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ABSTRACTObjectivesThe national oesophago-gastric cancer audit evaluates the care given to patients with OG cancer diagnosed in England and Wales, identifying areas for local services to improve and so achieve better patient outcomes. While the audit follows a standard approach by collecting a core dataset, it extends this by linking to other national databases in order to (1) reduce the burden of data collection, (2) add data that could not otherwise be obtained, (3) verify the quality of audit data. This presentation will provide an overview of the modern approach to national clinical audits and introduce anticipated future developments.
ApproachThe data collected by hospitals and submitted to the audit is expanded by linkage to radiotherapy data (RTDS), date of death from the Office for National Statistics and administrative hospital admission data (HES). The linked data enables the Audit to: (1) examine whether radiotherapy regimens used in definitive oncology comply with guideline recommendations, using dosage information drawn from RTDS; (2) publish comparative short-term survival figures for NHS trusts and surgeons using ONS date of death; and (3) assess the quality of data submitted from hospitals by comparing coded procedural information in HES and the audit dataset.
ResultsThe analysis of the linked data has led to several important audit findings, namely: (1) Access to RTDS data confirmed reasonable compliance with official guidelines on recommended radiotherapy dosing schedules. (2) Linked mortality data has provided robust and credible estimates of surgical outcomes and is a critical output to NHS trusts and surgeons, as well as the wider public. Our analysis has highlighted a gradual decline in post-operative mortality. (3) Linkage of audit and HES data identified gaps in the recording of endoscopic stenting, with many procedures not being submitted by participating trusts. These diverse results underline the usefulness of linked data in revealing a more complete picture of the care received by OG cancer patients.
ConclusionLinked data has become integral for the successful implementation of a national clinical audit, supplementing the core dataset with information that would otherwise be unavailable or difficult and costly to collect. Linkage enhances the audit's ability to assess health services' compliance with professional standards and to give service providers the opportunity to benchmark their performance. Future developments are expected to expand on this by including primary care service use before diagnosis.

ABSTRACTBackgroundBabies born late preterm (34-36 weeks gestation) or early term (37-38 weeks) are at increased risk of unplanned readmissions compared with full-term babies. We examined differences in neonatal and infant outcomes in England and Ontario.
MethodsLinked maternity-baby hospitalisation data were extracted from two universal healthcare systems, Ontario (n=702,565; 2005-2013) and England (n=1,165,375; 2011-2013). We modelled rates of unplanned readmissions within 30-days post-discharge of delivery, and readmissions, emergency department (ED) visits, deaths and total inpatient days within 12-months post-discharge, adjusting for neonatal, maternal and delivery factors.
ResultsThe median newborn length of stay was 4 and 5 days in Ontario and England respectively for late preterm babies, and 2 days in both countries for early term babies. Early neonatal readmissions were lower in Ontario: 4.8% of early term and 7.2% of late preterm babies compared with 8.3% and 11.4% respectively in England (p<0.05). Within 12-months post-discharge, 9.6% of early term and 13.5% of late preterm babies were readmitted in Ontario compared with 24.0% and 30.5% in England (p<0.05); total inpatient days per 100 babies were 36.5 for early term and 61.9 for late preterm (Ontario) compared with 62.7 and 107.6 (England). Infant mortality (0.1-0.4%) and ED visits (40-44%) were similar between countries.
ConclusionsUnplanned readmissions and total inpatient stay are significantly higher in England than Ontario for early term / late preterm babies, despite similar ED attendances and lengths of newborn stay. Further investigation of differences in healthcare practices between countries should evaluate access to paediatric primary care and thresholds for admission.