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This important 3 year project focuses on the identification and management of people with CKD (Chronic Kidney Disease) in primary care to: Improve the identification of CKD patients in primary care, improve the management and outcomes of CKD patients and tailor the care of people with CKD to local care pathways.

National CKD Audit

The National Chronic Kidney Disease Audit (NCKDA) focuses on the identification and management of people with CKD (Chronic Kidney Disease) in primary care.

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The audit

The National CKD Audit was implemented in England and Wales to provide a comprehensive picture of management and outcomes for people with CKD stages 3-5 in the region.

History

The National Chronic Kidney Disease Audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP), and funded by NHS England; as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP); and the Welsh Government.

Welsh homepage
CKD Audit Welsh homepage

Mae’r Archwiliad Cenedlaethol ar Glefyd Cronig yr Arennau yn canolbwyntio ar adnabod a rheoli pobl sydd a chlefyd cronig yn yr arennau (CKD) mewn gofal sylfaenol.

Archwiliad

Mae archwiliad yn weithgaredd wedi’i gynllunio a’i ddogfenu er mwyn penderfynu dichonolrwydd a chydymffurfiaeth gweithdrefnau sefydledig, ac effeithiolrwydd eu gweithredu. Caiff archwiliad ei gynnal gan staff cymwys sy’n asesu tystiolaeth wrthrychol am sut y caiff gweithdrefnau eu dilyn, er enghraifft drwy ddefnyddio dogfennau am ddull penodol.Mae Archwiliad Cenedlaethol Clefyd Cronig yr Arennau yn bwriadu ymchwilio pa mor gyffredin yw CKD a darganfod os oes modd gwella rheolaeth CKD drwy wella diagnosis yng nghyfnod cynnar y clefyd.

Clefyd Cronig yr Arennau (CKD)

Mae CKD yn golygu bod clefyd yn eich arennau neu eu bod wedi’u niweidio rywsut, neu yn heneiddio. O ganlyniad, nid yw eich arennau yn gweithio cystal ag oedden nhw. Felly, ceir effaith ar swyddogaethau amrywiol yr arennau. Gall amrywiaeth eang o gyflyrau achosi CKD.

Mae cronig yn golygu parhaol neu hirdymor. Nid yw’n golygu difrifol, fel mae rhai pobl yn ei feddwl. Gellir dioddef o ffurf ysgafn o glefyd cronig. Mae gan sawl un ffurf ysgafn o CKD.

Gellir disgrifio CKD weithiau fel methiant arennol cronig.

Ffug-anhysbysu

Disgrifir ffug-anhysbysu gan y GIG fel a ganlyn:

“y broses dechnegol o gyfnewid adnabyddwyr person mewn set data gyda gwerthoedd eraill (ffugenwau) sydd ar gael i’r defnyddiwr data, heb fod modd darganfod hunaniaeth unigolyn drwyddynt, drwy er enghraifft gyfnewid rhif GIG gyda rhif arall ar hap, cyfnewid enw gyda chôd neu gyfnewid cyfeiriad gyda chôd lleoliad. Ni ddylai ffugenw gynnwys unrhyw wybodaeth allai arwain at adnabod yr unigolyn perthnasol (ee ni ddylai gynnwys rhifau dyddiad geni, ayyb).”

Cysylltwch â

dorothea.nitsch@lshtm.ac.uk
gyda’ch ymholiadau.

The Audit
The Audit CKD Audit
Welsh version

Yr Archwiliad

Cafodd yr Archwiliad Cenedlaethol ar Glefyd Cronig yr Arennau (CKD) ei gyflwyno yng Nghymru a Lloegr yn 2015-2016 er mwyn adolygu’r gwahaniaethau rhwng gofal cleifion o ran adnabod a rheoli cleifion mewn gofal sylfaenol sydd â chlefyd cronig yr arennau. Fe ddatblygodd y tîm archwilio offer gwella safonau a gafodd eu gosod o fewn meddalwedd Informatica, gan ganiatáu proses well i adnabod cleifion, a dull rheoli wedi’i dargedu’n well ar gyfer y rheiny sydd mewn perygl. Daeth y gwaith o gasglu’r data gofal sylfaenol i ben yn 2016.

