SSNAP Reporting

Following the data analysis period after each data locking deadline, an array of bespoke reporting outputs are disseminated to participating teams, commissioners of services, wider NHS stakeholders and the general public. These reports are many and varied designed to maximise impact and usefulness for improving patient care.

Case ascertainment and participation

In order for results to be meaningful and robust it is essential to have fully complete data on every new stroke admission. At the time of writing over 90% of expected stroke hospital admissions are recorded on SSNAP by acute stroke services. These estimations are based on Hospital Episode Statistics (HES) and Patient Data Episodes in Wales (PEDW) for the previous year for hospitals in England and Wales respectively. For ‘routinely admitting teams’ to be included in SSNAP results minimum proportion of all their expected cases are required to be entered on SSNAP. For ‘non-routinely admitting teams’, HES/PEDW projections have not been utilised; rather a proxy has been generated comparing the number of patients arriving at a team with the number of patients leaving the team. This is a measure of record completion rather than a measure of case ascertainment in the true sense. It is recognised that neither method can be totally accurate which is why results are presented in bands. In order for non-inpatient teams to receive SSNAP results a minimum of 20 records are required to be entered and locked across the previous six month period. Case ascertainment for 6 month assessments is based on patients due for 6 months assessment in the last 6 months, and seen by teams at any point during their inpatient stay. Case ascertainment is included as a component in the overall SSNAP score. Results and further information on case ascertainment can be found in sheet B ‘Case Ascertainment’ of the full results portfolio https://www.strokeaudit.org/results/Clinical-audit/National-Results.aspx

Audit Compliance

The success of SSNAP depends on complete and timely data being submitted so that there is rapid turnaround of reporting to facilitate change.  The element called audit compliance summarises these aspects and as a result each team will be given a score (in bands).  Many teams are transferring records, which enables subsequent teams to complete the relevant sections by the deadline and it is important that all transfers leave sufficient time for subsequent teams to complete their parts of the record by the deadlines. Audit compliance is included as a component of the SSNAP score. Results and further information on audit compliance can be found in sheet C ‘Audit Compliance’ of the full results portfolio https://www.strokeaudit.org/results/Clinical-audit/National-Results.aspx

Key indicators, domains and scoring

44 Key Indicators have been chosen by the ICSWP as representative of high quality stroke care. These include data items included in the CCG Outcomes Indicator Set and NICE Quality Standards (covering England only). The key indicators are grouped into 10 domains covering key aspects of the process of stroke care. Both patient-centred domain scores team-centred domain scores are calculated.

An overall SSNAP score calculated as follows:

• Domain levels are combined into separate patient-centred and team-centred total key indicator scores
• A combined total key indicator score is derived from the average of these two scores
• This combined score is adjusted for case ascertainment and audit compliance

A simple summary document listing the 10 SSNAP domains and the key indicators contained within each is available here

Frequency of reporting cycles

As part of the new contract from April 2018, SSNAP has increased the frequency of reports, returning to reporting every 3 months. This means that inpatient teams will now be receiving 4 bespoke SSNAP routine reports each year, in addition to the annual report and executive summary.

See a link to a full guide on our future reporting output frequency here.

Phased dissemination of results

Dissemination of SSNAP reports follows a phased process. This means that participating teams receive their results approximately 3 weeks after each data locking deadline, providing them with the opportunity to review performance and formulate action plans as necessary. Most of these data are then shared within the wider NHS in the following 2 weeks before being made available publically thereafter. The data deadline section above provides expected dissemination dates for upcoming reporting periods.

Reporting Outputs

More than 1000 unique reporting outputs area disseminated to hospitals within 4 weeks of each data locking deadline with almost all reports made publically available in the following weeks. Included in SSNAP’s reporting suite are colour coded performance tables which give a high level summary of hospitals’ performance across 10 key aspects of stroke care, an overall SSNAP score is also given. The summary results portfolio gives a more detailed analysis of every hospitals' performance across each key indicator of care measured by SSNAP. The full results portfolio enables users to further ‘drill down’ into the data for deeper analysis for e.g case mix variation, AF status upon admission or discharge, infection rates or length of stay. An executive summary report is produced annually which provides a summary of team-level performance and clinical trends over time clearly highlighting areas of good, adequate and poor performance.
An annual public report is produced which includes contextualising clinical commentary at national level. Easy Access Version reports are also created which are written specifically for stroke survivors and their carers using simple language and colour coded maps to display results across each domain of care.

Mortality reporting

In addition to analysing and reporting results based on data submission to SSNAP, 30 day case mix adjusted mortality after stroke is also reported back to services. Higher than expected mortality rates may signal an issue with a particular stroke service. Mortality is reported annually as to report it more frequently does not yield high quality data. Mortality reporting is only possible by linking SSNAP records using the NHS number, with data from the Office for National Statistics (ONS) in order to determine mortality for the directly admitted patients with known stroke type. It is a privilege for teams to have access to this linked data and it should be treated with a great degree of sensitivity in accordance with information governance rules. For details on the methodology adapted for mortality reporting please follow this link: https://ssnap.zendesk.com/hc/en-us/articles/115005129885-Mortality-Information-Sheet

To access SSNAP mortality reports go to https://www.strokeaudit.org/results/Clinical-audit/National-Results.aspx

Calculating key indicators

As part of SSNAP’s efforts to ensure transparency in reporting, a comprehensive document outlining how each of the key indicators is calculated has been created. It is expected that this document will better enable teams to understand how each of the key indicators is derived and help empower individuals to understand where performance could be improved. It is available to download here: https://www.strokeaudit.org/SupportFiles/Documents/Clinical-Audit-Resources/Simplified-Technical-Information.aspx

Accessing SSNAP reports

All SSNAP reports are available to download from our SSNAP results portal www.strokeaudit.org/results. You can view the outputs for each reporting period here, in addition to annual reports.