HES. This project used the following data: HES APC 2003/4-2013/14; HES OP 2003/4-2013/14; HES A&E 2007/8-2013/14 and HES Critical Care 2008/9-2013/14. The 11-year period is specified for this evaluation in order to capture sufficient baseline trends before and after any alert is published. Safety alerts take a general form i.e. the interventions they recommend may have implications for any number of clinical settings, which is why all HES setting-specific data is requested. ~~Project 3 - Hospital-acquired infections study:~~ ~~Project Completed~~ The objective of the project is to assess the magnitude and nature of the discrepancies between incident rates as implied by frequency in the National Reporting and Learning System (NRLS) - derived both from the NRLS metadata and analyses of the textual description of incidents - and the frequency in HES. [2 paragraphs unchanged] ~~Project Completed~~ (PROJECT COMPLETED) The project ~~aims to evaluate~~ evaluated the impact of the implementation of a patient-accessible personal health record, provided [14 words unchanged] and social care, relatives) through a website. This Health Information Exchange (HIE) ~~will be~~ was piloted in the autumn of 2015 and the Institute for Global Health Innovation ~~will evaluate~~ evaluated the impact of the HIE in this pilot population. [2 paragraphs unchanged] The Department of Surgery and Cancer confirms that the data under this application would only be used for the 4 projects listed in this Data Agreement, and any additional project for which the use of data provided under this agreement has been separately approved by NHS Digital and is subject to a valid Data Sharing Agreement with NHS Digital. Equally individuals working on each project will only be permitted to access the data relating to that project, as identified within this application. Access is granted for each project only to the named individuals associated with that project under authorised user names. Such access is password controlled (with a password reset required on a regular refresh). The Department of Surgery and Cancer confirms that the data under this Agreement will only be used for the 4 projects listed in this Data Sharing Agreement. Under this Agreement, Imperial College London, the data controller, will complete Project 2. Projects 1, 3 and 4 have been completed. Any additional project using the data provided under this Agreement has been separately approved by NHS Digital and is subject to a valid Data Sharing Agreement with NHS Digital. Individuals working on each project will only be permitted to access the data relating to that project, as identified within this application. Access is granted for each project only to the named individuals associated with that project under authorised user names. Such access is password controlled (with a password reset required on a regular refresh). [1 paragraph unchanged] The ~~raw~~ data will be handled only within the Department of Surgery, to support academic ~~research, subject to obtaining the required ethical approval where applicable. However none~~ research. None of the specific projects mentioned in this ~~form needs~~ Agreement requires ethical approval. [1 paragraph unchanged] GDPR Legal Basis: Article 6(1)(e): processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller; Article 9(2)(j): processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject.

