2015/16 CQUIN Schemes
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- Gabriella Griffin
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1 Barnet, Enfield & Haringey Mental Health Trust 2015/16 CQUIN Schemes Version: 3.0 Version Date Revision Author /03/15 Excel to Word Document A Bland /04/15 1 st Discussion with BEHMHT A Bland /05/15 2 nd discussion with BEHMHT A Bland Contents: REF Goal Name Page number Introduction 2 National CQUINs 4 N4 Improving physical healthcare to reduce premature mortality in people with severe mental illness (SMI) 5 BEHMHT Specific CQUINs 13 BEHMHT N8 Improving diagnoses and re attendance rates of Patients with mental health needs at A&E 13 Local NCL CQUINs 18 L4 Prevention 18 L4.1 Smoking cessation 19 L4.2 Alcohol misuse 26 L4.3 Domestic Violence Year 1 31 L5 Safe and timely discharge 35 L5.1 Effective Discharge Arrangements 38 L5.2 Medicines on discharge 40 L5.3 Discharge information for GPs 42 Page 1
2 Guidance from NHS England To support the national priorities NHSE have set a scheme that focuses on: The physical health of patients. The mental health and wellbeing of patients. Enabling care to be provided closer to home for those that need access to urgent and emergency care. The National Scheme is as follows: Two of the current national indicators will remain in place, with limited updating; these cover improving dementia and delirium care and improving the physical health care of patients with mental health conditions; Two new indicators will be introduced, one on the care of patients with acute kidney injury, the other on the identification and early treatment of sepsis; There will also be a new national CQUIN theme on improving urgent and emergency care across local health communities, commissioners will select one or more indicators locally from a menu of options; As planned, the other national CQUIN indicators in 2014/15 covering the safety thermometer and the friends and family test will instead be covered from 2015/16 by new requirements within the NHS Standard Contract. Mental health services The national indicator on physical health assessment of patients with severe mental illness will apply, with a value of 0.25% A further 0.5% will be available through the UEC menu Up to 1.75% will be available for local indicators National CQUINs Indicator Area Mental Health: Improving Physical Healthcare for Patients with Severe Mental Illness (SMI) Indicator Indicator Description Number 4 Two part indicator: 4a: Cardio Metabolic Assessment and treatment for Patients with psychoses. 4b: Communication with General Practitioners. UEC Menu 5 Three part indicator: 5a: A reduction in the proportion of NHS 111 calls that end in an inappropriate 999 referral. 5b: Capture of disposition (and referral) to type 1 and 2 A&E separately from type 3 and 4, thereby improving the quality of the Directory of Services (DoS). 5c: Proportion of NHS 111 calls that end in an inappropriate type 1 or type 2 A&E referral. UEC Menu 6 A reduction in the rate per 100,000 population of ambulance 999 calls that result in transportation to a type 1 or type 2 A&E Department. UEC Menu UEC Menu 7 Reducing the proportion of avoidable emergency admissions to hospital. UEC Menu 8 Two part indicator 8a: Improving recording of diagnosis in A&E 8b: Reduction in A&E MH re-attendances Suggested weighting 0.25% 0.5% (Weighting for each indicator to be agreed locally). Page 2
3 Proposed CQUIN Goals & Indicators for 2015/16: Estimated Contract Value??? REF Goal Name Description Weighting % of Schemes Approx. Value N4 N4a N4b BEHMHT N8 BEHMHT N8 National CQUINs Improving physical healthcare to reduce premature mortality in people with severe mental illness (SMI) BEHMHT Specific CQUIN Improving diagnoses and re attendance rates of Patients with mental health needs at A&E Local NCL CQUINs Full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in patients with psychoses, including schizophrenia. Local audit of communication with patients GPs Cardio Metabolic Assessment and Treatment for Patients with Psychoses Communication with General Practitioners Reduction in A&E MH reattendances L4 Prevention L4.1 Smoking Cessation L4.2 Alcohol Misuse L4.3 Domestic Violence-Year 1 L5 Safe and Timely Discharge L5.1 Effective Discharge Arrangements L5.2 Medicines on discharge L5.3 Discharge information for GPs Page 3
4 Description of CQUIN Schemes Goal National N4: Improving Physical Healthcare to Reduce Premature Mortality in People with Severe Mental Illness N4 Improving physical healthcare to reduce premature mortality in people with severe mental illness (SMI) Full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in patients with psychoses, including schizophrenia. Local audit of communication with patients GPs % % N4a N4b 80% - To demonstrate full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in inpatients with psychoses and community patients in Early Intervention psychosis teams. 20% for Communication with General Practitioners 0. 15% % 0.1% % Page 4
