National Cardiac Audit Programme (NCAP) Mark de Belder Chair NCAP Operational and Methodology Group

Transcription

1 National Cardiac Audit Programme (NCAP) Mark de Belder Chair NCAP Operational and Methodology Group

2 CVD: it s not all over Although there has been a significant reduction in deaths from CVD in the past 20 years, it accounted for 27% of all deaths in % of deaths in men and 17% of women under the age of 75 Concern that rates might rise with increasing incidence and prevalence of DM and obesity, and greater survival from other disease By 2022, the number of people with a >20% risk of CVD could rise from 3.5m in 2010 to 4.2m

3 Obesity on the rise

4 Diabetes on the rise

5 Use of Data in Heart Disease What can we do to make sure we are doing enough to prevent it? Primary prevention Prevent in the population Secondary prevention Prevent in pre-symptomatic disease Tertiary prevention Prevent in symptomatic disease What can we do to ensure that patients who have it are getting the best care?

6 Rationale for Audit Am I (are we) doing a good job? If my (our) results aren t as good as they should be, how can I (we) improve? If my (our) results seem OK, can I (we) get even better? What would my reaction really be if my results weren t as good as I had expected them to be? What would I want my colleagues reaction to be?

7 Sir Bruce Keogh April 2013: Organisations cannot know they are providing safe or effective care unless they are measuring and monitoring their services

8 NICOR data Audit Yr Est. Clinical lead Prof Society No records New records/yr Congenital 2000 Dr Rodney Franklin SCTS/BCCA 125,000 11,000 Cardiac Rhythm management Late 1970s Dr Francis Murgatroyd HRUK 900,000 65,000 Heart Failure 2007 Prof Theresa McDonagh BSH 200,000 44,000 PCI 2002 (1988) Dr Peter Ludman BCIS 694,598 95,000 MINAP 1998 Dr Clive Weston BCS 1m 80,000 Adult cardiac surgery 1977 Mr Andrew Goodwin Mr David Jenkins SCTS 505,361 34,000 TAVI 2007 TBC BCIS/SCTS 5,000 1,000 New technology audits 2014 Dr Rob Henderson Prof Nick Linker Dr Mark de Belder BCIS/BCCA BCIS/HRUK BCIS/SCTS ~600 ~450 ~300

9 National Institute for Cardiovascular Outcomes Research Established: 2011 Commissioned: HQIP Director: Prof John Deanfield Mission: to provide information to improve heart disease patients' quality of care and outcomes Website:

10 National Congenital Heart Disease Audit Myocardial Ischaemia National Audit Project National Audit of Percutaneous Cardiovascular Interventions National Adult Cardiac Surgery Audit National Audit of Heart Failure National Audit of Cardiac Rhythm Management UK TAVI Registry Commissioning though evaluation registries PFO Closure Left Atrial Appendage Occlusion MitraClip

11 The national audits Improve and maintain healthcare outcome standards Quality assurance Quality improvement Markers of process and outcomes Stay fit for purpose and up-to-date

12 PROFESSION NHS ADMINISTRATION NHS ENGLAND RESEARCH GRANT BODIES Revalidation Performance Centre performance Research Research/outcome information Dr Foster CEO/COO Commissioning through Evaluation NHS Choices Governance Implementation of policy Information regarding choice Understanding of disease and pathways Use of data transparency PUBLIC Social care Health Checks UCL FARR Institute SOCIAL CARE 12 DH PUBLIC HEALTH ENGLAND CV INTELLIGENCE UNIVERSITY

13 PCI Outcomes 13

14 14 Adult cardiac surgery: Hospital level

15 Adult cardiac surgery: Consultant level 15

16 Congenital Heart Disease Audit

17 Measurements in CHD National Datasets: Based on the Audit Cycle Select a topic Review standards Evaluate change Implement change Structure Appropriateness Process Outcome Set standards Collect data Analyse and compare Decide on change

18 NCAP Basic details Case ascertainment Data quality Classical audit design Structure Process Appropriateness Outcomes Highlight areas where improvements are needed

19 The challenge Moving from 6 separate reports to a single aggregate report Web-based reports to every provider in a meaningful way on the key QI markers COP and QI data have to be included Take account of other national initiatives/levers, eg BPT, GIRFT, CQC NICOR has a smaller team, compounded by the move to Barts and the restructure Very challenging timetable Need to adapt and change Communications

20 National Cardiac Audit Programme (NCAP) Budget reduced by 25% ( 1.8m to 1.4m) One audit of cardiovascular services rather than 6 separate audits Minimum dataset with critical fields (required for QI) Data fields needed for other purposes (risk adjustment) Design of the audit include synergies between the audit and other national initiatives: CSQM, BPT, COP, NHSE Congenital review. Annual spotlight audits of specific patient sub-groups or care pathways

21 NCAP 100% Provider participation rate Case ascertainment (100%) using national data sources, e.g. HES, Patient Episode Database for Wales Data Linkages - of audit records locally and centrally when patients present to more than one service and /or undergo more than one intervention Data completeness and quality of data collected (a central data source for financial and other improvement levers throughout the NHS) Use Audit outputs for quality improvement initiatives (local) Real time reporting interactive, accessible and relevant for trusts (to drive quality improvement locally) PROMs / PREMs Extended use of Audit data Sustainability of a future NCAP

