Evaluating hospital-level and patient-level factors that influence quality and safety outcomes for acute myocardial infarction patients in the UK (20-MINAP-01)

London School of Economics and Political Science: requires access to NHS England data for the purpose of the service evaluation project:

Evaluating hospital-level and patient-level factors that influence quality and safety outcomes for acute myocardial infarction patients in the UK (20-MNP-01).

The UK has significantly improved outcomes in patients presenting with heart attacks over the last few decades. However, there remains significant variation in quality of care and outcomes between both hospitals and different patient groups. This creates opportunities for research and is the focus on this project undertaken by the Department of Health Policy, London School of Economics and Political Science. Achieving a better understanding of the different factors which drive these variations is the first step towards finding ways to improve performance of hospitals and narrow inequalities between different patient groups.

The following is a summary of the aims of the service evaluation project provided by London School of Economics and Political Science:

There are two main themes to the evaluation:

• Objective One: To evaluate how hospital-level factors including mergers influence quality and safety outcomes.

• Objective Two: To examine differences in the level of adherence to guideline indicated treatment and quality of care in different patient groups.

The first aim is to understand different hospital characteristics which are associated with improved quality of care, and the subsequent impact of an ongoing policy to promote hospital mergers.

The second aim is to benchmark hospital performance in terms of narrowing or widening inequalities in quality of care over time.

The following NHS England data will be accessed:

- Civil Registrations of Death - This is required to evaluate 30-day and 1 year mortality.

- NICOR Myocardial Ischaemia National Audit Project (MINAP) necessary to achieve aims 1 and 2.

The level of data will be pseudonymised.

The data will be minimised as follows:

• Patients aged over 18 years admitted (date of admission) to hospitals in England and Wales with a discharge diagnosis of ST-segment elevation myocardial infarction (STEMI) or non- ST-segment elevation myocardial infarction (NSTEMI).

• Limited to the years between 01/04/2010 and 31/03/2023 (inclusive).

London School of Economics and Political Science is the controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above.

The lawful basis for processing personal data under the UK GDPR is:

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.

The relevant legitimate interests are related to ensuring that healthcare professionals, policymakers, and the public understand the determinants of quality of care for myocardial infarction to improve patient outcomes and population health.

The lawful basis for processing special category data under the UK GDPR is:

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.

This processing is in the public interest because it adheres to the UK Policy Framework for Health and Social Care Research, which protects and promotes the interests of patients, service users and the public, and aims to produce generalisable and publicly available information to inform future decisions over patients’ treatments or care.

The funding is provided by London School of Economics and Political Science. The funding is for the department and is not specifically limited to the project described. Funding is in place until 31st December 2026. The funder will have no ability to suppress or otherwise limit the publication of findings.

Data will only be accessed by substantive employees of London School of Economics.

Relevant professional societies including British Cardiovascular Society, and European Society of Cardiology have been contacted and will help shape the methods, and promote dissemination of findings.

This project was reviewed and supported by the NICOR Research Access Committee (RAC) on 14/06/2024.

National Institute for Cardiovascular Outcomes Research (NICOR) data management team at NHS England will transfer data to the NHS England data provisioning team. The data will consist of identifying details: NHS Number, Date of Birth, Postcode, Gender and a unique person ID derived from the NICOR Myocardial Ischaemia National Audit Project (MINAP) registry for the cohort to be linked with NHS England Civil Registrations of Death data.

The NHS England provisioning team will provide the relevant records from the Civil Registrations of Death dataset to National Institute for Cardiovascular Outcomes Research, who will then pseudonymise the data as requested before securely disseminating to London School of Economics and Political Science. The Data will contain no direct identifying data items. The Data will be pseudonymised and individuals cannot be reidentified through linkage with other data in the possession of the recipient.

The Data will be stored on servers at London School of Economics and Political Science.

The Data will be accessed by authorised personnel via remote access.

The Controller(s) must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.

For remote access:

- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;

- Access controls granting users the minimum level of access required are in place;

- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;

- Multifactor authentication (MFA) is required for remote access;

- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;

- All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy.

The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).

The data will not leave England/ Wales at any time.

Access is restricted to individuals within the Health department of London School of Economics and Political Science who have authorisation from the Principal Investigator. All such individuals are substantive employees of London School of Economics and Political Science.

All personnel accessing the Data have been appropriately trained in data protection and confidentiality.

Analysts from London School of Economics and Political Science will process and analyse the Data for the purposes described above.

The expected outputs of the processing will be:

• A report of findings to academic health services journals such as the BMJ Quality & Safety, and Health Policy and NICOR.

Paper 1: An analysis of the impact of hospital mergers on the quality and safety of care in the treatment of myocardial infarction in England and Wales (31/12/2025)

Paper 2: Examining inequalities in guideline adherence and quality of care for the treatment of acute myocardial infarction(AMI) in different patient groups (31/12/2025)

The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived.

The outputs will be communicated to relevant recipients through the following dissemination channels:

• Journals

• Social media

• Public reports

• Direct bilateral engagement with NICOR, British Society for Cardiology and European Society for Cardiology

• Press/media engagement

Findings will be disseminated among relevant professional organisations such as the British Society of Cardiology, NICOR, and European Society of Cardiology.

The target date for dissemination is 31st December 2025.

The findings of this service evaluation are expected to contribute to evidence-based decision-making for policy-makers, local decision-makers such as doctors, and patients to inform best practice to improve the care, treatment and experience of health care users relevant to the subject matter of the study.

Objective 1: An analysis of the impact of hospital mergers on the quality and safety of care in the treatment of myocardial infarction in England and Wales.

Expected Benefits: Current literature on the impact of hospital mergers on quality of care provided is largely inconclusive, or points to unchanged quality of care. With the hospital market in England becoming increasingly consolidated, it is important to obtain up-to-date estimates of the resulting effect on quality and safety. This is to facilitate future policy developments in this important area and ensure that any economically driven decisions do not negatively impact the quality of care provided to acute myocardial infarction patients.

Objective 2: Examining inequalities in guideline adherence and quality of care for the treatment of AMI in different patient groups.

Expected Benefits: Benchmarking performance of hospital providers is an important exercise which can help improve transparency and accountability by identifying hospitals with poorer than expected performance. It is also a valuable exercise to extend this benchmarking to categorise hospitals according to progress in narrowing or widening inequalities in quality of care. By just focusing on aggregate outcomes, it is possible that hospitals associated with widening inequalities are overlooked. There have been some initial analyses of MINAP which have taken this perspective, specifically with gender. However, there is a strong rationale to repeat these analyses iteratively, taking account of a broad set of patient factors including gender, ethnicity and socioeconomic background, and change over time.

This analysis would produce benefits for patients in relation to improved outcomes following myocardial infarction.

It is hoped that through publication of findings in appropriate media, the findings of this service evaluation will add to the body of evidence that is considered by the bodies, organisations and individual care practitioners charged with making policy decisions for or within the NHS or treatment decisions in relation to specific patients.

Yielded Benefits is not a requirement for new applications.