The use of routinely collected, or administrative, data for measuring and monitoring patient safety in primary care is a relatively new phenomenon. With increasing availability of data from different sources and care settings, their application for adverse event surveillance needs evaluation. In this thesis, I demonstrated that data routinely collected from primary care and secondary care can be applied for internal monitoring of adverse events at the general practice-level in England, but these data currently have limited use for safety benchmarking in primary care. To support this statement, multiple approaches were adopted. In the first part of the thesis, the nature and scope of patient safety issues in general practice were defined by evidence from a literature review and informal consultations with general practitioners (GPs). Secondly, using these two methods, measures of adverse events based on routinely collected healthcare data were identified. Thirdly, clinical consensus guided the selection of three candidate patient safety indicators for investigation; the safety issues explored in this thesis were recorded incidents with designated adverse event diagnostic codes and complications associated with two common diseases, emergency admissions for diabetic hyperglycaemic emergencies (diabetic ketoacidosis, DKA and hyperglycaemic hyperosmolar state, HHS) and cancer. In the second part of the thesis, the contributions of routinely collected data to new knowledge about potentially preventable adverse events in England were considered. Data from a primary care trust (NHS Brent), national primary care data (from the General Practice Research Database, GPRD) and secondary care data (Hospital Episode Statistics, HES) were used to explore the epidemiology of, and patient characteristics associated with, coded adverse events and emergency admissions for diabetic hyperglycaemic emergencies and cancer. Low rates of adverse events were found, with variation by individual patient factors. Finally, recommendations were made on extending the uses of routinely collected data for patient safety monitoring in general practice.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:616853 |
| Date | January 2013 |
| Creators | Tsang, Carmen |
| Contributors | Aylin, Paul ; Majeed, Azeem |
| Publisher | Imperial College London |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/10044/1/14712 |
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