22 NCAP Excludes: Cardiac Rehabilitation alignment and joint working encouraged Data collection from primary care settings; Development of new PREMs/PROMs; Patients who receive care outside of England and Wales Private patients

23 NCAP Governance and Delivery Barts Health Board Professional Liaison Group Chair: President, BCS Patient Advisory Group Chair: Mark Hunter MBE H Q I P Quarterly Contract Reviews (n=4) 4 1 Barts Performance Review Group Chair = Charles Knight Monthly (n = 12) (BHC HR, Finance, IT and Operations with ND, NOL, COO and IT Lead) NCAP Delivery Group Chair: James Chal Weekly (n = 52) (KPI, HR, Finance, IT) Programme Management (monitoring progress and risk management) 2 NCAP Stakeholder Board Chair: John Deanfield Quarterly (n = 4) 3 NCAP Operational & Methodology (NOM) Group Chair: Mark de Belder Monthly (n = 12) Domain Expert Working Groups (with Domain Clinical Lead) NCAP Staff (Multi- Disciplinary Team) n Reporting Lines Accountability Lines Risk Management Number of meetings per year

24 A commissioner s perspective What are the results of our local providers? How do they compare with other providers in the region? How do our providers compare with providers in other regions? Is there evidence of improvement? Temporal trends Insufficient insight into importance of data collection

25 Reporting for impact People who receive care Patients and Carers People who deliver care Clinicians, Allied Health Professionals, Trust Boards People who commission care NHS England, Welsh Govt, other devolved authorities, local commissioning groups People who regulate care CQC, NHS Improvements [incorporating the NHS Trust Development Authority (TDA), Monitor, etc], clinical audit and quality improvement professionals

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27 Data Quality Case ascertainment Compliance with minimum data set Timeliness

28 Analyses for 2016/17 report Type of metric Congenital (NACHD) Heart Attack (MINAP) Angioplasty (NAPCI) Adult Cardiac Surgery (NACSA) Heart Failure (NAHF) Cardiac Rhythm Management (NACRM) Safety 1. Numbers of procedures (Paediatric / Adult) - Overall - Surgical - Interventional - EP 1. Admission under cardiologist 2. Admission to cardiac ward 3. Timeliness to angio (NSTEMI) 1. Centre case volume 2. PPCO DTB time - Temporal trends - Split by admission route 3. Time to PCI for NSTEMI - Temporal trends - Slit by admission route 4. CTD times 1. Waits for CABG - IHU cases - Elective cases - Temporal trends 1. Centre volume - Devices - Ablations 2. Operator volume - Devices - Ablations Effectiveness 2. Antenatal detection and diagnosis 4. Discharged on appropriate medications - STEMI - NSTEMI 5. % of STEMI not receiving reperfusion therapy 6. % of pts having in house echo 5. Hospital radial access - Operator (COP) 1. % of HFrEF patients discharged on ACE- I/ARB 2. % of HFrEF patients discharged on beta blocker 3. % of HFrEF patients discharged on MRA 3. Dual chamber pacing for SND 4. Indications for primary ICD 5. Indications for secondary ICD Outcomes day risk-adjusted mortality day risk adjusted mortality day riskadjusted mortality - All cases - Operator cases (in COP) 7. In-hospital major adverse cardiac events 2. Re-operation - any cause - Bleeding - Infection - Temporal trends 3. New dialysis 4. New post-op CVA day hospital mortality day mortality 6. 1yr re-intervention rates - PM - ICD/CRT - AF ablations - All non-af ablations

29 Presentation of data

30 Clinical Services Quality Measures Programme initiated by Prof Mike Richards in 2013

31 SSNAP We are developing a CSQM system for MI

32 Presentation of data Wythenshawe Hospital Hip Fracture Audit Metric CQC Key Question 2014¹ Report 2015² Report National Aggregate (England) National Aspirational Standard Comparison to other hospitals 339 cases Case ascertainment All eligible patients Well Led n/a % 93.5% none Higher than national aggregate Crude proportion of patients having surgery on the day or day after admission Crude perioperative medical assessment rate Crude proportion of patients documented as not developing a pressure ulcer Effective 80.3% 77.6% 72.1% 85%* Effective 90.1% 95.9% 85.3% 100%* Safe n/a 97.4% 97.2% none Crude overall hospital length of stay Responsive 24.9 days 28.4 days 20.3 days none Risk-adjusted 30-day mortality rate Effective 8.0% 6.2% 7.5%** none Within expected range Anticipated date of next update is 09/ Jan 13- Dec 13 2 Jan 14- Dec 14 *Audit recommendation based on NICE guideline **England & Wales

33 Main messages HQIP is funding the national CV audits as one programme (6 domains) There is a reduced budget and a smaller team We have moved from UCL to Barts We are harmonising processes We are learning from each other and other National Audits We will maintain feedback to the Trusts/Societies But make it easier for them to see how they are doing and where improvement is needed Including analyses that reflect acknowledged Quality Standards (NICE, ESC, Society, peer performance, etc) Taking account of other national levers We acknowledge and will conform to the requirements of those who are funding us (their requirements are consistent with our aims) We need to continue to meet the demands of other stakeholders

34 Questions?