National COPD Audit Programme: secondary care workstream 2015–18

The COPD secondary care workstream comprised two parts: a continuous clinical audit of patients admitted to hospital in England and Wales with COPD exacerbations, and a snapshot audit of the organisation and resourcing of COPD care. A range of resources to assist in local implementation of the audit are also available.

On 1 March 2018, adult and paediatric asthma were added to the COPD audit programme when the National Asthma and COPD Audit Programme (NACAP) was launched.

What we are doing

COPD: Time to integrate care presents secondary care organisational audit data collected from 3 April to 30 June 2017. This report succeeds the 2014 organisational audit report published in November 2014.

COPD: Working together is the first report since the launch of continuous data collection on 1 February 2017. It presents the results of the cohort of patients discharged between the audit’s launch date and 13 September 2017. The national report from the previous secondary care clinical audit (conducted and published in 2014) is also available.

For both of the above reports a quality improvement (QI) slide set focused on the key findings from the 2017 audits is also available.

A snapshot organisational audit ran in 2017, with data collection via the bespoke web-based audit tool.

Datasets

The datasets for each part of the audit have been developed and refined from the 2014 audit round, with effort made to reduce the burden on clinical teams. The final datasets are available to view. The clinical dataset focuses on:

  • specialist review
  • oxygen
  • non-invasive ventilation (NIV)
  • spirometry
  • smoking cessation
  • discharge.

The organisational dataset focused on the resources and organisation of care, and included a quality improvement element, with sites asked to submit action plans developed as a result of the last round of audit.

Participation in the COPD audit is a requisite of trust quality accounts. Guidance, help notes and patient information posters and leaflets have been produced for the audit period, and are available on this website; provisional versions of the datasets are available for download from our resources page.

The secondary care audit also has a programme page on the Respiratory Futures website, as well as a forum where healthcare professionals can share learning about doing and learning from the audit.

Best Practice Tariff and Care Quality Commission

Two audit indicators within the clinical dataset form the basis of a COPD best practice tariff (within the National Tariff for 2017–18 and 2018–19).  This was introduced in April 2017:

  • specialist review within 24 hours
  • BTS, or equivalent, discharge bundle for admission.

From late 2017 six key COPD metrics that are measured through the audit will be used by the Care Quality Commission (CQC) as part of the National Clinical Audit Benchmarking (NCAB) project to measure trust performance. The following hospital level data will be provided to the CQC on a 6-monthly basis regarding the percentage of patients receiving:

  • specialist review within 24 hours
  • prescription of oxygen to stipulated target oxygen saturation
  • NIV within 3 hours of arrival
  • prescribed smoking-cessation pharmacotherapy (for documented current smokers)
  • BTS, or equivalent, discharge bundle for admission
  • spirometry confirming FEV1/FVC ratio <0.7 recorded in case file.

Each of the above metrics will be compared to an aspirational standard (either BPT attainment or upper quartile), as well as against national medians.

Audit timeline

  • May–June 2016: public consultation of the clinical dataset
  • August–September 2016: a 4-week pilot of the bespoke web-based tool and the audit datasets
  • summer–autumn 2016: recruitment of sites for participation in both the clinical and the organisational audits
  • November 2016: ‘soft’ launch of the clinical and organisational dataset web tools
  • February 2017: full launch of continuous data collection for the clinical dataset
  • spring 2017: launch of live run chart reporting on the clinical dataset web tool
  • April–June 2017: data collection for organisational dataset
  • autumn-winter 2017: service level reporting for the organisational and clinical audits sent to participants
  • winter 2017–18:
    • publication of a national organisational audit report
    • publication of a national clinical audit annual report.

The above timeline may be subject to change but we will keep you updated regarding any changes and provide additional timeline details as they are confirmed.

Data processing

All data that will be collected by the audit programme will be processed to ensure patient confidentiality is maintained.