5 Indicators N4a Cardio Metabolic Assessment and Treatment for Patients with Psychoses IMPROVING PHYSICAL HEALTHCARE TO REDUCE PREMATURE MORTALITY IN PEOPLE WITH SEVERE MENTAL ILLNESS IMPROVEMENT GOAL SPECIFICATION Indicator number N4a Indicator name Indicator weighting Description of indicator Numerator Denominator Rationale for inclusion Data source Frequency of data collection Organisation responsible for data collection Frequency of reporting to commissioner Baseline period/date Baseline value Final indicator period/date (on which payment is based) Final indicator value (payment threshold) Cardio Metabolic Assessment and Treatment for Patients with Psychoses 4a and 4b total weighting be agreed locally (suggested minimum of 0.25%): 4a = 80% of total funding To demonstrate full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in inpatients with psychoses and community patients in Early Intervention psychosis teams. As set out in National Audit of Schizophrenia. As set out in National Audit of Schizophrenia. National CQUIN scheme. Audit data collected via a national process which will be notified early in 2015 Separate audits for inpatients and EIP, with data expected to be submitted during Quarters 2 and 3 of 2015/16 results to be available in Quarter 4. BEHMHT Audit reporting requirements as set out above. Additional direct reporting to commissioners locally in Quarters 1, 3 and 4. Not applicable Not applicable January March % (inpatients), 80.0% (EIP) Page 5
6 Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Final indicator reporting date Are there rules for any agreed in-year milestones that result in payment? Are there any rules for partial achievement of the indicator at the final indicator period/date? Quarter 4 audit results demonstrate that, for 90% of patients audited during the period (inpatients) or for 80% of patients audited during the period (community EIP), the provider has undertaken an assessment of each of the following key cardio metabolic parameters, with the results recorded in the patient's notes/care plan/discharge documentation as appropriate, together with a record of associated interventions (eg smoking cessation programme, lifestyle interventions, medication review, treatment according to NICE guidelines and /or onward referral to another clinician for assessment, diagnosis, and treatment) The parameters are: Smoking status; Lifestyle (including exercise, diet alcohol and drugs); Body Mass Index; Blood pressure; Glucose regulation (HbA1c or fasting glucose or random glucose as appropriate); Blood lipids. Provider supplies evidence of systematic feedback on performance to clinical teams. 30 April 2016 Yes see below Yes see below Page 6
7 Indicator N4a Milestones Date/period milestone relates to Rules for achievement of milestones (including evidence to be supplied to commissioner) Quarter 1 Implementation plan covering: Board commitment sign-up identified clinical leadership detailed project plan planning for training for all clinical staff** systematic feedback process for individual clinical teams planning for implementation of electronic healthcare records data collection of physical health assessment and measurable outcomes with a view to going live in 16/17 (assessed locally by commissioners) Quarter 2 No milestone Quarter 3 Clinical staff training plan fully implemented (assessed locally by commissioners) Electronic recording of outcomes fully implemented Quarter 4 Results of national Royal College audit - separate samples for: inpatients community early intervention patients (See sliding scales below for payment details.) Evidence of systematic feedback on performance to clinical teams (assessed locally by commissioners) Date milestone to be reported 31 July % 31 January 2016 Milestone weighting (% of CQUIN scheme available) 20% 29 April % in all, made up of: 30% 20% 10% **Definition of all clinical staff Staff working in a clinical role within the adult Mental Health Inpatient settings/ teams and the Early Intervention Psychosis Teams Page 7