Mae Data’r Archwiliad CKD Cenedlaethol yn cael eu defnyddio yn awr ar gyfer ymchwil pellach ar agweddau ar reoli gofal sylfaenol sy’n gwella canlyniadau  hirdymor cleifion sydd â chlefyd yn yr arennau, neu sydd mewn perygl o’i gael.

Mae Ysgol Hylendid a Meddygaeth Drofannol Llundain (LSHTM) yn cadw data o’r Archwiliad wedi eu ffug-anhysbysu er mwyn eu dadansoddi. Mae hyn yn golygu nad oes unrhyw wybodaeth unigol allai arwain at adnabod unrhyw unigolyn. Mae’r wybodaeth am rifau GIG ac unrhyw fanylion ffug cyfatebol yn cael eu cadw ar wahân yng Ngholeg Prifysgol Llundain (UCL) ar weinydd hynod ddiogel.

Bydd Data’r Archwiliad CKD Cenedlaethol yn cael eu cysylltu â gwybodaeth sy’n cael ei chadw yng Nghofrestrfa Arennol y DG ac â data am glefyd y galon sy’n cael eu cadw yn y Sefydliad Cenedlaethol Canlyniadau Ymchwil Cardiofasgwlaidd. Bydd hyn yn caniatáu dilyn canlyniadau hirdymor cleifion dros y pum mlynedd nesaf. Bydd cwmni allanol dibynadwy yn cysylltu’r data er mwyn sicrhau bod data’r cleifion yn aros yn gwbl gyfrinachol.

Os ydych yn ystyried gwneud cais i beidio â chaniatáu i’ch data chi fod yn rhan o’r archwiliad hwn, yna argymhellir eich bod yn trafod hyn gyda’ch meddyg teulu lleol. Os ydych yn penderfynu, yn sgil hynny, eich bod yn dymuno peidio â bod yn rhan o’r archwiliad, yna bydd angen i chi ofyn i’ch meddyg nodi hynny ar eich cofnod lleol. Ni fydd unrhyw ddata pellach yn cael eu rhannu â ni, nac unrhyw archwiliad cenedlaethol arall.

Pa ranbarthau sy’n rhan o’r archwiliad?

Ceir y rhanbarthau perthnasol isod.

75% posibl

50-75%

25%-50%

<25%

Dim cyfranogwr posibl

Cliciwch ar GCC (Grŵp Comisiynu Clinigol) neu BILl (Bwrdd Iechyd Lleol)

Casglu Data

Sut rydym yn casglu data?

Cafodd y data’u casglu drwy ddefnyddio meddalwedd Informatica yr Archwiliad CKD Cenedlaethol, sy’n cael ei ddarparu am ddim i’r practisiau sy’n cymryd rhan. Cafodd y meddalwedd ei osod drwy broses osod fer o bell. Fe gyfunodd datrysiad yr Archwiliad CKD Cenedlaethol yn awtomatig â system glinigol meddygon teulu er mwyn casglu’r data gofal sylfaenol. Roedd pob practis meddyg teulu yn cael ei adnabod fel endid unigol, gan roi darlun gwell o’r gofal CKD ar lefel leol neu o fewn practis.

Roedd proses yr archwiliad yn cael ei redeg bob nos ac roedd yn creu archwiliad llawn ar gyfer pob practis meddyg teulu. Gellir cael mynediad at y wybodaeth hon, a’i defnyddio o fewn y practis ac, ar ddau achlysur, cafodd ei hanfon yn ôl i warws data canolog, diogel ar rwydwaith N3 y GIG.

Pa wybodaeth sy’n cael ei chasglu?