Processing activities

The data was received from NHS Digital and is stored on a [61 words unchanged] parts of the organisation. The data will not be made available to ~~3rd~~ third party individuals, institutions or companies. [1 paragraph unchanged] ~~Data will be moved to the Big Data & Analytical Unit (BDAU) within the duration of the agreement.~~ [12 paragraphs unchanged] ~~2018 Update -~~ Imperial College London will use pseudonymised patient level data to flag admissions where adverse outcomes occur and use [104 words unchanged] analyse information relating to patient demographics, hospital service utilization, and hospital types. Data required for project 2 ~~will be~~ was extracted from the master dataset for 315716-L0F4M which is ~~currently~~ only accessible to substantive BDAU staff. This data will be made accessible in a ring-fenced dataset [12 words unchanged] which will only be accessible by researchers assigned to the approved update. It has been agreed with all academic supervisors that any further work going forward will require a new HES application. Once project 2 has completed all data ~~for 315716-L0F4M~~ under this Agreement will be destroyed. Controls related to point 2 are handled through a robust security mechanism within the BDAU secure environment which is ISO 27001 certified and ~~100%~~ compliant with ~~Level 3 of IG~~ the Data Security Protection Toolkit ~~v14.1.~~ (DSPT). This includes restriction of access to data to only researchers who require access with yearly renewal and accompanying robust audits. The following projects are now closed, data will be retained in the event of any queries or challenge related to the research ~~findings~~ findings. Under this Agreement there will be no further flows of data. Data is only held from previous versions. For the historic projects, processing activities are as follows: [1 paragraph unchanged] The effectiveness and economic efficiency of system-level interventions ~~will be~~ were evaluated using multi-level modelling of patient safety incidents before and after intervention(s) are disseminated. HES endpoints of interest are diagnostic and procedural codes, which ~~will be~~ was used to measure health service utilisation and associated resource use in order [13 words unchanged] patient safety. To achieve this ICL will manipulate the data, as follows: • The HES record ~~will be~~ was used to generate patient and/or hospital trust level panel data. • The monthly rates of safety incident related diagnoses ~~will be~~ were calculated • Hospital resources used at either patient or hospital level ~~will be estimated(unit~~ were estimated (unit cost data ~~will be~~ was derived from secondary sources) • In ~~any publication,~~ all publications, monthly and annual safety incident rates, resource use, and associated costs ~~will be~~ were published at an aggregate (national) level. ~~Rates are likely to be reported by hospital or patient characteristics / clusters.~~ ~~• Incident rates are unlikely to be reported by geography / region.~~ [2 paragraphs unchanged] Analysis of historic trends in patient safety events, comparing the reported incidence [13 words unchanged] the calculable counts in HES and official counts from Public Health England Department of Surgery & Cancer used HES to calculate time trends for rates of ~~Department of Surgery & Cancer will use HES to calculate time trends for rates of~~ [3 paragraphs unchanged] Work on project 3 was closed due to departure of primary researcher. No dataset was produced ~~from the 315716-L0F4M~~ for this project and only theoretical benefits of linking HES and NRLS [12 words unchanged] be done for this project and no further data will be extracted. [1 paragraph unchanged] • GP practice populations ~~will be~~ were analysed (except where small numbers are present) to build a baseline of [8 words unchanged] implementation of a health information exchange and their participation in the pilot. • These populations ~~will be~~ were analysed for a change in clinical outcomes (e.g. readmissions, avoidable admissions, emergency admission, length of stay) before and after the implementation of a health information exchange. Work on project 4 has completed and no new work will be done using the existing dataset. This dataset has been ~~destroyed and yielded benefits were updated last year. Due to delays in CIE rollout item 4b was not produced.~~ destroyed.. All organisations party to this agreement must comply with the Data Sharing [11 words unchanged] that use) by “Personnel” (as defined within the Data Sharing Framework Contract ~~ie:~~ - i.e. employees, agents and contractors of the Data Recipient who may have access to that ~~data)~~ data). [1 paragraph unchanged] Data will only be accessed and processed by substantive employees of Imperial College ~~London.~~ London who have been appropriately trained in data protection and confidentiality.

Expected output

[2 paragraphs unchanged] 2. Project 2 - Quality of care for elderly patients with chronic conditions ~~study~~ study: [5 paragraphs unchanged] Update ~~2018~~ 2020: [1 paragraph unchanged] b. ~~A published~~ An academic paper on quantifying the costs of care for frail ~~patients (March 2019).~~ patients. Draft paper presented at the iHEA conference in Basel in July 2019 and EuHEA conference in Porto, August 2019 (Expected submission July 2020). c. ~~A published~~ An academic paper on the association of frailty syndromes and patient safety incidents ~~(June 2019).~~ (Expected submission October 2020). ~~d. A published academic paper on the reliability of using penalty as an incentive to reduce hospital readmission rates for frail patients (December 2019).~~ d. A study on the factors affecting change of frailty status over time. e. A published paper on the relationship between competitions and quality in healthcare markets for frail patients - assessing the change in the quality of care for frail patients after the 2006 NHS reform in giving patients more freedom on choice of hospitals and healthcare service providers (May 2020) e. An academic paper on the reliability of using penalty as an incentive to reduce hospital readmission rates for frail patients (Expected submission December 2020). f. The applicant aims to have all four papers published in the Journal of Health Economics. We hope to present the study findings in international health economics conferences such as: Health Economists’ Study Group (HESG) Conference, European Conference on Health Economics by the European Health Economics Association (EuHEA). [1 paragraph unchanged]

