Myocardial Ischaemia National Audit Project (MINAP) Annual Report

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

Objective for processing

[13 paragraphs unchanged] NICOR is hosted by Bars Barts Health NHS Trust, as such Barts Health NHS Trust is the sole data processor, and only processes the data for the purposes described in this agreement. [4 paragraphs unchanged]

Processing activities

[4 paragraphs unchanged] For the purpose of the MINAP annual report, NICOR cannot allow for any requires small numbers to be suppressed. unsuppressed for their NAPCI Annual Report. If numbers were supressed, suppressed, comparison to HES figures with the number of records that hospitals have submitted would result in NICOR numbers being inaccurate. I.e. i.e. If 300 cells are suppressed, suppressed with each cell representing up to 7, that is up to 1500 2100 admissions excluded from the total, which is a significant amount. [2 paragraphs unchanged] To protect patient confidentiality, when presenting results calculated from HES data, outputs will contain only aggregate level data with small numbers suppressed in line with HES analysis guide. When publishing HES data, it must be ensured that cell values from 1 to 7 are suppressed at a local level to prevent possible identification of individuals from small counts within the table. Zeros (0) do not need to be suppressed. All other counts will be rounded to the nearest 5.

Expected output

[1 paragraph unchanged] NICOR must deliver to HQIP and NHS England the NCAP Annual Report - as a contracted deliverable. Following the formal sign off and publication of the NCAP 2020 2021 Annual Report there will be some individual discussions and presentations of the [25 words unchanged] NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes). Both the National Cardiac Audit Programme (NCAP) 2020 2021 Annual Report and the domain-specific Summary MINAP Annual Report will be distributed [33 words unchanged] appear in Quality Accounts and are made available to CQC visiting teams. [1 paragraph unchanged]

Benefits reported

[2 paragraphs unchanged] So, for example, in 2018 while the median case ascertainment rate for English Trusts is 99%, there are 11 Trusts that have rates above 150% (implying substantially greater MINAP submissions than coded discharges) and 11 Trusts that have rates below 50% (implying inadequate case finding). For example in the 2019/20 year the case ascertainment rate for England was 93.8% (78,966 cases submitted to MINAP and 84,210 cases coded in HES). [9 paragraphs unchanged]

Unchanged: Expected measurable benefits.

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

Objective for processing

The Healthcare Quality Improvement Partnership (HQIP) have commissioned, on behalf of NHS [17 words unchanged] which are managed by the National Institute for Cardiovascular Outcomes Research (NICOR) based within hosted by Barts Health NHS Trust. The six audits, collectively termed the National Cardiac Audit Programme (NCAP) audits, are based on prospectively collected, patient-level data on patients in all NHS providers in England and Wales. NCAP is managed by NICOR, and their funding contract for the National Cardiac Audit Programme, has been extended for a further 2 years, Programme runs until June 2022. [3 paragraphs unchanged] Hospital Provider codes (pseudonymised) are now required as MINAP must publish an [14 words unchanged] relevant cases for feeding back to NHS England and the Care Quality Commission . The primary purpose has not changed. Commission. The tabulation tabulated HES Admitted Patient Care data requested is necessary for the performance of a task carried out in [7 words unchanged] of care for people being treated for heart attack – Myocardial Ischaemia. DATA CONTROLLERSHIP There are no alternative, less intrusive ways of achieving the purpose. [5 paragraphs unchanged] NICOR is hosted by Bars Health NHS Trust, as such Barts Health NHS Trust is the sole data processor, and only processes the data for the purposes described in this agreement. [4 paragraphs unchanged]