Mae’r Archwiliad CKD Cenedlaethol wedi casglu’r wybodaeth ganlynol am gleifion oddi ar system glinigol gofal sylfaenol meddygon teulu:

  • Oed, rhyw, cenedligrwydd, cod post (er mwyn cyfrifo’r Mynegai Amddifadedd Lluosog)
  • Ffactorau risg, a chydafiacheddau perthnasol ar gyfer CKD yn y rheiny a ddylai gael eu profi (clefyd cardiofasgwlaidd, ysmygu, pwysedd gwaed uchel, diabetes, ffibriliad atrïaidd, gordewdra, gowt, clefyd arennol sylfaenol, osteoporosis, anemia, canser, clefyd systemig, dementia, problemau iechyd meddwl)
  • Meddyginiaeth (cyffuriau gwrth pwysedd gwaed uchel o ddosbarthiadau cyffuriau gwahanol, statinau, cyffuriau sy’n wenwynig i’r arennau, aspirin, warfarin, moddion diabetes) gyda dyddiadau presgripsiwn o gofnodion meddygon teulu
  • Profion labordai a’r canlyniadau
  • Rhestriad ar gofrestrau sydd eisoes yn bodoli, fel diabetes, pwysedd gwaed uchel, clefyd cardiofasgwlaidd, a ffibriliad atrïaidd.

Fe gasglon ni hefyd amrywiaeth eang o ddangosyddion cymdeithasol sy’n cael eu defnyddio i archwilio tegwch y gofal. Bydd y rhan fwyaf o’r data ar gael fel mater o drefn (Atebion Iechyd Cymru/Cronfa Ddata Cyfnodau Gofal Cleifion Cymru, y Swyddfa Ystadegau Gwladol, yr Archwiliad Diabetes Cenedlaethol) ac/neu wedi’u tynnu o systemau practisau clinigol meddygon teulu.

Er mwyn darganfod mwy am y math o ddata sy’n cael eu casglu, a fyddech cystal â lawrlwytho’r daflen wybodaeth. I gael rhagor o wybodaeth am sut mae mesuryddion yr archwiliad wedi cael eu cyfrifo, gweler y Rhestr Dull Categoreiddio ac Amrywiadau.

Gellir dod o hyd i’r rhestr lawn o godau READ yma

Mae setiau data wedyn yn cael eu cysylltu â Gofal Eilaidd (Atebion Iechyd Cymru/ Cronfa Ddata Cyfnodau Gofal Cleifion Cymru), data’r Swyddfa Ystadegau Gwladol, y Gofrestrfa Arennol Genedlaethol a’r Sefydliad Cenedlaethol Canlyniadau Ymchwil Cardiofasgwlaidd, NICOR (ar gyfer canlyniadau cardiofasgwlaidd). Er mwyn gwneud hyn, rydym yn defnyddio data adnabyddadwy’r claf (rhif GIG).

Pan fydd y cyswllt hwn yn gyflawn, rydym yn gwneud y data’n anhysbys drwy ddileu’r elfennau y mae modd eu hadnabod, cyn eu darparu i Ysgol Hylendid a Meddygaeth Drofannol Llundain, lle mae’r gronfa ddata o ymchwil anhysbys yn cael ei chadw.

Sut mae modd gwarchod preifatrwydd?

Mae’r rhaglen wedi sicrhau cymeradwyaeth Adran 60/Adran 251 o’r Ddeddf Iechyd a Gofal Cymdeithasol/Deddf y GIG oddi wrth Grŵp Cynghori Cyfrinachedd yr Awdurdod Ymchwil Iechyd, sydd â diddordeb arbennig yn y cysylltiadau data â chronfeydd eraill.

Cyn gynted ag y bydd cyswllt yn cael ei sefydlu, bydd data sy’n gallu datgelu hunaniaeth unigolyn, fel rhif claf GIG, yn cael ei ddileu (drwy weithred algorithm hash SHA256). Bydd y set data sy’n defnyddio ffugenwau canlyniadol yn cael ei gadw gan Ysgol Hylendid a Meddygaeth Drofannol Llundain i’w ddadansoddi ymhellach.