Expected measurable benefits

[1 paragraph unchanged] 2. Project 2 - Quality of care for elderly patients with chronic conditions ~~study~~ study: a. The publication (see output 2B) ~~will be~~ was targeted at epidemiologists and public health commissioners. By publishing in journals read [15 words unchanged] in the population and assess various factors affecting it in different settings. [1 paragraph unchanged] 2018 Update - Since it is unclear if the recent NHS policies targeting quality and safety of care are equally effective for different patient groups, or whether vulnerable groups such as frail patients miss out on quality improvements for example due to gaming of quality indicators, the project will assess the performance of these policies e.g. penalties for readmissions and hospital competitions on frail patients. This will benefit Health and Social Care by providing validation of efficacy for such policies both retrospectively and going forward. This could also lead to more efficient budget allocations for policy interventions related to frail elderly patient. Lastly it will provide information which can be used to assess future programmes for quality and safety improvement taking into account this vulnerable patient group. 2020 Update: Since it is unclear if the recent NHS policies targeting quality and safety of care are equally effective for different patient groups, or whether vulnerable groups such as frail patients miss out on quality improvements for example due to gaming of quality indicators, the project will assess the performance of these policies e.g. penalties for readmissions and hospital competitions on frail patients. This will benefit Health and Social Care by providing validation of efficacy for such policies both retrospectively and going forward. This could also lead to more efficient budget allocations for policy interventions related to frail elderly patient. Lastly it will provide information which can be used to assess future programmes for quality and safety improvement taking into account this vulnerable patient group. [1 paragraph unchanged]

Benefits reported

1. Project 1 - Patient safety alerts ~~study~~ study: a. A PhD thesis, which ~~will~~ was be published online (January 2018) [1 paragraph unchanged] c. A published academic paper on the relationship between patient safety alerts and the rate of patient safety incidents (May 2017). ~~Open access journals are preferred.~~ [9 paragraphs unchanged] 2. Project 2 - Quality of care for elderly patients with chronic conditions ~~study~~ study: ~~Study now amended to achieve output, output will be going forward 2018 - 2020.~~ Study not yet complete 3. Project 3 - Hospital-acquired infections ~~study~~ study: [4 paragraphs unchanged] This study is now closed, any further work in this area will require a new ~~application~~ application. 3. Project 3 - Hospital-acquired infections ~~study~~ study: [4 paragraphs unchanged] 4. Project 4 - Health information exchange evaluation [2 paragraphs unchanged] b. ~~Awaiting link for~~ White paper "Economics evaluation building a business case for CIE ~~programme" white paper,~~ programme", findings presented at annual Sowerby Symposiums to health leaders. [6 paragraphs unchanged]

Objective for processing

Project 1 - Patient safety alerts study: (PROJECT COMPLETED)

This was an evaluation of the effectiveness and economic efficiency of system-level interventions. The national reporting and learning system (NRLS) and selected patient safety ‘alerts’ that have been produced for the NHS during its existence will be evaluated retrospectively to inform the configuration of the system in future. The study investigated whether there were reductions in patient safety incidents after the publication of an alert, which is expected to reduce health service resource use and indicates that the intervention is successful. The evidence from this study supported decisions about the types of incident reporting activities the system should prioritise in future. This was important given the important role of incident reporting in the NHS and the economic constraints within which these systems must function.

Project 2 - Quality of care for elderly patients with chronic conditions study: (ONGOING)

Further, Imperial College London would like to use the existing data to investigate the impact of government policies for improving quality and patient safety for frail patients.

