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SSNAP Governance

SSNAP Governance

Contract and funding

The Sentinel Stroke National Audit Programme (SSNAP) is the national stroke audit for England, Wales, and Northern Ireland. King's College London is now the hosting organisation for SSNAP following a successful tender process. Funded by the Healthcare Quality Improvement Partnership (HQIP), SSNAP is now the single source of stroke data in England, Wales and Northern Ireland. SSNAP's current contract runs from April 2018 - March 2021. 

About the Healthcare Quality Improvement Partnership (HQIP)

The Sentinal Stroke National Audit Programme (SSNAP) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programmes and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual projects, other devoted administrations and crown dependencies: www.hqip.org.uk/national-programmes

Audit Organisation

This audit is part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) commissioned by the Healthcare Quality Improvement Partnership (HQIP) and run by the School of Population Health and Environmental Sciences. Data were collected at team level within trusts using a standardised method. The audit is guided by a multidisciplinary steering group responsible for the King's College Stroke Programme, the Intercollegiate Stroke Working Party (ICSWP). Membership of the ICSWP is available here

Audit design

The SSNAP clinical audit is continuous. It collects data prospectively on all patients in England and Wales admitted to hospital following a stroke, from admission to 6 months after stroke. The audit covers the pathway across providers by transferring the electronic record on a password protected webtool. The webtool has been developed to measure against evidence-based processes and outcomes of care. Data are of very high quality and completeness, which enable analysis at both team- and patient-centred level (patient-centred level represents a "patient's eye" view of care quality across the whole stroke pathway). All patients with a primary diagnosis of stroke coded as I-61, I-63, I-64, but excluding subarachnoid haemorrhage should be submitted to SSNAP. Patients already in hospital for another condition and those patients not treated on a stroke unit should also be included. The minimum age for patient submission to SSNAP is 16. 

Collection of patient data

SSNAP currently has approval under Section 251 to collect patient-level data on the first six months of patient care (ECC 6-02(FT3)/2012). More information on section 251 is available here: www.hra.nhs.uk/approvals-amendments/what-approvals-do-i-need/confidentiality-advisory-group/. The rationale for this legal basis is that many stroke patients are extremely unwell in the acute phase of their treatment and it is therefore not feasible to rely on patient consent during this time period. In Northern Ireland however no patient identifiable information is collected via the electronic SSNAP webtool. 

Patient consent is explicitly sought at six months post-stroke though it can also be recorded during the patient's inpatient stay. Where a patient refuses consent for inclusion in SSNAP, all their personal identifiable information will be wiped from the dataset and no further linkages to other data sources will therefore be possible, however their non-identifiable data will continue to be held on the database as it is important for the purpose of SSNAP to analyse all data without selection bias. The SSNAP team do not have access to patient identifiable information at any point in the patient pathway. More detailed information on how patient and service user data are collected, stored and processed by SSNAP is available within the programme's fair processing statements: SSNAP’s Fair Processing Notice for users and SSNAP's Fair Processing Statement for patients.

For a visual representation which explains how data are collected and processed SSNAP have created a data flow diagram. The patient area of the website also includes helpful information sheets for both England, Wales and Northern Ireland which explains how and why patient data is collected by SSNAP. 

Access to SSNAP data

Only approved clinical users at each participating stroke service have access to individual patient level data. This is for the purpose of submitting timely patient data to SSNAP for analysis, reviewing periodic SSNAP results including patient-level quality improvement tools produced by SSNAP, and facilitating additional interim analysis of patient data between SSNAP reporting periods. Aggregate level SSNAP data at service (hospital), population and national level are accessible by the public following the completion of a phased report dissemination process. These reports do not contain any patient identifiable information. To access published SSNAP reports go to: www.strokeaudit.org/results

Aggregate level SSNAP data are also published under the Transparency and Open Data Agenda on the data.gov.uk website. These reports are accessible publicly and are the same as those reports published on the SSNAP website. https://data.gov.uk/dataset/09517a13-6475-48b1-af5a-990a5a5cbd29/sentinel-stroke-national-audit-programme-ssnap-clinical-audit-results

SSNAP data are also shared with NHS England as part of new initiatives, including NHS Choices and myNHS, to make information on healthcare provision available in a simple, digestible and consistent form. (LINK?) SSNAP data at aggregate and patient level may also be shared to facilitate important research studies in stroke. However this will only be done following the successful completion of a comprehensive application process. More details on this application process can be found here: https://www.strokeaudit.org/Research/Data-requests.aspx  

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