The purpose of the National Prostate Cancer Audit (NPCA) is to evaluate the patterns of care and outcomes for patients with prostate cancer in England and Wales, and to support services to improve the quality of care for these patients.
This third quarterly report introduces the NPCA’s first quarterly performance indicator, “Emergency readmission within 90 days of radical prostate cancer surgery”. This follows NPCA methodological development work that deemed the Rapid Cancer Registration Dataset a suitable data source for this indicator. This report also continues to present data completeness of key data items including the new data quality metric “Data completeness for Gleason score”.
The data quality metrics in this report provide an overview of the quality of key data items for 144,398 people diagnosed with prostate cancer in England between 1st January 2021 and 31st December 2023.
The performance indicator (emergency readmission within 90 days of radical prostate cancer surgery) in this report includes 15,590 people who underwent radical prostate cancer surgery between 1st January 2021 – 31st March 2023.
Why do we report data completeness?
We report on data completeness as this aspect of data quality underpins what we can reliably and robustly report as an audit. We encourage all provider teams to review their data completeness and make improvements as this will increase the number of people we can include in analyses and increase the range of analyses we can conduct.
How did we select our performance indicator?
The first performance indicator we are going to report quarterly is “Emergency readmission within 90 days of radical prostate cancer surgery”. This was selected based on methodological development work conducted by the NPCA which deemed RCRD a suitable data source for this indicator. The other NPCA State of the Nation report indicators are currently challenging to report quarterly due to the length of follow-up required (2 years) or due to current limitations of the RCRD such as lag in availability of TNM and Gleason score which are used for cohort definition.
Going forward, the team will continue development work, in consultation with stakeholders, to determine which performance indicators are appropriate for quarterly reporting using the RCRD.
How have we chosen these specific data items to focus on for our data quality metrics?
The specific data items we report the completeness of were chosen in collaboration with the audit’s clinical and methodological experts.
Ethnicity was chosen as we would like to thoroughly explore inequalities in cancer care which is a priority for NHS England. To enable this, it is important that every patient has ethnicity accurately recorded.
Gleason score, which is a measure assigned by a pathologist to determine how aggressive an individual’s prostate cancer is when the prostate cancer tissue is examined using a microscope, was chosen as it is essential for risk stratifying patients. This allows us to compare results between providers and assess the eligibility of patients for different treatments.
Performance status was chosen as it is important across cancers for assessing the eligibility of patients for different treatments.
PSA, which is the result from a Prostate Specific Antigen test, is essential for risk stratifying patients. This allows us to compare results between providers and assess the eligibility of patients for different treatments.
TNM, which is stage of disease where “T” represents the local stage, “N” represents the presence of lymph node involvement and “M” represents the presence of metastatic disease, is essential for risk stratifying patients. In prostate cancer TNM is particularly important as knowing whether a patient is stage I-IV does not provide information regarding regional lymph node involvement as well as distant metastatic disease.
NPCA Quarterly Report, January 2021 to December 2023How to interpret the graph
It is natural for metric values to vary from quarter to quarter. This might be due to random variation or to changes in hospital activity.
Data quality metrics
The moving average reduces the amount of random variation in the sequence of values, and this helps to reveal trends / changes in patterns of data completeness.
Performance indicator (emergency readmission within 90 days of radical prostate cancer surgery)
The time series line reduces the amount of random variation in the sequence of values, and this helps to reveal trends / changes in patterns of the indicator. If the time series line is outside the control limits, this suggests that there is a change in performance beyond what we would expect due to chance.