Frailty bears close relation with chronic conditions in the sense that both are crucial drivers of a person’s health trajectory in later life. In England, different policies were introduced to improve the quality of care for patients in general, for example: payment by results (PbR) reform (see Department of Health’s Payment by results – Guidance for 2012-13, Emergency readmissions section) and freedom of choice of healthcare providers (see Martin Gaynor’s Death by market power: Reform, competition and patient outcomes in the national health service). However, there has been limited existing evidence in research literature of how these government policies would specifically affect frail patients and this invokes concern that frail patients are less likely to benefit from such policies.

Project 3 - Hospital-acquired infections study: (PROJECT COMPLETED)

This project used the following data: HES APC 2003-most recent; HES A&E 2007-most recent, to correlate with the live updates from the NRLS.

Project 4 - Health information exchange evaluation:

(PROJECT COMPLETED)

This project used the following data: HES APC 2013/14 and going forward; HES OP 2013/14 and going forward; and HES A&E 2013/14 and going forward.

In the event that other purposes are envisioned, a new request or amendment will be submitted to NHS Digital to obtain appropriate authorisation for these additional projects.

The Department of Surgery and Cancer confirms that the data under this Agreement will only be used for the 4 projects listed in this Data Sharing Agreement.

The data will be handled only within the Department of Surgery, to support academic research. None of the specific projects mentioned in this Agreement requires ethical approval.

GDPR Legal Basis:

Article 6(1)(e): processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller;

Expected output

All outputs will contain only aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Project 2 - Quality of care for elderly patients with chronic conditions study:

a. A PhD thesis (October 2017)

e. A white paper publication evaluating pattern and variation in preventable risk factors that leads to functional health decline in elderly population with chronic conditions.

Update 2020:

a. A PhD thesis (December 2020)

c. An academic paper on the association of frailty syndromes and patient safety incidents (Expected submission October 2020).

d. A study on the factors affecting change of frailty status over time.

e. An academic paper on the reliability of using penalty as an incentive to reduce hospital readmission rates for frail patients (Expected submission December 2020).

f. The applicant aims to have all four papers published in the Journal of Health Economics.

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide

Benefits reported

Project 1 - Patient safety alerts study:

a. A PhD thesis, which was be published online (January 2018)

b. A published academic paper on the methodology for identifying patient safety incidents and measuring impact of system-wide interventions using HES (Sep 16)

c. A published academic paper on the relationship between patient safety alerts and the rate of patient safety incidents (May 2017).

b. A paper was published on a patient safety indicator for obstetrics http://dx.doi.org/10.1136/bmjopen-2016-015463

This study is now closed, any further work in this area will require a new application

Project 2 - Quality of care for elderly patients with chronic conditions study:

Study not yet complete

Project 3 - Hospital-acquired infections study:

Study discontinued due to primary researcher leaving

This study is now closed, any further work in this area will require a new application.

Project 3 - Hospital-acquired infections study:

a. A published academic paper on this topic (December 2016)

b. Promulgation of findings to a conference of relevant commissioners and policymakers co-sponsored by NHS England at the NRLS summit (22nd September 2015 at the Royal Society)

c. A white paper on the role of the National Reporting and Learning System as a resource for quantifiable metrics (December 2016)

This study is now closed, any further work in this area will require a new application

Project 4 - Health information exchange evaluation

b. White paper "Economics evaluation building a business case for CIE programme", findings presented at annual Sowerby Symposiums to health leaders.

d. A white paper on the evaluation methodology and baseline data used for the evaluation (Spring 2017)

This study is now closed, any further work in this area will require a new application

DARS-NIC-315716-L0F4M-v4.2 1 September 2019 to 1 August 2020

Title: Quarterly HES Extract - Health Policy HES projects
Commercial: No
Sublicensing: No
Datasets: 4
Files released: 0

What changed from DARS-NIC-315716-L0F4M-v3.8

Text removed is ~~struck through~~; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Fields changed from DARS-NIC-315716-L0F4M-v3.8
Field	Was	Became
Start date	~~2018-08-02~~	2019-09-01