8 Rules for partial achievement at final indicator period/date The two tables below provide for a sliding scale of payment in relation to the element of the indicator which is payable on the basis of the actual audit results for Quarter 4. Audit of inpatients Final indicator value for the partial achievement Q4 threshold % of CQUIN scheme available for meeting final indicator value 49.9% or less No payment 50.0% to 69.9% 25% payment 70.0% to 79.9% 50% payment 80.0% to 89.9% 75% payment 90.0% or above 100% payment Audit of community EIP patients Final indicator value for the partial achievement Q4 threshold % of CQUIN scheme available for meeting final indicator value 39.9% or less No payment 40.0% to 59.9% 25% payment 60.0% to 69.9% 50% payment 70.0% to 79.9% 75% payment 80.0% or above 100% payment Page 8
9 N4b Communication with General Practitioners IMPROVING PHYSICAL HEALTHCARE TO REDUCE PREMATURE MORTALITY IN PEOPLE WITH SEVERE MENTAL ILLNESS (SMI) IMPROVEMENT GOAL SPECIFICATION Indicator number N4b Indicator name Indicator weighting Description of indicator Communication with General Practitioners 4a & 4b total weighting be agreed locally (suggested minimum of 0.25%): 4b = 20% of total weighting 90% of patients should have either an updated CPA ie a care programme approach care plan or a comprehensive discharge summary shared with the GP. A local audit of communications should be completed. Completion of a local audit of communication with patents GPs, demonstrating that, for 90% of patients audited, an up-to-date care plan and/or discharge summary has been shared with the GP, which meets the standards of the Academy of Royal Colleges and includes NHS number, ICD codes for all primary and secondary mental and physical health diagnoses, medications prescribed and monitoring requirements, physical health conditions and ongoing monitoring and treatment needs and Recovery focussed healthy lifestyle plans.* Numerator The number of patients in the audit sample for whom the provider has provided to the GP an up-to-date copy of the patient s care plan or a discharge summary which sets out appropriate details of all of the following: NHS number; All primary and secondary mental and physical health diagnosis, including ICD codes; Medications prescribed and monitoring requirements; an Physical health condition and ongoing monitoring and treatment needs; Recovery focussed healthy lifestyle plans. Denominator A sample of a minimum of 100 patients who are subject to the CPA and who have been under the care of the provider for at least 100 days at the time of the audit. Rationale for inclusion National CQUIN scheme Data source Local audit Frequency of data One audit in Quarter 2 collection Organisation responsible BEHMHT for data collection Frequency of reporting to Reports required in respect of Quarter 2. commissioner Baseline period/date NA Baseline value NA Final indicator Audit undertaken in Q2, July September period/date (on which payment is based) Page 9
10 Final indicator value (payment threshold) Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Final indicator reporting date Are there rules for any agreed in-year milestones that result in payment? Are there any rules for partial achievement of the indicator at the final indicator period/date? 90.0% Quarter 2 audit demonstrates that, for 90% of patients audited during the period, the provider has provided to the GP an up-to-date copy of the patient s care plan or a comprehensive discharge summary for patients with no CPA initiated. Quarter 2 audit demonstrates that, for 90% of patients audited during the period, the provider has provided to the GP an up-to-date copy of the patient s care plan**, which sets out appropriate details of all of the following: NHS number; All primary and secondary mental and physical health diagnosis, including ICD codes; Medications prescribed and monitoring requirements; an Physical health condition and ongoing monitoring and treatment needs; Recovery focussed healthy lifestyle plans. 31 October 2015 No Yes see below *Definition of Recovery focussed healthy lifestyle plan A care plan that focusses not only on recovery from mental illness but also promotes a healthy lifestyle in order to aid that recovery and prevent deterioration. Examples WRAP (Wellness Recovery Action Plan) and STAR outcomes (Triangle) **Definition of up to date A care plan that has been documented as reviewed at the previous contact. Page 10
11 Rules for partial achievement at final indicator period/date Final indicator value for the partial achievement threshold % of CQUIN scheme available for meeting final indicator value 49.9% or less No payment 50.0% to 69.9% 25% payment 70.0% to 79.9% 50% payment 80.0% to 89.9% 75% payment 90.0% or above 100% payment Note Baseline in Q /15 BEHMHT achieved 60% Page 11