Os ydych yn ystyried atal eich data rhag cael eu defnyddio ar gyfer yr archwiliad hwn, argymhellir eich bod yn trafod hyn gyda’ch meddyg teulu lleol. Gallwch hefyd wirio’r wybodaeth am ymeithrio ar wefan y Rhaglen Ymeithrio Genedlaethol. Os ydych wedyn yn penderfynu dewis peidio â bod yn rhan o’r archwiliad, yna bydd angen i chi ofyn i’ch meddyg nodi hynny ar eich cofnod lleol. Yna, ni fydd unrhyw wybodaeth bellach yn cael ei rhannu â ni, nac unrhyw archwiliad cenedlaethol arall.

A oes modd i eraill gael mynediad at y data?

Cafodd yr Archwiliad CKD Cenedlaethol ei gomisiynu gan y Bartneriaeth Gwella Ansawdd Gofal Iechyd ar ran Archwiliad Clinigol Cenedlaethol a Rhaglen Canlyniadau Cleifion (NCAPOP) GIG Lloegr. Mae’n gydnabyddedig bod data a gesglir dan NCAPOP yn adnodd gwerthfawr a ddylai fod ar gael i sefydliadau gofal iechyd perthnasol priodol.

Rhaid i geisiadau am fynediad i’r data gael eu gwneud drwy broses ceisiadau data y Bartneriaeth, sydd ar gael ar ei gwefan, a gellir cael cyngor am sut i wneud hyn drwy bwyllgor llywio’r gronfa ddata.

Bydd angen i unrhyw geisiadau pellach a chaniatâd i rannu’r data ddod gan Gofrestrfa Arennol y DU a NICOR, yn dibynnu ar y math o ddata sydd eu hangen.

The National CKD Audit was implemented in England and Wales in 2015-2016 to review variation in patient care with regards to the identification and management of patients with chronic kidney disease in primary care. The Audit team developed quality improvement tools which were embedded in the Informatica software, allowing improved patient identification and more targeted management of those at risk. The collection of primary care data was discontinued in 2016.

The National CKD Audit Data on are now used for further research on which aspects of primary care management improve long-term patient outcomes of patients at risk of or with kidney disease.

Pseudoanonymised data from the Audit are held for analysis at the London School of Hygiene & Tropical medicine. Pseudoanoymisation means that there are no individual identifiers that allow linking the health information back to individuals. The information on NHS numbers and corresponding pseudo-identifiers are held separately at UCL in a super-secure server.

The National CKD Audit Data will be linked to information held at the UK Renal Registry and to data on heart disease held at the National Institute for Cardiovascular Outcomes Research. This will allow tracking the long-term outcomes of patients over the next 5 years. The data linkage will be done by trusted third parties to maintain maximum confidentiality of the patient data.

If you are considering requesting that your data not be used for this audit it is recommended that you discuss this with your local GP. If you then decide that you wish to 'opt-out' of the audit you will need to ask your GP to mark your local record as opted out. Then no further data will be shared with us, or any other national audit.

What regions does it cover?

The current coverage is shown below

Click on a CCG or LHB for more details.

Data collection

How do we collect data?

Data was collected using Informatica's National CKD Audit software which is provided free of charge to participating practices. The software was delivered by a short remote installation process. The National CKD Audit solution automatically integrated with the GP clinical system to collect primary care data. Each GP Practice was identified as an individual entity, giving greater visibility of CKD care at a practice or at a local level.

The audit process ran each night and compiled a full audit for each GP practice. This information can be accessed and used within the practice and it was transmitted back to a secure central data warehouse on the NHS N3 network on two occasions.

What information is collected?

From the GP Primary Care clinical system, the National CKD Audit has collected a patient’s:

  • age, sex, ethnicity, post-code (to calculate Index of Multiple Deprivation [IMD])
  • risk factors and relevant comorbidities for CKD in those who should be tested (cardiovascular disease, smoking, hypertension, diabetes mellitus, atrial fibrillation, obesity, gout, underlying kidney disease, osteoporosis, anaemia, cancer, systemic disease, dementia, mental health problems)
  • medications (anti-hypertensive drugs in different drug classes, statins, nephrotoxic drugs, aspirin, warfarin, diabetes medication) with prescription dates from GP records
  • laboratory tests and results
  • listing on existing registers like diabetes mellitus, hypertension, cardiovascular disease and atrial fibrillation.

