National Prostate Cancer Audit (NPCA) Context Page

NPCA is the first national clinical audit of the care that men receive following a diagnosis of prostate cancer. It collects information about the diagnosis, management and treatment of every patient newly diagnosed with prostate cancer in England and Wales, and their outcomes. The audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme. The Royal College of Surgeons’ Clinical Effectiveness Unit (CEU) was awarded the contract for the audit, which started on the 1st April 2013, and is managed as a collaboration between a team of clinical, cancer information and audit experts from the British Association of Urological Surgeons, the British Uro-oncology Group, and the CEU. In partnership with the National Cancer Registration and Analysis Service (NCRAS), Public Health England and the Wales Cancer Network, Public Health Wales, the Audit is able to collect data on a national level.

All trusts in England participate in the audit, and data is submitted for approximately 100% of patients. Case ascertainment is therefore not presented separately. Stage 1 of the participation of the audit in NCAB covers those centres providing a radical prostatectomy service only.

To view the full audit data set visit www.npca.org.uk/annual-report-2017

Metrics:

1. Percentage of men with complete information to determine disease status

  • Rationale: The higher the proportion of patients diagnosed with prostate cancer who have complete information for clinical staging (low-risk, intermediate-risk, locally advanced and advanced), the more reliable the findings of the audit will be. NCRAS manages the data flows that constitute the audit data set including Cancer Outcomes & Services Dataset (COS-D), National Radiotherapy Dataset (RTDS) and Hospital Episode Statistics (HES).
  • Guideline/mapping: The NHS standard contracts for acute hospital, mental health, community and ambulance services set a requirement that provider organisations shall participate in appropriate national clinical audits that are part of the National Clinical Audit and Patient Outcome Programme (NCAPOP)
  • Graph/relative performance: Providers should aim for 100%. The national average figure is provided. This metric is published at the level of specialist MDT.
  • Quality improvement prompt question: If the figure is low this should prompt questions about data collection and engagement with the audit data flows, the COS-D flow in particular as it is used to create this metric.

2. Percentage of patients who had an emergency readmission within 90 days of radical prostatectomy

  • Rationale: Unplanned readmission after surgery is an unpleasant experience for patients and may reflect delayed presentation of post-operative complications, over-expedient discharge policies and/or deficiencies in community care capacity. This metric is risk adjusted for age and comorbidities.
  • Guideline/mapping: There is no national guideline related to readmission after radical prostatectomy.
  • Graph/relative performance: Risk-adjusted funnel-plot cross-section; this shows the position of the Trust relative to 99.8% control limits. The grey zone means that the hospital’s performance is not significantly different to the national average. Outside the grey zone means the unit is an outlier and there is statistical evidence the performance is different to the national average.
  • Quality improvement prompt question: If the unit is a negative outlier this should prompt questions about what steps the Trust can take to reduce unplanned readmissions after radical prostatectomy.

3. Percentage of patients experiencing a severe urinary complication requiring intervention following radical prostatectomy

  • Rationale: Reflects the occurrence of treatment-related complications comparable to grade 3 toxicity according to the NCI Common Toxicity Criteria for Adverse Events Scoring system (i.e. requiring hospital admission or procedural intervention) up to two years after radical prostatectomy. High complication rates will impact negatively on patient experience and the quality of clinical care. This metric is risk adjusted for age and comorbidities.
  • Guideline/mapping: There is no national guideline relating to the development of severe urinary complications following radical prostatectomy.
  • Graph/relative performance: Risk-adjusted funnel-plot cross-section; this shows the position of the Trust relative to 99.8% control limits. The grey zone means that the hospital’s performance is not significantly different to the national average. Outside the grey zone means the unit is an outlier and there is statistical evidence the performance is different to the national average.
  • Quality improvement prompt question: If the unit is a negative outlier this should prompt questions about what steps the Trust can take to reduce complication rates following radical prostatectomy operations.

4. Percentage of patients experiencing a severe gastrointestinal complication requiring an intervention following external beam radiotherapy

  • Rationale: reflects the occurrence of treatment-related complications comparable to grade 3 toxicity according to the NCI Common Toxicity Criteria for Adverse Events Scoring system (i.e. requiring hospital admission or procedural intervention) up to two years after external beam radiotherapy. High complication rates will impact negatively on patient experience and the quality of clinical care. This metric is risk adjusted for age and comorbidities.
  • Guideline/mapping: There is no national guideline relating to the development of severe GI complications following radiotherapy.
  • Graph/relative performance: Risk-adjusted funnel-plot cross-section; this shows the position of the Trust relative to 99.8% control limits. The grey zone means that the hospital’s performance is not significantly different to the national average. Outside the grey zone means the unit is an outlier and there is statistical evidence the performance is different to the national average.
  • Quality improvement prompt question: If the unit is a negative outlier this should prompt questions about what steps the Trust can take to reduce complication rates following radiotherapy.