Hospital Episode Statistics Outpatient (England), 2003/04- : ADRN

<p>Abstract copyright ADRN and data collection copyright owner.</p><div class="ExternalClassC5B16636DF8E4F8296801D129857A3C9"><div class="ExternalClass66DD0B6B5E004AA6B21AC04EF9197C1B" style="text-align&#58;justify;"><p>Hospital Episode Statistics (HES) is a data warehouse that details admissions to all NHS trusts in England, including acute hospitals, primary care trusts and mental health trusts. HES information is stored as a large collection of separate records – one for each period of care – in a secure data warehouse. The information is collected into three main datasets&#58; Inpatient (including maternity), Outpatient and Accident &amp; Emergency. The data is collected during a patient’s time at hospital and is submitted to allow hospitals to be paid for the care they deliver. HES data is designed to enable secondary use for non-clinical purposes.</p><p>The Outpatient dataset provides a wide variety of information on outpatient appointments to NHS hospitals. It includes appointment dates, attendance types and non-attendances, waiting times, clinical and geographical data, patient details, socio economic factors, referral source and outcome results. This can be used to produce detailed information about patterns of service.</p><p>The Outpatient dataset is approximately four times the size of the Inpatient dataset. This is because outpatient appointments work with patients that have conditions that require continuous attendance. In 2007/08, more than 60 million records were collected from almost 400 different Trusts.</p><p>The <strong><em>Outpatient dataset</em></strong> is collected by the Secondary Uses Service (SUS) who liaise with health care providers and commissioners. This is then forwarded to HES. The dataset is compiled from data sent by all NHS and Primary Care Trusts in England. It does not cover accident &amp; emergency attendances or inpatient admissions (there are separate datasets for these), or outpatient appointments of English patients to hospitals outside of England.</p><p>The collection of the outpatient dataset began in 2003/04 on an annual basis and covers the period 1st April – 31st March of each year. Information was first released by the NHS Information Centre in July 2006 on an ‘experimental basis’. In 2008, the experimental statistics label was removed and the dataset is now produced in accordance with National Statistics standards.</p><p>The Outpatient dataset is updated annually and availability and summary information is published in December, following the previous financial year. Monthly updates are also available from the HSCIC website.</p><p>You must take care when conducting time series analysis of any HES datasets as variable inconsistencies may occur. You may need to look out for changes in the structure of an NHS organisation or Trust, new coding schemes introduced and ‘Best Practice’ procedures being changed or updated. As information is collected directly from NHS organisations, there could be data quality issues specific to a particular year as well.</p><p>As the Outpatient dataset is relatively new (introduced in 2003/04), there are data quality issues. The NHS Information Centre (now known as HSCIC) has produced a number of reports on this and you are advised to consult these prior to conducting any research. Many variables within the dataset are not mandatory and subsequently data provided by Trusts maybe low. </p><p>Generally, at the end of each financial year both a manual and automatic clean is applied to all HES data. Manual cleans occur through the application of specific rules at a Trust level. Some Trusts also specify their own rules to correct data as well. Automatic cleans are a set of rules which are applied to the dataset as a whole where data appears to be either inconsistent or invalid.</p><p>All HES datasets are reliant on trusts to provide accurate and reliable information. However many fields in the Outpatient dataset are not yet mandatory and as such coverage is low. Efforts are made by the NHS Information Centre to ensure that data is not disclosive.. When conducting longitudinal analyses it is recommended to check that there have been no boundary changes.</p><p><strong>Research Usage and Linkage</strong></p><p>The size and complexity of the Outpatient dataset present excellent research opportunities. It can be used to help better understand referral patterns across the country and examine the ways that different outpatient services perform and operate. Health care providers use the information to assess and benchmark performance with national and regional trends.</p><p>Researchers have used the dataset in the past to examine gender variation in outpatient staff attendance. However, it is a resource underused by researchers at present due to its size, complexity and current data quality issues.</p><p>In theory, all HES and Health &amp; Social Care Information Centre (HSCIC) datasets can be linked together as they contain unique identifiers such as National Health Service Number, year of birth, sex, name and postcode. HSCIC has a dedicated Data Linkage and Extract Service to perform the linkage and matching process. HSCIC routinely linked datasets together to provide better decisions about care, improve quality and safety standards and identify developing trends in population health. These are as follows&#58;</p><p><em>1. Hospital Episode Statistics linked to Patient Reported Outcome Measures</em></p><p>Data from PROMs questionnaires alone allows for a wide range of basic analysis but is limited by the lack of more detailed information about patients and their hospital stays. Linking PROMs to hospital inpatient episodes data from HES gives a much richer data set which provides the ability to analyse the data by patient demographics and by the extensive procedure and diagnosis information which are present in HES. </p><p><em>2. Hospital Episode Statistics linked to Mortality Data from the Office for National Statistics </em></p><p>Linking HES data to mortality data from the Office for National Statistics permits the analysis of deaths in and outside hospital for all patients with a record in HES. It is also a rich source of data for analysis on a wide range of subjects including outcomes of hospital care, such as postoperative mortality. </p><p><em>3. Hospital Episode Statistics linked to Mental Health Minimum Data Set</em></p><p>The linkage between HES and MHMDS is provided as a bridging file which enables mental health records to be matched with records in HES through a pseudonym that protects the identity of individual patients. This enables analysis of acute patient pathways for mental health service users in England, which could be used to assess equality of access or identify opportunities for service improvement</p><p>The HES datasets has been linked to other external datasets with varying degrees of success. For example, the inpatient admissions dataset has been linked with the General Practice Research database for in depth analysis of primary care and hospitalisation, and also linked to police records to analyse the circumstances and medical consequences of road accidents. It has also been linked with the STATS19 Road Accident dataset and the Millennium Cohort Study. Consent has also been requested to link HES data to the English Longitudinal Study of Ageing and the Health Survey for England.</p></div>