We also collected a wide range of social indicators which are used to audit the equity of care. Most data will be routinely available data (HES/PEDW, ONS, NDA) and/or extracted from GP practice clinical systems.

To find out more about the type of data that is collected, please download the Information sheet. For further information on the basis by which audit measures have been calculated please see the Categorisation Method and Variables List.

The full list of READ codes is found here.

Datasets are then linked to Secondary Care (HES/PEDW), Office of National Statistics data, the UK renal Registry and NICOR (for cardiovascular outcomes). To do this, we use the patient identifiable data (NHS number).

Once this linkage is complete, we anonymise the data by blocking the identifiable elements, before supplying it to LSHTM where the anonymised research database is held.

How is privacy protected?

The programme has obtained Section 60 /Section 251 Health and Social Care Act / NHS Act approval from the Confidentiality Advisory Group of the Health Research Authority, which is particularly interested in the data linkages with other databases.

Once that linkage is achieved, data which can be used to identify patients, such as patient NHS numbers, is blocked (using an SHA256 hash function algorithm). The resulting pseudoanonymised data set held at LSHTM for further analysis.

If you are considering requesting that your data not be used for this audit it is recommended that you discuss this with your local GP. Please also check the information on opt out on the National Opt Out Programme website. If you then decide that you wish to 'opt-out' of the audit you will need to ask your GP to mark your local record as opted out. Then no further data will be shared with us, or any other national audit.

Can others access the data?

The National CKD Audit was commissioned by HQIP on behalf of NHS England's National Clinical Audit and Patient Outcome Programme (NCAPOP). It is recognised that the data collected under NCAPOP is a valuable resource that should be made available to appropriate related healthcare organisations.

Requests for data access must be made using the HQIP data access request process available on their website, and advice on how to do this can be obtained from the Steering committee of the database.

Depending on the types of data required, further data sharing requests and approvals need to be obtained from the UK Renal Registry and NICOR.

History
History CKD Audit
Welsh version

Hanes

Cafodd yr Archwiliad Cenedlaethol ar Glefyd Cronig yr Arennau (CKD ei gomisiynu gan y Bartneriaeth Gwella Safon Gofal Iechyd, a’i gyllido gan Wasanaeth Iechyd Gyhoeddus Lloegr; fel rhan o’r Archwiliad Clinigol Cenedlaethol a’r Rhaglen Canlyniadau Cleifion (NCAPOP); a Llywodraeth Cymru.

Roedd y cynllun pwysig tair blynedd yma yn canolbwyntio ar adnabod a rheoli pobl sydd â CKD (Clefyd cronig yr aren) o fewn y system ofal sylfaenol er mwyn:

  • Gwella’r dasg o adnabod cleifion sydd â CKD o fewn y system ofal sylfaenol
  • Gwella rheolaeth a chanlyniadau cleifion CKD
  • Teilwra gofal pobl sydd â CKD o fewn llwybrau gofal lleol.

Fe gasglodd a dadansoddodd yr Archwiliad CKD Cenedlaethol ddata a chynhyrchu adroddiadau ar gyfer practisau, i Grwpiau Comisiynu Clinigol/Byrddau Iechyd Lleol, yn ogystal ag adroddiadau cenedlaethol sydd ar gael i’r cyhoedd. Hefyd, fe ddarparodd offer gwella safonau y gallai meddygon teulu ddymuno defnyddio i helpu rheoli pobl sydd â CKD.

Cafodd yr Archwiliad ei gynnal gan Informatica (yn wreiddiol yn rhan o’r BMJ) yn gweithio ar y cyd â Chanolfan Arenneg Coleg Prifysgol Llundain, Ysgol Hylendid a Meddygaeth Drofannol Llundain, Grŵp Effeithiolrwydd Clinigol Prifysgol Brenhines Mary Llundain, gyda mewnbwn gan y Grŵp Cyswllt Cleifion. Roedd clinigwyr a phobl â CKD yn cael eu hannog yn frwd i gymryd rhan yn yr archwiliad er mwyn sicrhau newidiadau a gwella safon gwasanaethau a chanlyniadau iechyd pobl sydd â CKD yng Nghymru a Lloegr.

