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National Ophthalmology Database Audit (NODA) Context Page

The Royal College of Ophthalmologists (RCOphth) has been commissioned by the Health Quality Improvement Partnership (HQIP) and funded by NHS England and the Welsh Government to manage the National Ophthalmology Database (NOD) Audit as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The NOD Audit prospectively collects, collates and analyses a standardised, nationally agreed cataract surgery dataset from all centres providing NHS cataract surgery in England & Wales to update benchmark standards of care and provide a powerful quality improvement tool.

View the National Ophthalmology Database (NOD) benchmarks here.

View the full NPDA data set here: Royal College of Ophthalmologists website

Metrics:

Case Ascertainment

  • Rationale: The case ascertainment rate is important as it compares the number of eligible cataract operations submitted by participating centres with the number of eligible cases reported to NHS Digital during the audit year. This provides information about the completeness of the information submitted to the audit.
  • Guideline/mapping: There is no national guideline related to case ascertainment however NHS providers are required to participate in national clinical audit as part of their standard contract.
  • Graph/relative performance: Compare to the national average. Centres and surgeons joining the audit towards the end of the data collection period would be expected to have reduced volumes of data. The date for the first submitted operation is used to clarify which centres submitted data for less than the full one-year period. Estimates of data completeness take this into account.
  • Quality improvement prompt question: Consider the other metrics in context of case ascertainment; particularly where ascertainment is low. If case ascertainment is low, this should prompt questions about data collection and engagement with the audit.

Risk-adjusted posterior capsule rupture rate

  • Rationale: Posterior Capsular Rupture (PCR) or Vitreous Loss or Both refers to a breach of the normal barrier between the front and back parts of the eye. PCR can arise as a complication of cataract surgery and may allow vitreous (a transparent substance with the consistency of egg-white which occupies the space inside the eye behind the lens) to move forward into the front part of the eye. When PCR occurs, it increases the risk of loss of vision after surgery.  PCR is a situation that can occur during surgery and be corrected during the same surgery. Patients can have good surgical outcomes if the complication is corrected. Patient characteristics and surgeon experience can influence the likelihood of PCR occurring and information collected pre-operatively can help to mitigate against these characteristics along with suitable surgeon allocation for each patient.
  • Guideline/mapping: Is there a college guideline we can reference?
  • Graph/relative performance: Individual hospitals’ rates are compared against other hospitals’ and the national average (see key). Higher values indicate better performance.  A funnel-plot cross-section shows the position of the Trust relative to 95% (alert) and 99.8% (alarm) control limits. The grey zone means that the hospital’s performance is not statistically significantly different to the national average. Outside the grey zone means that the performance is different to the national average.
  • Quality improvement prompt question: Priority should be given to alarm level negative outliers. Performance outside of the expected range should prompt questions about action taken to identify those patients at higher risk of PCR and to allocate to surgeons appropriately.

Risk-adjusted Visual Acuity Loss

  • Rationale: For cataract surgery, the most important outcome is vision; this is what matters most to patients. Vision worse after the operation is an adverse outcome.
  • Guideline/mapping: As above
  • Graph/relative performance: The VA data recording is currently not complete at most participating trusts. Data completeness varies widely by centre depending on the local patient pathway for post-op care. Centres and surgeons with <= 40% of both pre- and post-op VA data will be excluded from this outcome with a note to indicate that data completeness is inadequate for reporting. Individual hospitals’ rates are compared against other hospitals’ and the national average (see key). Higher values indicate better performance.  A funnel-plot cross-section shows the position of the Trust relative to 95% (alert) and 99.8% (alarm) control limits. The grey zone means that the hospital’s performance is not statistically significantly different to the national average. Outside the grey zone means that the performance is different to the national average.
  • Quality improvement prompt question: Priority should be given to alarm level negative outliers. Performance outside of the expected range should prompt questions about accurate collection of visual acuity data and about measures taken to monitor the performance and outcomes of individual surgeons

 

 

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