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Background: The widely used OpenPrescribing.net service provides standard measures which compare prescribing of Clinical Commissioning Groups (CCGs) and English General Practices against that of their peers. Detecting changes in prescribing behaviour compared with peers can help identify missed opportunities for medicines optimisation. Automating the process of detecting these changes is necessary due to the volume of data, but challenging due to variation in prescribing volume for different measures and locations. We set out to develop and implement a method of detecting change on all individual prescribing measures, in order to notify CCGs and practices of such changes in a timely manner.

Methods: We used the statistical process control method CUSUM to detect prescribing behaviour changes in relation to population trends for the individual standard measures on OpenPrescribing. Increases and decreases in percentile were detected separately, using a multiple of standard deviation as the threshold for detecting change. The algorithm was modified to continue re-triggering when trajectory persists. It was deployed, user-tested, and summary statistics generated on the number of alerts by CCG and practice.

Results: The algorithm detected changes in prescribing for 32 prespecified measures, across a wide range of CCG and practice sizes. Across the 209 English CCGs, a mean of 2.5 increase and 2.4 decrease alerts were triggered per CCG, per month. For the 7578 practices, a mean of 1.3 increase and 1.4 decrease alerts were triggered per practice, per month.

Conclusions: The CUSUM method appears to effectively discriminate between random noise and sustained change in prescribing behaviour. This method aims to allow practices and CCGs to be informed of important changes quickly, with a view to improve their prescribing behaviour. The number of alerts triggered for CCGs and practices appears to be appropriate. Prescribing behaviour after users are alerted to changes will be monitored in order to assess the impact of these alerts.

Titel:	Detecting change in comparison to peers in NHS prescribing data: a novel application of cumulative sum methodology.
Autor/in / Beteiligte Person:	Walker, AJ ; Bacon, S ; Croker, R ; Goldacre, B
Link:	Full Text Finder (Volltext)
Zeitschrift:	BMC medical informatics and decision making, Jg. 18 (2018-07-09), Heft 1, S. 62
Veröffentlichung:	London : BioMed Central, [2001-, 2018
Medientyp:	academicJournal
ISSN:	1472-6947 (electronic)
DOI:	10.1186/s12911-018-0642-6
Schlagwort:	Humans Peer Group United Kingdom Algorithms Drug Prescriptions statistics & numerical data Medical Order Entry Systems statistics & numerical data National Health Programs statistics & numerical data Practice Patterns, Physicians' statistics & numerical data
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Research Support, Non-U.S. Gov't Language: English [BMC Med Inform Decis Mak] 2018 Jul 09; Vol. 18 (1), pp. 62. <i>Date of Electronic Publication: </i>2018 Jul 09. MeSH Terms: Algorithms* ; Drug Prescriptions / statistics & numerical data ; Medical Order Entry Systems / statistics & numerical data ; National Health Programs / statistics & numerical data ; Practice Patterns, Physicians' / statistics & numerical data ; Humans ; Peer Group ; United Kingdom References: Postgrad Med J. 2005 Oct;81(960):647-52. (PMID: 16210461) ; Anesth Analg. 2014 Sep;119(3):679-85. (PMID: 25137002) ; PLoS Med. 2016 Aug 30;13(8):e1002115. (PMID: 27575599) ; Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259. (PMID: 22696318) ; J Thorac Cardiovasc Surg. 2006 Aug;132(2):386-91. (PMID: 16872967) ; J Eval Clin Pract. 2011 Feb;17(1):71-7. (PMID: 20807294) ; BMJ. 2016 Aug 18;354:i4079. (PMID: 27540041) ; Qual Saf Health Care. 2004 Aug;13(4):243-5. (PMID: 15289621) ; J Med Eng Technol. 1997 May-Aug;21(3-4):111-20. (PMID: 9222952) ; Biostatistics. 2000 Dec;1(4):441-52. (PMID: 12933566) ; N Engl J Med. 2016 Mar 17;374(11):1053-64. (PMID: 26981935) ; BMJ Qual Saf. 2011 Jan;20(1):46-51. (PMID: 21228075) ; BMJ Qual Saf. 2015 Dec;24(12):748-52. (PMID: 26316541) ; Qual Saf Health Care. 2007 Oct;16(5):387-99. (PMID: 17913782) ; J Clin Pharm Ther. 2011 Dec;36(6):680-6. (PMID: 21143614) ; BMC Med Res Methodol. 2007 Nov 03;7:46. (PMID: 17980042) Grant Information: 327 United Kingdom Department of Health Contributed Indexing: Keywords: CUSUM; Change detection; Prescribing data Entry Date(s): Date Created: 20180711 Date Completed: 20190319 Latest Revision: 20190319 Update Code: 20231215 PubMed Central ID: PMC6038291

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Detecting change in comparison to peers in NHS prescribing data: a novel application of cumulative sum methodology.