“O’m safbwynt i, fel meddyg yr arennau ers dros bum mlynedd ar hugain, un o’r themâu oesol yw dod ar draws cyfleon a gollwyd i adnabod clefyd yr arennau yn gynnar, a thrwy hynny fethu atal ei gymhlethdodau na chaniatáu cynllunio gofal i’r dyfodol mewn partneriaeth â chleifion.”

Dr Donal O’Donoghue FRCP
Cyfarwyddwr Clinigol Cenedlaethol Kidney Care
Mai 2012

The National Chronic Kidney Disease Audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP), and funded by NHS England; as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP); and the Welsh Government.

This important 3 year project focused on the identification and management of people with CKD (Chronic Kidney Disease) in primary care to:

  • Improve the identification of CKD patients in primary care
  • Improve the management and outcomes of CKD patients
  • Tailor the care of people with CKD to local care pathways.

The National CKD Audit collected and analysed data and produced reports for practices, CCGs/LHBs, as well as a publicly available national reports. It also provided Quality Improvement Tools which GPs may wish to use to help manage people with CKD.

The Audit was delivered by Informatica (initially part of the BMJ) working with UCL Centre for NephrologyLSHTM, Clinical Effectiveness Group QMUL, with input from the Patient Liaison Group. Clinicians and people with CKD were actively encouraged to participate in the audit to drive changes and improve the quality of services and health outcomes for people with CKD in England and Wales.

"From my point of view, as a kidney doctor for over 25 years, one of the most enduring themes has been encountering missed opportunities to identify kidney disease early, therefore not being able to prevent its complications or enable the planning of future care in partnership with patients."

Dr Donal O’Donoghue FRCP
National Clinical Director for Kidney Care
May 2012

Glossary
Glossary CKD Audit
Term Description
Audit

An audit is a planned and documented activity performed by qualified personnel to determine by investigation, examination, or evaluation of objective evidence, the adequacy and compliance with established procedures, or applicable documents, and the effectiveness of implementation.

The National CKD Audit aims to investigate the prevalence of CKD and identify whether the management of CKD can be improved through better early stage diagnosis.

Chronic Kidney Disease (CKD)

CKD means that your kidneys are diseased or damaged in some way, or are ageing. As a result, your kidneys may not work as well as they used to. So, the various functions of the kidney can be affected. A whole range of conditions can cause CKD.

Chronic means ongoing (persistent or long-term). It does not mean severe as some people think. You can have a mild chronic disease. Many people have mild CKD.

CKD can sometimes be described as chronic renal failure.

Further information can be found here.

Pseudoanonymisation

Pseudoanonymisation is described by the NHS as:

“the technical process of replacing person identifiers in a dataset with other values (pseudonyms) available to the data user, from which the identities of individuals cannot be intrinsically inferred, for example replacing an NHS number with another random number, replacing a name with a code or replacing an address with a location code. Pseudonyms themselves should not contain any information that could identify the individual to which they relate (e.g. should not be made up of characters from the date of birth, etc.).”

Steering committee
Steering committee CKD Audit
David Wheeler (UCL Nephrology) Chair
Spiros Denaxas UCL Farr
Dr David Adlam NICOR
Dr Chris Gale NICOR representative, Leeds
Dr Fergus Caskey UK Renal Registry
Dr Stephanie McNeill UK Renal Registry
Dr Richard Fluck National Think Kidneys Programme
Dr Dorothea Nitsch LSHTM
Dr Ben Caplin UCL Nephrology
Welsh representative To be nominated
Dr Kathryn Griffith RCGP
Dr Sally Hull GP
Contact
Contact CKD Audit

Please email dorothea.nitsch@lshtm.ac.uk for initial queries.