Real-World Data
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About the real-world data used in our projects
Our studies will use data normally collected within England’s healthcare system, known as 'real-world data'. For both the SilverCloud Target Trials and the Target Therapies Project we will use information about people who accessed NHS Talking Therapies for anxiety and depression (TTad) services in England between April 2021 and March 2024.
TTad services provide psychological therapies for common mental health disorders such as depression and anxiety disorders. For these people, we will use information about them and their treatment originally recorded by the TTad services, acute hospital services (including A&E attendances, outpatient appointments and inpatient care), community and hospital mental healthcare services, and pharmacies.
We will also use some information recorded in death registrations of people in this group who have died.
All these data are collated and managed by NHS England, which makes them available for research through a thorough application process and with strict conditions.
Protecting patient data
The strict conditions under which patient data may be used for research include:
Ensuring the data are only used for pre-specified objectives which aim to benefit patients using the NHS in England.
We only ask for the minimum amount of data to fulfil the research objectives.
We follow policies and procedures that keep all data safe and secure, and we protect everyone’s privacy.
We store all patient data in secure computing environments which meet NHS standards for data security and protection.
For these research projects, we will only receive pseudonymised (also known as 'de-identified') data from NHS England. This means that the data does not contain any names or addresses, and we cannot re-identify individuals represented within the data. We will only use this data for our RWD Study.
Datasets of interest
Our data of interest come from four separate datasets that are collated by NHS England. The following are the official names for the datasets, as stated on NHS England’s data sets website:
Hospital Episode Statistics (HES), including:
Admitted Patient Care (APC)
Outpatient (OP)
These datasets are described in brief below.
Improving Access to Psychological Therapies (IAPT) v2
The IAPT v2 dataset comprises data collected within NHS Talking Therapies for anxiety and depression (TTad) services (IAPT refers to the old name for these services, Improving Access to Psychological Therapies).
We are only using version 2 of the IAPT dataset, as it includes more data and better coding of aspects of interest to our programme, such as the use of digital therapies.
This dataset includes patient-reported outcome measure data which aids us in understanding the patients’ depression or anxiety symptom severity, for example based on the Patient Health Questionnaire-9 (PHQ-9) measure for depression severity or Generalised Anxiety Disorder-7 (GAD-7) measure for anxiety severity.
Example data of interest from this dataset include:
Patient characteristics: including demographics, presenting disorder classification (depression, anxiety disorder), condition severity (PHQ-9, GAD-7), among other patient and care relevant information.
Recovery and reliable change rates: rates based on final depression and anxiety symptom severity scores,
Stopping treatment: rates and reasons for ending.
Proxy relapse rate: new TTad-service treatment episode (or meeting caseness criteria) for the same presenting condition.
Changes in level of psychological treatment (stepping-up care): Moving from low-intensity to high-intensity treatment during episode.
Adverse effect – reliable deterioration: rates based on final depression and anxiety symptom severity scores, where there has been a significant increase in symptoms.
Patient experience: based on the Patient Experience Questionnaire (PEQ).
Resource-use: the type of care and what was involved in providing this care, which we refer to as resource-use, as received pre, during, or post treatment.
Hospital Episode Statistics (HES), Emergency Care Data Set (ECDS), and Civil Registrations of Death (DR) data
Our HES data of interest includes Admitted Patient Care (HES APC), Outpatients (HES OP), and Emergency Care Data Set (which includes information about A&E attendances).
We have requested death registration data as it provides additional useful information, such as the cause of deaths and deaths outside of hospital, which are not available in HES.
Example data of interest from this dataset include:
Patient characteristics: including use of hospital and emergency care services pre-index-TTad-service contact.
Proxy relapse rate: hospital admission for a mental health treatment-episode.
Adverse effect – non-TTad mental health service contact: inpatient admission or receipt of community care (including crisis team) under a mental health service provider.
Adverse effect – suicide: death registrations recorded as suicide, e.g. 'intentional self-harm' or 'Injury/poisoning of undetermined intent'.
Adverse effect – self-harm: emergency attendance or hospital admission recorded as self-harm.
Resource-use: the type of care and what was involved in providing this care, which we refer to as resource-use, as received pre, during, or post treatment.
Mental Health Services Data Set (MHSDS)
The MHSDS includes data about adults in receipt of NHS-funded specialist, secondary mental health or learning disability services.
Example data of interest from this dataset include:
Patient characteristics: such as having a serious mental illness diagnosis.
Adverse effect – non-TTad mental health service contact: inpatient admission or receipt of community care (including crisis team) under a mental health service provider.
Resource-use: the type of care and what was involved in providing this care, which we refer to as resource-use, as received pre, during, or post treatment
Medicines Dispensed in Primary Care (MDPC)
The MDPC dataset contains records of medicines dispensed in community pharmacies, usually prescribed by a GP.
Example data of interest from this dataset include:
Patient characteristics: including anti-depressant or anxiolytic prescription pre-index-TTad-service contact and after.
Proxy relapse rate: a new anti-depressant or anxiolytic prescription with ≥1-refill for those not prescribed the medication at TTad-service-discharge.
Resource-use: the type of care and what was involved in providing this care, which we refer to as resource-use, as received pre, during, or post treatment.