QSurveillance: improving the health of the nation

For healthcare professionals, access to accurate and timely data is vital for the prevention and cure of infectious diseases. It is also needed for assessing trends, highlighting health inequalities and planning for the future.

The use of electronic health records is facilitating the collection of factual and reliable data to help direct resources to areas of greatest need, so improving health and ultimately saving the health service money.

QResearch, the not-for-profit partnership between the University of Nottingham and EMIS, has developed QSurveillance, a project that collates data from more than 3,500 practices using EMIS systems and covering around 22 million patients.

Only summary data is extracted, aggregated by age and sex; no individual patient is identifiable. But the data can be used to support healthcare agencies and authorities in a number of ways.

Reports and bulletins

QSurveillance provides data from general practices to create the Health Protection Agency/Nottingham University Division of Primary Care National Surveillance System Weekly Bulletin.

This is combined with other surveillance data collected from the Royal College of General Practitioners Weekly Returns Service and NHS Direct in the weekly Health Protection Report.

The QSurveillance weekly bulletin collects, analyses and reports on rates of infectious diseases, including influenza related conditions and gastrointestinal diseases. The data can also be used to give early warning of - and track - outbreaks such as Norovirus, so that the relevant precautions can be taken and, if needed, more hospital beds made available.

Data highlights are provided in table and graph format indicating rates per hundred thousand, comparisons with the previous week and the previous year, as well as indicating regions with the highest instances.

The flexibility and timeliness of the data means that in the event of an unexpected, urgent public health situation, the relevant information can be collated overnight and distributed by 8am the next morning.

QSurveillance project leader, Professor Julia Hippisley-Cox of the University of Nottingham says: “The near real-time data available to QSurveillance is highly dynamic. By working with agencies and partners, it can be used to help improve public health.

“With QSurveillance data coming directly from primary healthcare sources, it is easy to track potential emerging public health issues, as the data can be broken right down to primary care trust level.

“This means that the pattern of outbreaks can be correlated with the regional availability of vaccines, so efforts can be targeted and a response planned. It can also help to inform the government on vital health issues.”

In the past, data has been used to track Flu B outbreaks, mumps epidemics and also to provide input into planning for flu pandemics by monitoring antiviral prescribing and estimates of NHS Direct ‘pandemic flu calls’.

Regional reporting

QSurveillance also works with the regional offices of the HPA to provide specific bulletins on infectious diseases. In October, it produced data for the 2008 Flu Surveillance bulletin for the North West. This presented regional and zonal influenza-like illnesses, taking data from over 330 practices and 1.8 million patients in the region.

QSurveillance data can also be used to monitor specific events and their impact on public health. In December 2005, regular bulletins were prepared for the East of England Regional Epidemiology Unit and Chemical Hazards and Poisons divisions to monitor the potential health effects of the Buncefield oil refinery fire in the Hemel Hempstead area.

Data was also used by the HPA Real-time Syndromic Surveillance Team to prepare reports for the Scientific and Technical Advisory Group when it needed to advise the government on the health impact of summer flooding in 2007.

Gillian Smith, Regional Epidemiologist and head of the syndromic surveillance team for the HPA, says: “This collaborative project between QSurveillance and the HPA provides very timely and local data for a range of diseases. This is of great help for those managing health protection incidents and in providing early warning for common infections.”

A research resource

The QResearch database is also one of the world’s largest primary care research resources. It can provide a powerful tool for giving accurate information on key health indicators. The NHS Information Centre is now working with QResearch on a project to provide Public Health Indicator summary reports.

Using anonymous data from more than four million patients, reports on obesity, smoking, blood pressure, cholesterol and ethnicity can be provided. This is on a larger scale than the Health Survey for England (HSfE) and it can broken down on a localised basis.

Among the findings in the first summary report were:

• The number of patients who smoke has declined over the past five years, although there is still a significant gradient between affluent and deprived areas;

• 58% of patients had their body mass index recorded in the previous five years and 26% were shown to be obese (to have a BMI greater than 30);

• Obesity levels are rising, with the North and Wales showing the highest levels and London and the South the lowest; and

• Cholesterol measurements that are now routinely recorded on electronic health records can be combined with other routine data such as age, sex, smoking and BMI, to estimate cardiovascular risk. Patients can be targeted with preventative measures, such as lifestyle advice and cholesterol lowering treatments.

Dr David Stables, clinical director of EMIS and a director of QResearch, said: “Health organisations will find access to the Public Health Indicators hugely beneficial when compiling localised health management plans for communities. Projects like this are only possible with the contribution from GPs, who provide the data on a basis that maintains patient confidentiality.”

Access to the summary reports, which can be tailored to reflect geographic areas, can be accessed on the QResearch website.

QResearch and QSurveillance are registered trademarks.