The document discusses the Hampshire Health Record (HHR), a database containing pseudonymized linked extracts of primary and secondary care records for about 1.3 million people in Hampshire, UK. It describes several uses of the HHR for research, including evaluating interventions, understanding variations in outcomes for conditions like COPD, and studying antibiotic prescribing in nursing homes and the incidence of chronic kidney disease and acute kidney injury. The HHR is seen as a valuable resource but also has some limitations like missing or incomplete data. Ongoing research uses the HHR to study topics like dementia pathways, cancer survivorship, and multimorbidity. Healthcare professionals report that the HHR enables informed decision making and provides a more comprehensive view of patients.

1. Use of linked health care data for
research: experiences with the
Hampshire Health Record (HHR)
P Roderick
Academic Unit of Primary Care and Population
Sciences, University of Southampton, UK
Contact: pjr@soton.ac.uk

2. Acknowledgements
 Hugh Sanderson (founding clinical director)
 NHS South, Central and West Commissioning
Support Unit and the Hampshire Health Record
Information Governance Group
– Elen Hall
 Matt Johnson (UoS analyst)

3. Hampshire Health Record
Analytical Database
3
• Pseudonymised, individual, linked
extracts of primary and secondary
care records
• Data from about 130 general
practices in Hampshire. Total
registered population about 1 3·
million people (80%)
• Laboratory data from Portsmouth and
Southampton hospitals (600k)

4. Hampshire Health Record

5. Uses
 Epidemiology of conditions
– Frequency, determinants, processes of care,
outcomes, costs
– Risk prediction
 Evaluation of interventions
– Primary or secondary care (natural expts)
– Benefits of HHR
 Linkage to existing studies; trial feasibility,
recruitment
 Whole population (Social care, housing…)

6. Understanding Variations in
Outcome in COPD: Early Results of
an Observational Study using
Routine Clinical Data
L Josephs, M Johnson, P Roderick, D M Thomas

7. Methods
 Retrospective observational study using
routine individual patient-anonymised data
 Selected Read Codes used to define and
characterise a prevalent cohort with a
practice diagnosis of COPD as at 31/12/10
 2 year follow up of outcomes:
– Hospital admissions (respiratory)
– A/E attendances (respiratory)
– Mortality 7

8.  Smoking status
recorded in 21,068
patients (99.2%)
 37.8% current
smokers
 51.0% ex-smokers
 10.4% never smokers
8
Smoking

9. Mortality
 2,446 (11.5%) died (12.2%
men, 10.7% women, p<0.001)
 In those who died:
• mean (SD) age was
greater: 79.2 (9.8) years
versus 70.5 (11.6) years
(p<0.001)
• median (IQR) FEV1 was
lower: 1.04 (0.73 to 1.49)
litres versus 1.39 (0.99 to
1.88) litres (p<0.001),
9

10. Conclusions
In a broad unselected UK primary care
COPD population, highlights:
high proportion of patients still
smoking (>1 in 3)
poor prognosis of COPD: one in ten
patients died during the 2 years, a third of
with a hospital admission

11. Antibiotic use in care homes
 High use in Nursing homes especially for
Urinary tract infection (UTI)
 Why--overtreatment for non specific
symptoms; asymptomatic bacteruria
common
 Retrospective cohort 2012. Postcode used
to identify nursing home.
 Sample 8.2% of 1.24 million >75, of whom
7.3% in care homes.
P Sundvall BMC Geriatrics 2015

12. Antibiotic prescriptions/100
0
20
40
60
80
100
120
140
160
180
200
<75 >75 no NH >75 NH
All
UTI
Adjusted odds ratio for NH UTI 2.2 if
no catheter, 1.4 if catheter

13. Chronic kidney disease (CKD)
 Identified people with prevalent (2008) and incident
CKD stage 3–5 between 2008 and 2011 was identified
from the UK Hampshire Health Record (HHR) using
eGFR values.
 Two values of eGFR <60 mL/min per 1 73 m² at least 3·
months apart (and previous eGFR >60 mL/min per
1 73 m² or no previous eGFR value)·
 QOF-registered CKD identified by relevant Read codes.
S Fraser et al BMC Family Practice 2015

15. CKD Results
88 practices with continuous pathology records 2008-
2013
Total over 18 population = 498,631
Prevalent CKD at end 2008 = 24,021 (4.8%)
Incident CKD 2008-2013 = 15,736

16. QoF register and Urinary ACR testing
Incident cohort:
46% had a
record of ever
having an uACR
63% QoF
registered

17. The Hampshire AKI Study
Simon Fraser
Paul Roderick
Mark Uniacke
Matthew Johnson
Borislav Dimitrov
David Culliford
Lily Yao

18. 2012 2013 2014 2015 2016 2017 2018
Incidence and consequences
of community and hospital AKI
Introduction of e-alerts and
clinician professional
development programme
Incidence and consequences
of community and hospital AKI
PRE POST
Validate community AKI
prediction tool

19. HHR
 Strengths
 Population based
 Used for individual care
 Laboratory data
 Scope for extension
– Geography, data
– Wider edu/env/housing
 Free text
 Limitations
 Data quality
– Missing
– enter, leave
 Exclusions from HHR
 No cause of death
 No microbiology/radiology
data
 Logistics
– size, coding

20. Ongoing
– EPIDEMIOLOGY /VARIATION
• Dementia, Liver disease pathways
• Cancer survivor prevalence
• Multimorbidity, frailty, treatment burden
• Maternity-child health
• Fuel poverty
– EVALUATION
• Atrial fibrillation detection (Watch BP), NHS Vascular
Checks
• Alcohol detoxification

21. HHR Users
“I think it is
fantastic and
use it all the
time.” - GP
“Having access to results
and reports from other
hospitals saves time and
resources”. Hospital
consultant.
“…help make
an informed
decision;
provides the
patient with
confidence.” -
GP
“Possibly the
Hampshire
Health
Record saved
her life” - GP
“it enables me to work
more closely with
consultants in
developing plans of
care” - Nurse
Specialist
“The patient is
prescribed the
correct and
appropriate
medication as
soon as possible.”
- Community
Pharmacist