Processing activities

The data was received from NHS Digital and is stored on a secure server hosted at ~~the South Kensington campus of~~ Imperial College. Access to data on this server is restricted to authorised [6 words unchanged] and processed by researchers in the Department of Surgery & Cancer at ~~the St Mary’s campus of~~ Imperial ~~College in Paddington, West London, who are based in rooms with keyless combination locks that are always locked when not in use.~~ College. This access is password-based and permitted solely to registered users logging on [19 words unchanged] will not be made available to 3rd party individuals, institutions or companies. [41 paragraphs unchanged]

Unchanged: Objective for processing, Expected output, Expected measurable benefits, Benefits reported.

Objective for processing

The Department of Surgery and Cancer, based at Imperial College London, is requesting to retain existing data for use in the following research project:

Project 2 - Quality of care for elderly patients with chronic conditions study:

2018 Update - Imperial College London would like to amend this study, using existing data and without further release of data, to investigate the impact of government policies for improving quality and patient safety for frail patients. Frailty bears close relation with chronic conditions in the sense that both are crucial drivers of a person’s health trajectory in later life. In England, different policies were introduced to improve the quality of care for patients in general, for example: payment by results (PbR) reform (see Department of Health’s Payment by results – Guidance for 2012-13, Emergency readmissions section) and freedom of choice of healthcare providers (see Martin Gaynor’s Death by market power: Reform, competition and patient outcomes in the national health service). However, there has been limited existing evidence in research literature of how these government policies would specifically affect frail patients and this invokes concern that frail patients are less likely to benefit from such policies.

This project will use the following data: HES APC 2003-2014 and HES A&E 2007-2014. The project will use 10-year inpatient data to understand risk factors that lead to long-term functional health decline, which was not assessed by previous clinical studies.

Project 1 - Patient safety alerts study:

Project Completed

This is an evaluation of the effectiveness and economic efficiency of system-level interventions. The national reporting and learning system (NRLS) and selected patient safety ‘alerts’ that have been produced for the NHS during its existence will be evaluated retrospectively to inform the configuration of the system in future. The study will investigate whether there are reductions in patient safety incidents after the publication of an alert, which is expected to reduce health service resource use and indicates that the intervention is successful. The evidence from this study will support decisions about the types of incident reporting activities the system should prioritise in future. This is important given the important role of incident reporting in the NHS and the economic constraints within which these systems must function.

This project used the following data: HES APC 2003/4-2013/14; HES OP 2003/4-2013/14; HES A&E 2007/8-2013/14 and HES Critical Care 2008/9-2013/14. The 11-year period is specified for this evaluation in order to capture sufficient baseline trends before and after any alert is published. Safety alerts take a general form i.e. the interventions they recommend may have implications for any number of clinical settings, which is why all HES setting-specific data is requested.

Project 3 - Hospital-acquired infections study:

Project Completed

The objective of the project is to assess the magnitude and nature of the discrepancies between incident rates as implied by frequency in the National Reporting and Learning System (NRLS) - derived both from the NRLS metadata and analyses of the textual description of incidents - and the frequency in HES.

This project used the following data: HES APC 2003-most recent; HES A&E 2007-most recent, to correlate with the live updates from the NRLS.

Project 4 - Health information exchange evaluation:

Project Completed

The project aims to evaluate the impact of the implementation of a patient-accessible personal health record, provided by the Imperial College NHS Trusts to patients and their other carers (GPs, community and social care, relatives) through a website. This Health Information Exchange (HIE) will be piloted in the autumn of 2015 and the Institute for Global Health Innovation will evaluate the impact of the HIE in this pilot population.

This project used the following data: HES APC 2013/14 and going forward; HES OP 2013/14 and going forward; and HES A&E 2013/14 and going forward.

In the event that other purposes are envisioned, a new request or amendment will be submitted to NHS Digital to obtain appropriate authorisation for these additional projects.

