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Data failings threaten NHS payments

Trial system blighted with inaccuracies

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The Payment by Results (PbR) system could be in jeopardy because data collected by the NHS is not accurate, a pilot has revealed.

The Royal College of Physicians has published a report on a trial of the system conducted by its iLab facility. It found that clinical data entered onto the Hospital Episode Statistics (HES) for England and the Patient Episode Database Wales (PEDW) – used for analysis for PbR – was inaccurately entered by administration staff.

Practice Based (GP) Commissioning and Payment by Results (PbR) was launched in April 2005 to overhaul the way secondary care was funded. Its aim was to provide a rules based system to pay trusts based on their needs for services, rewarding efficiency and support of patient choice, but the RCP said the two year pilot has found the information it relies on is incomplete and inaccurate.

The Engaging clinicians in improving data quality in the NHS report concludes that although coding staff are very effective at accurately coding and entering information, the "information clinicians provide in patient notes and discharge summaries, can often be incomplete or unclear for the purposes of coding. This has been cited as a possible weak link in the data quality chain."

Mistakes included codes entered by individual trusts into a central system that allocated a patient to the wrong consultant, incorrect lengths of stay for inpatients, and failures by hospital administrators to collect and record all the relevant data.

An iLab spokesperson told GC News that the PbR is in jeopardy because the clinical information cannot be relied on.

"If the consultant undertook a particular procedure and it is then coded as something else then that can lead to problems," the spokesperson said.

The report recommends that in the short term existing national hospital databases should be expanded to include outpatient data, administrative, demographic, and clinical. In the longer term, the Department for Health will need to develop clinical information systems which better reflect working practices.

Consultants and doctors should also be more involved in the process of collecting data to ensure its accuracy.

"As a result of these limitations and existing consultant level data quality problems, national comparisons of individuals practice using HES/PEDW data should not be made," says the report.

Dr Giles Croft, project manager for iLab, said: "This research highlights the inadequacy of centrally collected clinical information in the NHS. The fact that we have to resort to decades old management information to examine clinical practice simply reflects the sad reality that there are currently no alternatives.

"We have shown that improvements can be made, but even if accuracy was at 100 per cent this data would still not come close to reflecting the complexities of the care doctors provide to their patients."

This article was originally published at Kablenet.

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