The Royal College of General Practitioners (RCGP) quality improvement initiative using Clinical Practice Research Datalink (CPRD) data: Lessons learned

Problem

Quality improvement (QI) is a priority for general practice across the UK, and GPs are expected to participate and provide evidence of QI activity. However, pressures on the primary care workforce mean that approaches to QI must be efficient, straightforward and effective. This project aimed to scale up production and distribution of bespoke quality improvement reports for GP practices contributing data to CPRD.

Approach

CPRD is a UK government research service facilitating public health research using anonymised primary care data. A pilot report was designed with stakeholder input and focused on two patient safety indicators from the RCGP Patient Safety Toolkit relating to prescribing of NSAIDs and glitazones in heart failure patients. The reports enabled GPs to identify patients needing case review using encrypted identifiers in addition to benchmarking data on practice-level prescribing. Reports for 12 practices, containing real patient data, were sent to GPs and feedback on the content, structure, frequency and utility of reports was obtained via telephone interviews before finalising for scale-up. Scale-up involved tailoring of programming to use data sourced from two GP software systems (EMIS® and Vision®), automation of production and distribution of reports, and manual validation of a sample of the automated reports. The report was scaled up to 457 CPRD practices in 2017 and a survey was sent to all practices to request feedback.

Findings

GP feedback during the pilot demonstrates that reports were used to review the care of individual patients and to implement other QI actions within the practice, such as discussing the indicators among clinicians or adding flags to patients notes. One participant fed back that they used the report as evidence for their annual appraisal and revalidation. Survey response has been limited (n=31, 7%) but overwhelmingly positive, with all respondents saying the reports were useful. Respondents have also highlighted the importance of clinical input when developing indicators and ensuring the tone of the reports is supportive.

Consequences

The collaborative RCGP/CPRD QI reports are unique in their ability to provide benchmarking and case-finding on a national scale. Consideration is needed in selecting indicators to ensure the reports are actionable. Clinical input is required to ensure that code lists are appropriate and that the reports are clinically relevant. Producing the reports based on data from two GP software systems adds complexity as there are differences in data coding and structure meaning that development of the queries must be undertaken separately and validation undertaken at each stage of the analysis. CPRD aims to send out two reports per year initially and to engage with GPs for the development of relevant new indicators.