Processing activities

[1 paragraph unchanged] The data from NHS Digital will not be used for any other purpose other than that outlined in this agreement. It will also not be linked to any other datasets. There will be no attempt to re-identify the data. There will be no flow of data into NHS Digital. NHS Digital will flow tabulated HES APC data to Barts Health NHS Trust. There will be no subsequent flow of data. The data from NHS Digital will not be used for any other purpose other than those outlined in this agreement. The data received from NHS Digital will not be linked to other available datasets. [2 paragraphs unchanged] Redcentric PLC [also known as Redcentric Managed Solutions, and Redcentric Solutions Limited as well as Redcentric PLC (Harrogate)] are NOT able to access the data stored on NICOR (Barts Health) servers. The data servers are managed by NICOR staff, including all server maintenance, backups etc. Redcentric only provide the secure facility (bricks and mortar) with power and internet connectivity for us to house our servers. Servers are in a secure locked environment which Redcentric do not access. Therefore, any access to the data held under this agreement by Redcentric Ltd would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Barts Health NHS Trust staff have access to the data via remote access. The tabulated HES data is stored on a shared drive only accessible to NICOR staff. Once the annual reports have been published, the data for that year is destroyed is destroyed. The back-ups are managed entirely by NICOR (either remotely or on site) and are not conducted by the data centre. The data centre functions only in providing infra-structure. [1 paragraph unchanged]

Expected output

[1 paragraph unchanged] NICOR must deliver to HQIP and NHS England the NCAP Annual Report - as a contracted deliverable. Following the formal sign off and publication of the NCAP 2019 2020 Annual Report there will be some individual discussions and presentations of the [25 words unchanged] NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes). Both the National Cardiac Audit Programme (NCAP) 2019 2020 Annual Report and the domain-specific Summary MINAP 2019 Annual Report will be distributed electronically to Trust chief executives, clinicians, British [5 words unchanged] stakeholders. These reports are also publicly available online on the HQIP webpages and on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/. Analyses from NCAP appear in Quality Accounts and are made available to CQC visiting teams. [1 paragraph unchanged]

Benefits reported

MINAP presented case ascertainment rates for participating Trusts – expressed as the [8 words unchanged] myocardial infarction (in Hospital Episode Statistics (HES) data provided by NHS Digital in for England to the number of cases submitted to MINAP – for the first time in 2017. This was has repeated in 2018. annually since. [9 paragraphs unchanged] The audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and feeds back on this to NHS England and the Care Quality Commission. The hospital level HES tabulation data requested is the minimum level of data required for case ascertainment purposes, which basically means that it’s a check for verifying the number of patients submitted to NICOR with the number of patients’ coded by the hospitals for HES. The data we receive is number of patients who received care by individual hospitals. So the hospital level HES tabulation data is NOT at patient level. We do not consider this to be “intrusive” however, there are no other ‘less intrusive’ ways of achieving this purpose. The data supplied by NHS Digital will be used to produce ‘participation’ tables for audit purposes, to determine whether hospitals are fully participating in the audit. This will confirm the validity of the numbers that are reported by the hospitals to other NHS databases e.g. HES data and Best Practice Tariff. The CQC also use our data for monitoring the performance of hospitals. For this case ascertainment process provides them with the required quality assurance.

Changed only in punctuation, spacing or capitalisation: Expected measurable benefits.