The Department of Surgery and Cancer confirms that the data under this application would only be used for the 4 projects listed in this Data Agreement, and any additional project for which the use of data provided under this agreement has been separately approved by NHS Digital and is subject to a valid Data Sharing Agreement with NHS Digital. Equally individuals working on each project will only be permitted to access the data relating to that project, as identified within this application. Access is granted for each project only to the named individuals associated with that project under authorised user names. Such access is password controlled (with a password reset required on a regular refresh).

The raw data will be handled only within the Department of Surgery, to support academic research, subject to obtaining the required ethical approval where applicable. However none of the specific projects mentioned in this form needs ethical approval.

Expected output

All outputs will contain only aggregated data with small numbers suppressed in line with the HES Analysis Guide.

2. Quality of care for elderly patients with chronic conditions study

a. A PhD thesis (October 2017)

e. A white paper publication evaluating pattern and variation in preventable risk factors that leads to functional health decline in elderly population with chronic conditions.

Update 2018

a. A PhD thesis (December 2020)

b. A published academic paper on quantifying the costs of care for frail patients (March 2019).

c. A published academic paper on the association of frailty syndromes and patient safety incidents (June 2019).

d. A published academic paper on the reliability of using penalty as an incentive to reduce hospital readmission rates for frail patients (December 2019).

e. A published paper on the relationship between competitions and quality in healthcare markets for frail patients - assessing the change in the quality of care for frail patients after the 2006 NHS reform in giving patients more freedom on choice of hospitals and healthcare service providers (May 2020)

f. The applicant aims to have all four papers published in the Journal of Health Economics. We hope to present the study findings in international health economics conferences such as: Health Economists’ Study Group (HESG) Conference, European Conference on Health Economics by the European Health Economics Association (EuHEA).

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide

Benefits reported

1. Patient safety alerts study

a. A PhD thesis, which will be published online (January 2018)

b. A published academic paper on the methodology for identifying patient safety incidents and measuring impact of system-wide interventions using HES (Sep 16)

c. A published academic paper on the relationship between patient safety alerts and the rate of patient safety incidents (May 2017). Open access journals are preferred.

b. A paper was published on a patient safety indicator for obstetrics http://dx.doi.org/10.1136/bmjopen-2016-015463

This study is now closed, any further work in this area will require a new application

2. Quality of care for elderly patients with chronic conditions study

Study now amended to achieve output, output will be going forward 2018 - 2020.

3. Hospital-acquired infections study

Study discontinued due to primary researcher leaving

This study is now closed, any further work in this area will require a new application

3. Hospital-acquired infections study

a. A published academic paper on this topic (December 2016)

b. Promulgation of findings to a conference of relevant commissioners and policymakers co-sponsored by NHS England at the NRLS summit (22nd September 2015 at the Royal Society)

c. A white paper on the role of the National Reporting and Learning System as a resource for quantifiable metrics (December 2016)

This study is now closed, any further work in this area will require a new application

4. Health information exchange evaluation

b. Awaiting link for "Economics evaluation building a business case for CIE programme" white paper, findings presented at annual Sowerby Symposiums to health leaders.

d. A white paper on the evaluation methodology and baseline data used for the evaluation (Spring 2017)

This study is now closed, any further work in this area will require a new application

DARS-NIC-315716-L0F4M-v3.8 2 August 2018 to 1 August 2020

Title: Quarterly HES Extract - Health Policy HES projects
Commercial: No
Sublicensing: No
Datasets: 4
Files released: 0

Objective for processing

The Department of Surgery and Cancer, based at Imperial College London, is requesting to retain existing data for use in the following research project:

Project 2 - Quality of care for elderly patients with chronic conditions study:

Project 1 - Patient safety alerts study:

Project Completed

Project 3 - Hospital-acquired infections study:

Project Completed

This project used the following data: HES APC 2003-most recent; HES A&E 2007-most recent, to correlate with the live updates from the NRLS.