12 Urgent and Emergency Care Menu National CQUINs 5 8 are from the Urgent and Emergency Care (UEC) Menu For Mental Health Providers the National CQUIN Guidance states A further 0.5% will be available through the UEC menu The UEC menu is as follows 5 Three part indicator: 5a: A reduction in the proportion of NHS 111 calls that end in an inappropriate 999 referral. 6 A reduction in the rate per 100,000 population of ambulance 999 calls that result in transportation to a type 1 or type 2 A&E Department. 7 Two part indicator 8 Two part indicator Reducing the proportion of avoidable emergency admissions to hospital. 8a: Improving recording of diagnosis in A&E 5b: Capture of disposition (and referral) to type 1 and 2 A&E separately from type 3 and 4, thereby improving the quality of the Directory of Services (DoS). 8b: Reduction in A&E MH re-attendances 5c: Proportion of NHS 111 calls that end in an inappropriate type 1 or type 2 A&E referral. 0.5% (Weighting for each indicator to be agreed locally). Indicator 8 Improving Diagnoses and Re-attendance Rates of Patients with Mental Health Needs at A&E - This is a two part indicator. Part 8b can only be implemented following completion of part 8a. It was suggested that UEC Menu 8 is indicated as Indicator 5 relates to 111 services only, indicator 6 to Ambulance services and Indicator 7 to A&E services, however on discussion with BEHMHT it was clarified that 8a relates to acute trust A&E services and 8b is also more related to acute Trusts. It was therefore agreed that a local CQUIN which is BEH specific would be developed to support the national UEC CQUIN objectives Page 12
13 Goal BEHMHT N8: Improving Diagnoses and Re-attendance Rates of Patients with Mental Health Needs at A&E BEHMHT N8 Improving Diagnoses and Re-attendance Rates of Patients with Mental Health Needs at A&E 0.5% % Reduction in A&E MH re-attendances 0.5% % Page 13
14 Indicators 8 Reduction in A&E MH Re-attendances UEC: IMPROVING DIAGNOSES AND RE ATTENDANCE RATES OF PATIENTS WITH MENTAL HEALTH NEEDS AT A&E IMPROVEMENT GOAL SPECIFICATION Indicator number BEHMHT N8 Indicator name Reduction in A&E MH re-attendances Indicator weighing To be agreed -? 0.5% Description of indicator Reduce the rate of mental health re-attendances at A&E in 2015/16 Provide training to staff in A&E and RAID to identify Mental Health conditions Provide ongoing support to A&E and RAID staff in the management of service users who reattend A&E repeatedly Coordinate and facilitate learning events aimed to o Improve identification and management of mental health conditions within A&E teams o Encourage improved and timely communication and intervention between acute trusts and mental health providers to improve outcomes for those with MH conditions seeking urgent and emergency care. And thereby o Reduce the rate of mental health re-attendances at A&E Numerator The number of times a re-attendance occurred (for any reason at any A&E) within 7 days following attendances specified in the denominator. See technical specification below. Denominator Number of attendances at A&E where the diagnosis identified is MH. Commissioners should determine locally what codes to use to define MH depending on local data quality and recording but should include psychosis and adult poisoning as a minimum. See technical specification below. Note - These have been left in as an indicative measure of whether the required actions are making a difference. However these should be as an annex to see if the acute trusts are able to measure in this way. Rationale for inclusion The national indicator was developed to incentivise better data recording and encourage improved and timely communication and intervention between acute trusts and mental health providers to improve outcomes for those with MH conditions seeking urgent and emergency care. Data source Frequency of data collection Organisation responsible for data collection This local specific CQUIN will support the reduction of A&E reattendances by people known to BEHMHT mental health services through support and education provided to A&E staff. BEHMHT Quarterly Acute trusts (RFL and NMUH) to measure reattendance rates. BEHMHT to provide reports on progress. Page 14
15 Frequency of reporting to commissioner Baseline period/date Baseline value Final indicator period/date (on which payment is based) Final indicator value (payment threshold) Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Final indicator reporting date Are there rules for any agreed in-year milestones that result in payment? Are there any rules for partial achievement of the indicator at the final indicator period/date? Quarterly Quarter /16. See milestone box below See milestone box below 19 th May 2016 See below No Indicator 8 Technical Specification For the data quality component, the first 2 and 3 digits of the raw DIAG_01 field in HES will be matched against a list of valid 2 character A&E diagnosis codes and valid ICD-10 codes. For the re-attendance component, all patients with an A&E 2 character diagnosis of 14 or 35 or with an ICD-10 diagnosis in the range F00-F99, G30, T36-T51 or X40-X49 should be included within the denominator. The numerator is then the number of these patients who re-attend ANY A&E for ANY reason within 7 days (inclusive) of the attendance in the denominator. Page 15