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

Data controllers: + NHS ENGLAND

Objective for processing

The Myocardial Ischaemia National Audit Project is a national clinical audit which monitors the care and treatment of hospitalised patients with Myocardial Ischaemia in England and Wales. Its findings have been made public since 2003 via annual public reports. The Healthcare Quality Improvement Partnership (HQIP) have commissioned, on behalf of NHS England as part of the National Clinical Audit and Patient Outcomes Programme (NACPOP), six national cardiovascular audits which are managed by the National Institute for Cardiovascular Outcomes Research (NICOR) based within Barts Health NHS Trust. The Myocardial Ischaemia National Audit Project (MINAP) is a domain within the National Cardiac Audit Programme (NCAP) that contains information about the care provided to The six audits, collectively termed the National Cardiac Audit Programme (NCAP) audits, are based on prospectively collected, patient-level data on patients in all NHS providers in England and Wales. NCAP is managed by NICOR, and their funding contract for the National Cardiac Audit Programme, has been extended for a further 2 years, until June 2022. patients who are admitted to hospital with acute coronary syndromes (heart attack). NCAP collects data from two domains that are concerned with particular disease processes (heart attacks and heart failure) and four that cover delivery of specific services (procedures for patients with congenital heart disease, percutaneous coronary intervention, cardiac surgery and the management of cardiac rhythm abnormalities). The aim of these NCAP audits is to measure and report delivery of care against defined guidance standards and to enable the improvement of the quality of care and outcomes of patients with a range of cardiac conditions. The audit aims to capture data on clinical indicators which have a proven link to improved outcomes for Myocardial Ischaemia patients, and to encourage the increased use of clinically recommended diagnostic tools, disease modifying treatments and referral pathways. The Myocardial Ischaemia National Audit Project (MINAP) is one of the six focal areas for audit within the NCAP that contains information about the care provided to patients who are admitted to hospital with acute coronary syndromes (heart attack). Its findings have been made public since 2003 via annual public reports. The tabulation requested is necessary for the performance of a task carried out in the public interest; improving the quality of care for people being treated for Myocardial Ischaemia (covered by Article 6 (1)(e) of the GDPR). MINAP aspires to include complete information about the care of every patient admitted to hospital with heart attack. By so doing there can be greater confidence in the reliability of subsequent analyses and in the validity of comparisons between participating hospitals. The audit must publish case ascertainment at Trust and hospital level to ensure it is capturing all relevant cases. This aspect of data quality is fed back to participating centres, to NHS England and regulatory bodies. The audit Hospital Provider codes (pseudonymised) are now required as MINAP must publish an audit case ascertainment at Trust AND hospital level to ensure it is capturing all relevant cases and also hospital level, and feeds for feeding back on this to NHS England and regulatory bodies. the Care Quality Commission . The primary purpose has not changed. The tabulation requested is necessary for the performance of a task carried out in the public interest, namely improving the quality of care for people being treated for heart attack – Myocardial Ischaemia. DATA CONTROLLERSHIP This agreement has Joint Data Controllership - consisting of the Healthcare Quality Improvement Partnership (HQIP) and NHS England. NHS England is responsible for determining which projects/topics are included as part of the NCAPOP. HQIP, as commissioner of the NCAPOP, is responsible for project specification development, procurement and extension activities, contract management and authorising data sharing requests. NHS England, as a funder of the NCAPOP, participates within specification development, procurement and project extension activities and authorises the publication of project outputs. NHS England is involved with developing the scope and purpose of the NCAPOP projects through participation within specification development activities and may authorise (as chair of the specification development meetings) the final project specifications. These specifications set out the purpose of the project, the patient groups and clinical services to evaluate and the types of data to collect. NHS England are a representative upon the HQIP Data access request group which authorises data sharing applications from third parties. NHS England is responsible for determining which projects/topics are included as part of the NCAPOP. HQIP, as commissioner of the NCAPOP, is responsible for project specification development, procurement and extension activities, contract management and authorising data sharing requests. NHS England, as a funder of the NCAPOP, participates within specification development, procurement and project extension activities and authorises the publication of project outputs. NHS England is involved with developing the scope and purpose of the NCAPOP projects through participation within specification development activities and may authorise (as chair of the specification development meetings) the final project specifications. These specifications set out the purpose of the project, the patient groups and clinical services to evaluate and the types of data to collect. NHS England are a representative upon the HQIP Data access request group which authorises data sharing applications from third parties. Legal Basis Justification: HQIP and NHS England both rely on the Article 6 (1) (e) legal basis under GDPR - "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". This is justified through commissioning arrangements which link back to NHS England and other national bodies with statutory responsibilities to improve quality of health care services. HQIP rely on Article 9 (2) (i) as the legal basis for processing under GDPR - "processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy". This is justified as all projects aim to drive improvements in the quality and safety of care and to improve outcomes for patients. NHS England rely on Article 9(2)(h) of the GDPR as the legal basis for processing. "Processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3". NHS England are responsible for provision of health and social care, and management of systems and compliance.