Project 4 - Health information exchange evaluation:

Project Completed

This project used the following data: HES APC 2013/14 and going forward; HES OP 2013/14 and going forward; and HES A&E 2013/14 and going forward.

In the event that other purposes are envisioned, a new request or amendment will be submitted to NHS Digital to obtain appropriate authorisation for these additional projects.

Expected output

All outputs will contain only aggregated data with small numbers suppressed in line with the HES Analysis Guide.

2. Quality of care for elderly patients with chronic conditions study

a. A PhD thesis (October 2017)

e. A white paper publication evaluating pattern and variation in preventable risk factors that leads to functional health decline in elderly population with chronic conditions.

Update 2018

a. A PhD thesis (December 2020)

b. A published academic paper on quantifying the costs of care for frail patients (March 2019).

c. A published academic paper on the association of frailty syndromes and patient safety incidents (June 2019).

d. A published academic paper on the reliability of using penalty as an incentive to reduce hospital readmission rates for frail patients (December 2019).

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide

Benefits reported

1. Patient safety alerts study

a. A PhD thesis, which will be published online (January 2018)

b. A published academic paper on the methodology for identifying patient safety incidents and measuring impact of system-wide interventions using HES (Sep 16)

c. A published academic paper on the relationship between patient safety alerts and the rate of patient safety incidents (May 2017). Open access journals are preferred.

b. A paper was published on a patient safety indicator for obstetrics http://dx.doi.org/10.1136/bmjopen-2016-015463

This study is now closed, any further work in this area will require a new application

2. Quality of care for elderly patients with chronic conditions study

Study now amended to achieve output, output will be going forward 2018 - 2020.

3. Hospital-acquired infections study

Study discontinued due to primary researcher leaving

This study is now closed, any further work in this area will require a new application

3. Hospital-acquired infections study

a. A published academic paper on this topic (December 2016)

b. Promulgation of findings to a conference of relevant commissioners and policymakers co-sponsored by NHS England at the NRLS summit (22nd September 2015 at the Royal Society)

c. A white paper on the role of the National Reporting and Learning System as a resource for quantifiable metrics (December 2016)

This study is now closed, any further work in this area will require a new application

4. Health information exchange evaluation

b. Awaiting link for "Economics evaluation building a business case for CIE programme" white paper, findings presented at annual Sowerby Symposiums to health leaders.

d. A white paper on the evaluation methodology and baseline data used for the evaluation (Spring 2017)

This study is now closed, any further work in this area will require a new application

Register history

When this agreement appeared in, or was edited in, each monthly edition of the register. Built by comparing every edition this site holds, the earliest of which is July 2021.

July 2021 — already listed in the earliest edition this site holds, so it may be older.
3 versions: DARS-NIC-315716-L0F4M-v3.8, DARS-NIC-315716-L0F4M-v4.2, DARS-NIC-315716-L0F4M-v5.8
October 2021
1 version added: DARS-NIC-315716-L0F4M-v6.3
December 2022
Register-wide edit DARS-NIC-315716-L0F4M-v3.8, DARS-NIC-315716-L0F4M-v4.2, DARS-NIC-315716-L0F4M-v5.8 — Datasets: legal basis: “~~s261(1) and~~” taken out. Made to 639 agreements in this edition, so it is reported once, on the changes page, and not counted as an amendment of this agreement.
July 2023
1 version added: DARS-NIC-315716-L0F4M-v7.10

Cite this page

NHS England (2026) Data Uses Register, September 2026 edition, agreement DARS-NIC-315716-L0F4M, “Quarterly HES Extract - Health Policy HES projects”. Read via NHS Data Access Explorer (unofficial), https://healthdatauses.uk/agreements/dars-nic-315716-l0f4m/ (accessed [date]).

This address stays the same, but the page is rebuilt with each monthly edition, so the citation names the edition it shows. Every edition's data is kept in the facts store.

Source: datausesregister_september2026.xlsx, September 2026 edition of the NHS England Data Uses Register. Search that workbook for DARS-NIC-315716-L0F4M to see the original rows.