16 Indicator BEHMHT N8 Milestones Date/period milestone relates to Rules for achievement of milestones (including evidence to be supplied to commissioner) Quarter 1 1. Implementation plan to be presented to July CQRG covering: Board commitment sign-up Detailed project plan to include plan for training for A&E and RAID staff at RFL and NMUH Training package Evaluation using case study method of case studies from 3 areas o Adult o Specialist services o Children s (CAMHS) of frequent attenders to A&E. The evaluation should include how action taken supports the patient pathway. 2 facilitated Events with acute Trusts (RFL & NMUH) A&E and RAID colleagues Final report to include actions taken by BEH to make a difference, lessons learned and results (as measured by acute trust colleagues) 2. Training sessions to be delivered to 30% A&E/ RAID staff Quarter 2 1. Training sessions to be delivered to 70% A&E/ RAID staff 2. Evaluation using case study method of case studies from 3 areas a. Adult b. Specialist services c. Children s (CAMHS) of frequent attenders to A&E. The evaluation should include how action taken supports the patient pathway. Quarter 3 1. Training sessions to be delivered to A&E/ RAID staff (no target but as close to 100% as possible) Date milestone to be reported 20 August 2015 at CQRG 20 August 2015 at CQRG 19 November 2015 at CQRG 19 November 2015 at CQRG 18 February 2016 at CQRG Milestone weighting (% of CQUIN scheme available) 15% 15% 15% 15% 0% Page 16
17 Date/period milestone relates to Quarter 4 Rules for achievement of milestones (including evidence to be supplied to commissioner) 2. At least 2 facilitated events to be held with acute trust A&E/RAID colleagues. a. At least 1 event at RFL b. At least 1 event at NMUH Note: Events do not necessarily have to be exclusive i.e. RFL staff may attend the NMUH event and vice versa 1. Final report to include actions taken by BEH to make a difference, lessons learned and results (as measured by acute trust colleagues) Date milestone to be reported 18 February 2016 at CQRG 19 May 2016 at CQRG Milestone weighting (% of CQUIN scheme available) 20% 20% Page 17
18 Local NCL CQUINs These CQUIN goals have been taken from the NCL suite of CQUINs agreed across NCL Commissioning bodies. Goal L4: Prevention L4 Prevention 0. %.00% L4.1 Prevention Smoking Cessation 0. 00% 0% L4.2 Alcohol Misuse 0. 0% 0% L4.3 Domestic Violence-Year % 0% Page 18
19 Indicators Indicator number L4.1 Local NCL CQUIN - Prevention Indicator name Indicator weighing Description of indicator Prevention- Smoking Cessation 10% (to be agreed) To support the stop smoking offer to patients attending or admitted to hospital, or in contact with community or mental health services. The incentive seeks to improve the recording of smoking status in community and secondary care and increase access to effective support and treatment to stop smoking. Routinely, at their initial contact with services, patients' smoking status should be established and smokers should be given effective brief stop smoking advice, treatment initiated for those wishing to quit, and referred to local NHS Stop Smoking Services Additionally, ensuring that staff are trained to ensure status is recorded, deliver the very brief advice or assistance (VBA), and to initiate treatment and refer for on-going support. Visible and influential leadership is important to promote stop smoking action in hospitals, and the appointment of clinical champions is encouraged, as is action to promote stop smoking support to staff. To encourage more successful quits among patients who smoke by improving the stop smoking offer for all patients attending A&E or outpatient departments or who are admitted as inpatients and day cases in hospitals in North Central London, or who have contact with community services or mental health services. Summary of CQUIN objectives: 1. To ensure that smoking status is established and recorded in all patients 2. Very brief advice (VBA) provided to all smokers thus identified 3. Initiation of treatment provided in inpatients who wish to make a quit attempt 4. Referral of aforementioned patients to community stop smoking arrangements 5.Offer Nicotine Replacement Therapy (NRT) for patients wishing to stop smoking 6. More targeted interventions (referral to appropriate community services) in selected specialties, including cardiac, stroke, vascular, respiratory, maternity and diabetes; 7. Identification of a smoking cessation clinical champion 8. Pro-active promotion of stop smoking to staff through in-house or local stop smoking service Page 19