Processing activities

The data requested is purely for comparative purposes only. NICOR collect clinical audit data directly from hospitals. The data will be used for audit purposes, to determine whether hospitals are fully participating in the audit. Aggregate HES data at Trust level will be compared to the number of records submitted to the audit by each Trust to measure case ascertainment. This is a key quality indicator. All those with access to the data are substantive employees of Bart's Health NHS Trust. 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 ie: employees, agents and contractors of the Data Recipient who may have access to that data). The MINAP audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and feeds back on this to NHS England and the Care Quality Commission. The data from NHS Digital will not be used for any other purpose other than that outlined in this agreement. It will also not be linked to any other datasets. There will be no attempt to re-identify the data. The HES tabulation data supplied by NHS Digital will be used to produce participation tables for audit purposes, to determine whether hospitals are fully participating in the audit. Aggregate HES data at Trust (and component hospital) level will be compared to the number of records submitted to the audit by each Trust and Health Board, to measure expressed (in tabular format) as case ascertainment. ascertainment rates for participating centres. This is a key quality indicator. [1 paragraph unchanged] The data is required for a national clinical audit so the data needs to be as accurate as possible. Over 200 hospitals in England and Wales are assessed against the NICOR published in reports in Quality Accounts and by the CQC. Redcentric PLC [also known as Redcentric Managed Solutions, and Redcentric Solutions Limited as well as Redcentric PLC (Harrogate)] are NOT able to access the data stored on NICOR (Barts Health) servers. The data servers are managed by NICOR staff, including all server maintenance, backups etc. Redcentric only provide the secure facility (bricks and mortar) with power and internet connectivity for us to house our servers. Servers are in a secure locked environment which Redcentric do not access. Therefore, any access to the data held under this agreement by Redcentric Ltd would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Barts Health NHS Trust staff have access to the data via remote access. The back-ups are managed entirely by NICOR (either remotely or on site) and are not conducted by the data centre. The data centre functions only in providing infra-structure. Upon instruction from NHS Digital, a Certificate of Data Destruction must be completed by the Data Controller confirming the data has been appropriately disposed of following use.

Expected output

The last report published for Myocardial Ischaemia National Audit Project was the Summary MINAP 2018 Annual Report and data was also presented in the National Cardiac Audit Programme (NCAP) 2018 Annual Report. These were distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP on its webpages on on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/ The MINAP audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and feeds back on this to NHS England and the Care Quality Commission. NICOR's first and foremost priority is to NICOR must deliver to HQIP and NHSE NHS England the NCAP Annual Report – - as a contracted deliverable. Following the formal sign off and publication of the NCAP 2019 Annual Report – there will be some individual publications discussions and presentations of the report e.g. at conferences. These presentations may not necessarily be presenting include the HES tabulation data as such, data, but the publication and any presentations would be based on the NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes). Case ascertainment is an important part of data quality and provides assurance that the audit covers all eligible patients and that results are a reliable indication of services in respective hospitals. It minimises the risk of hospitals ‘cherry picking’ patients entered into the audit. Enables the audit to measure like with like and provide national comparative data. Both the National Cardiac Audit Programme (NCAP) 2019 Annual Report and the domain-specific Summary MINAP 2019 Annual Report will be distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP webpages on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/. Analyses from NCAP appear in Quality Accounts and are made available to CQC visiting teams. Case ascertainment is important to gain an accurate assessment of the quality and quality improvement of cardiac care in England. It is a key quality measure that supports Best Practice Tariff and CQC quality measures. All outputs will be restricted to aggregate data with small number suppressed in line with the HES analysis guide.

