Validation and initial reports

Validation of the UK QResearch database: 

Analysis and reports for the Department of Health


Background to the QResearch reports for the Division of Statistics, Department of Health

Between December 2003 and April 2005, the Division of Statistics in the Department of Health had an agreement with QResearch to undertake a series of analyses to explore the utility of QResearch data for research and informing health policy. At the time the Division of Statistics were exploring possibilities to fill information gaps with information from GP management system databases using QResearch and other database systems. Information gaps were identified by a number of people within the Division of Statistics in conjunction with policy colleagues, and specifications were drawn up in conjunction with QResearch. In April 2005, the main contract between QResearch and the Department of Health was novated to the new Information Centre (now NHS Digital). The QResearch database was in the process of development at the time and reports were produced using different versions of the database. 

Some of the reports give background to QResearch, the way it can be used, and compare it with other data sources. The other reports look at particular areas of interest and can be grouped into two main sets. One of these sets looks at various aspects of prescribing: reports on particular therapies and how they were being used, and reports on various aspects of prescribing for the elderly. The other set looks at prevalence of diseases in the new GMS contract and trends and variations in the indicators in the Quality and Outcomes Framework for three of these conditions. There is also a report on obesity, a risk factor for several conditions. 

The reports give important information not obtainable from routine sources, notably about how medicines are used to treat elderly people and how the recording of lifestyle information in GP systems has improved over time. Overall, these reports provide valuable information not just on the topics studied but on the overall quality and utility of QResearch for health service analysis and research, which is excellent. 

QResearch has since expanded and provides a valuable analysis and information service based on clinical data from primary care to Public Health England using QSurveillance® – more details can be found at www.qsurveillance.org. Information on other recent research using QResearch can be found here.

Summary of reports using QResearch for the Division of Statistics, February 2004-January 2007

Report No. Department of Health report: Title Comments
1. Comparison of the recording of procedures on QRESEARCH and Hospital Episode Statistics databases This report describes how well common hospital procedures are recorded in the database, and finds those where clinical implications attach to procedure rather than underlying diagnosis are better recorded. Whilst QResearch is very good for consultations in some locations it is not a suitable source for determining the source of operative procedures.
2. An analysis of prescribing of Methylphenidate Hydrochloride in QRESEARCH Reports on treatment for attention deficit disorder (including Ritalin), finds similar levels of prescribing as can be found in published prescription data. The report demonstrates the ability to report by age and gender of patients and amounts typically prescribed per prescription.
3. Patterns of prescribing of selective serotonin reuptake inhibitors in children in QRESEARCH There was concern at the time this report was written over prescribing of SSRIs (a type of antidepressant), particularly paroxetine to those aged under 18. The report presents analyses of prescribing rates to those aged under 18 by age and gender in 2002. Numbers of prescriptions for SSRIs to children and young people available already from routine statistics but not rates or number of patients involved.
4. Types of clinical and administrative users in QRESEARCH This report describes categories of people who enter clinical and administrative information on the EMIS clinical computer system within primary care. For example, 85% of data is entered by administrative staff, nurses and GPs.
5. An analysis of the top ten most commonly prescribed chemical entities in QRESEARCH. This analysis compares which chemical entities were recorded as most commonly prescribed on the database compared with published prescription data. The analyses compare very favourably which means QResearch is likely to be an excellent source of information on prescribing in primary care.
6. A report on basic prescribing rates in older people using QRESEARCH This analysis compares prescribing rates in older people found in QResearch with published prescription data. Again, there is a good correspondence where comparative information exists. The work then extends to give detail on age groups within the group as a whole and examines trends over time.
7. Prescribing in older people by BNF Chapter: analysis of QRESEARCH data This analysis compares with Key Health Statistics in 1998 (analysis based on an older database called the General Practice Research Database) and routine prescribing statistics, produced to check on quality of database.
8. Polypharmacy in the elderly: analysis of QRESEARCH data This work extends work of report 7 to look at how many different medicines the elderly are prescribed.
9. Repeat prescribing in elderly people: analysis of QRESEARCH data The analysis examines the proportion of prescriptions that are recorded as repeats and how frequently consultation was involved.
10. Obesity in the UK: analysis of QRESEARCH data Reports on changes in the level of recording of body mass index in QResearch, over time, and by various characteristics. The report describes the increase in recorded obesity 1994 to 2003 and compares it with reported obesity from Health Survey for England.
11. Diabetes in the UK: analysis of QRESEARCH data Reports on 10-year trends in incidence, prevalence and mortality of diabetes and obesity by age, sex, deprivation and geographical area.
12. Trends and variations in GMS indicators for diabetes: analysis of QRESEARCH data This report looks at the achievement of quality indicators for diabetes and how it varies over time and between different practices.
13. Co-morbidity of diseases in the new GMS contract for GPs: analysis of QRESEARCH data The report analyses the number of patients who have more than one condition listed in the new GMS contract Quality and Outcomes Framework.
14. Trends and variations in GMS quality indicators for hypertension: analysis of QRESEARCH data This report looks at the achievement of quality indicators for hypertension (high blood pressure).
15. A description of the 4th version of the QRESEARCH database. This report looks at issues reported about pilot database now a more substantial version available (version 4 of the national database). The data quality in the full national database compare favourably with the more select sample which made up the pilot database.
16. The population prevalence and inter-practice variation of diabetes: analysis of QRESEARCH data This and all subsequent reports looked at recording of conditions and indicators that are part of new GMS contract Quality and Outcomes Framework. They were used in advance of data being available on the achievement of these indicators as reported to QMAS system, two years worth of QMAS data reporting on achievement has now been published and was in line with the expectations based on QResearch analysis.
17. Prevalence of diseases in the new GMS contact for GPs: analysis of QRESEARCH data This is an update on the prevalence of conditions in the GP contract - interestingly the results are similar to the analysis based on the much smaller pilot database.
18. Trends and variations in GMS quality indicators for coronary heart disease: analysis of QRESEARCH data. This report looks at the achievement of quality indicators for coronary heart disease over a three-year period in the run up to the end of the first year of the new GMS contract. Overall, it demonstrated a trend to improvement across the large majority of indicators and the variation between practices is narrowing even over the relatively short time frame of this analysis. The scale of the improvement, even over three years, is likely to have an impact on clinical outcomes for patients, including risk of further myocardial infarction and death. These indicators suggest that, for whatever reason, primary care is likely to be saving significantly more lives than three years ago and this warrants further study.