20 Numerator Denominator Rationale for inclusion Comment Extension of smoking prevention service to all non-admitted and admitted patients. For community services smoking status will be established at time of first contact. 1 Smoking status Number of patients with smoking status recorded 2 Very brief advice Number of patients recorded as current smoker who have had first very brief advice at time of attendance or start of admission. 3 Quit attempts and initiation of treatment and referrals for on-going support Number of patients who wish to make a quit attempt with a record of initiation of treatment including setting a quit date or receiving Varenicline or NRT or referred for on-going support into community services 4 Selected specialties or patient groups Number of patients recorded as current smoker who have had offer of assistance Number of patients who wish to make a quit attempt with a record of initiation of treatment including setting a quit date or receiving Varenicline or NRT or referred for on-going support into community services, or maternity patients undergoing CO monitoring. Comment Selected patient groups to include maternity, cardiology, stroke, diabetes, respiratory. 1 Smoking status All patients attending A&E, outpatients, or admitted as inpatients or day cases 2 Very brief advice Number of above patients recorded as current smoker 3 Quit attempts and initiation of treatment and referrals for on-going support Number of above patients recorded as current smoker 4 Selected specialties or patient groups Number of patients in selected patient groups recorded as current smoker Comment Selected patient groups to include maternity, cardiology, stroke, diabetes, respiratory. Helping patients to stop smoking is among the most effective and costeffective of all interventions the NHS can offer patients. Despite this, however, rates of intervention by healthcare professionals often remain low. Simple advice from a physician or nurse, during routine patient contact can have a small but significant effect on smoking cessation more so than Nicotine Replacement Therapy (NRT) alone. Very brief stop Page 20
21 smoking advice need take only 30 seconds, and clinicians should be encouraged to deliver very brief advice to all smokers at every opportunity, and in selected patient groups, a more proactive offer of assistance. Patients wishing to set a quit date should have anti-smoking treatment initiated and be referred for on-going stop smoking support. This significantly increases the likelihood of a successful quit attempt. For patients not wishing to set a quit date, provision of NRT can reduce cravings. Data source Data to be provided for denominator as part of regular reporting arrangements. Data for numerator to be collected manually or through trust recording systems. Frequency of data collection Organisation responsible for data collection Frequency of reporting to commissioner Baseline period/date Baseline value Final indicator period/date (on which payment is based) Final indicator value (payment threshold) Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Final indicator reporting date Are there rules for any agreed in-year milestones that result in payment? Are there any rules for partial achievement of the indicator at the final indicator period/date? On-going, real time data collection through Trust recording systems. BEHMHT Quarterly NA NA Quarter 4 Payment based on results at end of each quarter against quarterly milestones. May 19 th 2016 Yes Yes Page 21
22 Date/period milestone relates to Quarter 1 Quarter 2 Rules for achievement of milestones (including evidence to be supplied to commissioner) 1. Smoking status recorded at time of attendance/ admission for 95% adult patients. 2. Baseline - Smoking status recorded at time of attendance/ admission patients age 14 to 18 years 3. Very brief advice for 95% of patients recorded as current smoker. 4. Quit attempts, initiation of treatment and referral: 20% of patients who are current smokers who wish to make a quit attempt with a record of initiation of treatment including setting a quit date or receiving Varenicline or NRT or referred for on-going support. 5. Quit attempts, initiation of treatment and referral: 25% patients in target patient groups who have been identified as current smokers who wish to make a quit attempt 6. Nomination of a clinical champion to promote smoking cessation for patients and staff 1. Smoking status recorded at time of attendance/ admission for 95% adult patients. 