Expected measurable benefits

Trusts will be able to use data to improve and maintain their clinical audit processes and ensure that all patients are captured in the NHS mandated project. The primary benefit is in the calculation (and presentation) of case ascertainment rates for participating centres. i.e. the results from MINAP allow NHSE to assess the quality of care and review which patients are receiving the ‘best practice’ solutions. Case ascertainment is an important aspect of data quality and provides an estimate as to what proportion of patients with the clinical condition under study are submitted to the audit. The publication of case ascertainment rates encourages participating centres to include as many patients as possible. This minimises the risk of hospitals ‘cherry picking’ patients for the audit and enables the audit to measure like with like and provide national comparative data. Access to HES trusts level data is crucial for establishing case ascertainment and ensuring the quality of patient care and patient outcomes is being monitored for all patients. Case ascertainment is key to measuring equity of access and care. A secondary benefit is in an understanding of the coding practices of participating hospitals with respect to similar cardiac conditions The audit aims to drive up the quality of the diagnosis, treatment and management of heart attack by collecting, analysing and disseminating data, measuring improvements in participation in the MINAP Audit; eventually to improve mortality and morbidity outcomes for heart attack patients. Transparency with respect to degree of participation in mandated clinical audit: The audit provides participation rates, and hospital level data, to organisations such as the Care Quality Commission’s Quality and Risk Profiles, the NHS Choices website and data.gov.uk. Case Ascertainment is also presented within annual public reports. Audit data is used in a number of ways to drive improvement in heart attack services and patient outcomes. Primarily, data is fed back to individual hospitals to report on their clinical practice and outcomes over time. Improved data quality: Publication and comparison of case ascertainment will identify poorer performing hospitals and encourage such hospitals to improve the quality of the data they submit. At the same time higher performing hospitals can receive credit. The audit provides participation rates, and hospital level data to organisations such as the Care Quality Commission’s Quality and Risk Profiles, the NHS Choices website and data.gov.uk. In addition to this, the audit produces an annual report, which is publicly available: the latest NCAP 2019 Annual Report and the MINAP 2019 Summary Report can be found at: https://www.nicor.org.uk/national-cardiac-audit-programme/ Confidence in the implications (and generalizability) of national audit: Access to HES trusts level data is crucial for establishing case ascertainment and ensuring the quality of patient care and patient outcomes is being monitored for all patients. Case ascertainment is key to measuring equity of access and care. This will lead to: (a) Improvements in patient care, as the NCAP supports both quality assurance and quality improvement initiatives both locally and nationally. (b) Understanding differences in hospital coding practices: Variation in cases ascertainment may also point to differences in HES coding practices between hospitals.

Benefits reported

The MINAP audit data is being used by the NHS to support Best Practice Tariff a quality improvement initiative to reward hospitals that provide a high standard of care. MINAP presented case ascertainment rates for participating Trusts – expressed as the ratio of the number of cases coded as myocardial infarction (in Hospital Episode Statistics (HES) data provided by NHS Digital in England to the number of cases submitted to MINAP – for the first time in 2017. This was repeated in 2018. Analysis revealed wide variation in case ascertainment. Some hospitals submit significantly fewer cases to MINAP than would be expected based upon the corresponding HES codes; others submit many more cases to MINAP than appear in HES. This latter point – a greater than expected number of cases submitted to MINAP – appears counterintuitive. It is likely to represent differences in hospital coding practices. So, for example, in 2018 while the median case ascertainment rate for English Trusts is 99%, there are 11 Trusts that have rates above 150% (implying substantially greater MINAP submissions than coded discharges) and 11 Trusts that have rates below 50% (implying inadequate case finding). Given the documented variation, MINAP will work with participating centres to better understand existing coding practice. This will lead to a request for additional ICD codes in HES returns. [5 paragraphs unchanged] NICOR require Following receipt of previous HES data in order data, MINAP has been able to report on this last aspect of data quality - case ascertainment. A reasonable level of case ascertainment reduces the likelihood that staff in participating centres are purposely selecting patients whose experiences do not provide a true reflection of the care provided to the majority of patients at that hospital. The avoidance (or identification) of such "cherry picking" is important with respect to the reliability of any subsequent comparisons of care between participating hospitals, and in the secondary use of the data sets for wealth service research purposes. Further, NICOR believe that reporting of case ascertainment encourages continued participation in the audit and 'flags up' differences in HES coding practices between hospitals. NICOR are in the process of harmonising the six national clinical cardiovascular audits into a national cardiac audit programme with 6 separate domains. This means that all domains will have standardised approach for (methodology, data collection, data completeness and data quality) conducting the audit programme. The standardised approach to conducting national clinical audit using best standardised practice will be of significant benefit to our key stakeholders as NICOR report back to commissioners, trusts, patients and public and clinicians data and information that is relevant and reliable on which decisions about commissioning and Quality Improvement (QI) of care can be made.re provided. NICOR are also using the audit data for developing risk adjustment models for MINAP which will feed back into the audit cycle of ensuring that the reports produced from NCAP are reliable and are being interpreted accurately and meaningfully for QI.