This audit has been granted Section 251 approval by the NHS Health Research Authority (CAG reference: CAG 8-06(b)/2013), meaning that we are allowed to collect patient-identifiable data without patient consent. More information about the data items collected, as well as about the data flows outlined below, is available in our patient information sheet as part of the audit resources for the secondary care workstream.

Identifiable patient data will be entered into an online data collection tool managed by Crown Informatics from 1 February 2017 onwards. These data will be sent to the RCP at periodic intervals by Crown Informatics in a completely anonymised format for analysis and reporting. A national report, similar  to the one published in 2014 (COPD: Who cares matters) will be published using these data, as will reports for Clinical Commissioning Groups (CCGs). Only aggregate data will be presented, and no information will be released that could be used to identify individuals.

The audit information will also be linked with data already held by NHS Digital: namely, the Hospital Episodes Statistics (HES) dataset and the Office of National Statistics (ONS) mortality data. HES is a record of all hospital admissions in England, while ONS mortality data is sourced from civil registration data. NHS Digital will receive patient identifiable information (NHS number, date of birth and postcode) from Crown Informatics to link the audit data to these sources.  Once the data has been linked, it will be sent back to Crown Informatics, who will remove all patient identifiable information. The RCP will then be sent anonymised patient level records for the patients that participated in the audit from both HES and ONS (cause of death, and month and year of death will be provided to the RCP from ONS mortality data).

These data (ie audit data linked to HES and ONS) will be used to produce a supplement to the national clinical report. Only aggregate data will be presented and no information will be released that could be used to identify individuals.

Please note that the data collected for this audit may periodically be shared with other organisations in a completely anonymised format. Circumstances may include research, or for local quality improvement initiatives. Data will only be shared if appropriate legal approvals are in place, and no information that could be used to identify individuals will be released. Any such use of the data will always be in line with the overall aims of improving care and services for people with COPD.

Contact

If you think your data may have been collected as part of this audit and wish to have it removed, then please speak to a member of your respiratory team at the hospital that treated you, or contact a member of the audit programme team by email at copd@rcplondon.ac.uk or phone on +44 (0)20 3075 1526.

Who's involved

Organisations

The datasets for each part of the audit were developed and refined during 2013 by the workstream steering group, with input from the NHS and British Thoracic Society (BTS) COPD leads, and in light of feedback from a short pilot audit run in September 2013.

All relevant secondary care providers in England and Wales were expected to participate. The National COPD Audit Programme is included in the list of national audits for inclusion in trusts’ Quality Accounts, and is also included in the NHS Wales Clinical Audit & Outcome Review Plan.

The National COPD Audit Programme has been commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and currently covers England and Wales only. We are very much aware that colleagues in Scotland and Northern Ireland may wish to audit their practice, and while this presents challenges in relation to resourcing and Information Governance rules that differ from country to country, the National COPD Audit team continues to explore ways in which this could be achieved in the future.

What we have produced

This report presents the data collected for the 2017 secondary care clinical audit of COPD exacerbations admitted to acute hospitals in England and Wales.
This report presents findings from the snapshot audit of the organisation and resourcing of COPD care that was undertaken in hospitals in England and Wales between 3 April and 30 June 2017.
Documents developed to help organisations participating in the national COPD secondary care 2017 audits navigate the process.

Site-level data as used in the analysis presented within the national COPD secondary care clinical and organisational audit 2017 reports.

This supplementary report details the outcomes of the cohort of patients included in the 2014 clinical audit of COPD exacerbations in England. It also includes a QI-focused slide set.

This organisational audit of COPD care was run in parallel with the 2014 secondary care clinical audit, with data collection via a bespoke web-based audit tool.

This clinical audit is the second in the current round of the 2014 secondary care component of the national Chronic Obstructive Pulmonary Disease (COPD) audit.
The secondary care workstream ran an audit in 2014. The organisational report was published in November 2014 and the clinical report followed in February 2015.
Documents developed to help organisations which participated in the national COPD secondary care 2014 audit navigate the process.