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

Objective for processing

[1 paragraph unchanged] The Myocardial Ischaemia National Audit Project (MINAP) is a domain within the National Cardiac Audit Programme (NCAP) that contains information about the care provided to patients who are admitted to hospital with acute coronary syndromes (heart attack). [1 paragraph unchanged] The tabulation requested is necessary for the performance of a task carried out in the public interest; improving the quality of care for people being treated for Myocardial Ischaemia (covered by Article 6 (1)(e) of the GDPR). [1 paragraph unchanged]

Expected output

The analysis was last report published in the for Myocardial Ischaemia National Audit Project report 2015/16 report. This is was the Summary MINAP 2018 Annual Report and data was also presented in the National Cardiac Audit Programme (NCAP) 2018 Annual Report. These were distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society, Society and is publically to other stakeholders. These reports are also publicly available online. It is published by online on the HQIP on its webpages and via NHS Choices. Previous reports can be found at: https://www.ucl.ac.uk/nicor/audits/minap/reports on on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/ NICOR's first and foremost priority is to deliver to HQIP and NHSE the NCAP Annual Report – as a contracted deliverable. Following the formal sign off and publication of the NCAP 2019 Annual Report – there will be some individual publications of the report e.g. at conferences. These presentations may not necessarily be presenting the HES tabulation data as such, but the publication would be based on the NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes). [2 paragraphs unchanged]

Expected measurable benefits

[5 paragraphs unchanged] The audit provides participation rates, and hospital level data to organisations such [15 words unchanged] In addition to this, the audit produces an annual report, which is publically publicly available: an archive of the latest NCAP 2019 Annual Report and the MINAP Audit Reports 2019 Summary Report can be found at: https://www.ucl.ac.uk/nicor/audits/minap/reports https://www.nicor.org.uk/national-cardiac-audit-programme/

Benefits reported

The MINAP audit data is being used by the NHS to support Best Practice Tarrif Tariff a quality improvement initiative to reward hospitals that provide a high standard of care. In 2016/17 NICOR harmonised the six national clinical cardiovascular audits into a national cardiac audit programme with 6 separate domains. This means that NICOR are standardising the approach in terms of (methodology, data collection, data completeness and data quality) conducting the audits. This will be reported back to all key stakeholders, commissioners, trusts, patients and public and clinicians data in a relevant and meaningful way which will lead to improvements in the quality of care provided. Additionally NICOR are mandated by HQIP to maintain and improve 'Data Quality'. Markers of data quality include: NICOR are using the audit data for developing risk adjustment models for MINAP to ensure that the reports are reliable and are being interpreted accurately and meaningfully. • timeliness of reporting - how soon after, and how often during, the relevant period of reporting are reports made available? • accuracy/validity of submitted data - are the data submitted to the audit a true reflection of the care provided? • data completeness - for each case, how many of the data fields are completed? • case ascertainment - what proportion of the entire 'population' of patients with the clinical condition of interest is submitted to the National Audit? NICOR require HES data in order to report on this last aspect of data quality - case ascertainment. A reasonable level of case ascertainment reduces the likelihood that staff in participating centres are purposely selecting patients whose experiences do not provide a true reflection of the care provided to the majority of patients at that hospital. The avoidance (or identification) of such "cherry picking" is important with respect to the reliability of any subsequent comparisons of care between participating hospitals, and in the secondary use of the data sets for wealth service research purposes. Further, NICOR believe that reporting of case ascertainment encourages continued participation in the audit and 'flags up' differences in HES coding practices between hospitals. NICOR are in the process of harmonising the six national clinical cardiovascular audits into a national cardiac audit programme with 6 separate domains. This means that all domains will have standardised approach for (methodology, data collection, data completeness and data quality) conducting the audit programme. The standardised approach to conducting national clinical audit using best standardised practice will be of significant benefit to our key stakeholders as NICOR report back to commissioners, trusts, patients and public and clinicians data and information that is relevant and reliable on which decisions about commissioning and Quality Improvement (QI) of care can be made.re provided. NICOR are also using the audit data for developing risk adjustment models for MINAP which will feed back into the audit cycle of ensuring that the reports produced from NCAP are reliable and are being interpreted accurately and meaningfully for QI.

Unchanged: Processing activities.