2. Smoking status recorded at time of attendance/ admission for 90% of patients age 14 to 18 years 3. Very brief advice for 95% of patients recorded as current smoker. 4. Quit attempts, initiation of treatment and referral: 21% of patients who are current smokers who wish to make a quit attempt with a record of initiation of treatment including setting a quit date, receiving Varenicline, NRT or referred for on-going support. 5. Quit attempts, initiation of treatment and referral: 27% patients in target patient groups who have been identified as current smokers who wish to make a quit attempt Date milestone to be reported 20 August 2015 at CQRG 19 November 2015 at CQRG Milestone weighting (% of CQUIN scheme available) 25% of *% 25% of *% Page 22
23 Date/period milestone relates to Quarter 3 Quarter 4 Rules for achievement of milestones (including evidence to be supplied to commissioner) 6. Provide evidence of a programme of events for staff approved by the Clinical Champion that is designed to encourage staff to quit smoking planned 1. Smoking status recorded at time of attendance/ admission for 95% adult patients. 2. Smoking status recorded at time of attendance/ admission for 95% of patients age 14 to 18 years 3. Very brief advice for 95% of patients recorded as current smoker. 4. Quit attempts, initiation of treatment and referral: 23% of patients who are current smokers who wish to make a quit attempt with a record of initiation of treatment including setting a quit date or receiving Varenicline or NRT or referred for on-going support. 5. Quit attempts, initiation of treatment and referral: 29% patients in target patient groups who have been identified as current smokers who wish to make a quit attempt 1. Smoking status recorded at time of attendance/ admission for 95% adult patients. 2. Smoking status recorded at time of attendance/ admission for 95% of patients age 14 to 18 years 3. Very brief advice for 95% of patients recorded as current smoker. 4. Quit attempts, initiation of treatment and referral: 24% of patients who are current smokers who wish to make a quit attempt with a record of initiation of treatment including setting a quit date or receiving Varenicline or NRT or referred for on-going support. 5. Quit attempts, initiation of treatment and referral: 30% patients in target patient groups who have been identified as current smokers who wish to make a quit attempt Date milestone to be reported 18 February 2016 at CQRG 19 May 2016 at CQRG Milestone weighting (% of CQUIN scheme available) 25% of *% 25% of *% Page 23
24 Date/period milestone relates to Rules for achievement of milestones (including evidence to be supplied to commissioner) 6. Provide evidence that a programme of events for staff approved by the Clinical Champion that is designed to encourage staff to quit smoking has been delivered Date milestone to be reported Milestone weighting (% of CQUIN scheme available) Page 24
25 Indicator number L4.2 Local NCL CQUIN - Prevention Indicator name Indicator weighing Description of indicator Prevention - Alcohol Misuse 10% (to be confirmed) Screening for increasing risk (hazardous) and high risk (harmful) alcohol use in Emergency Departments, Urgent Care Centres, Maternity serivces, Community Services and Mental Health Services - Patients (aged 14 years or over). Trusts should use an evidence-based screening and brief advice tool. This may include universal offer (i.e. to all patients aged 14+) or for those patients whose reason for attendance is: collapse (inc falls and fits); head injury; assault; psychiatric (self-harm, overdose); repeat attender; gastro-intestinal; hypertension/chest pain; and other presentations where alcohol problem is indicated (e.g. intoxication, withdrawal fits or DTs). The initial screening time is generally very brief. It is anticipated that on average 25-30% of patients screened would be positive, requiring a brief intervention and advice, taking 5-7 minutes, and is shown to be highly effective in reducing alcohol consumption. There should be communication of positive results to patients' GPs. Referral to alcohol liaison services will be indicated for some patients. Trusts need to ensure that staff have been trained to identify patients, deliver the screening and do the brief intervention. Additionally, recording the locations of alcoholrelated violence/trauma, including domestic violence, can assist local crime reduction partnerships in targeting and reducing future incidents. The overall objective is to reduce alcohol harm among users of ED, UCC, Community and Mental Health services in North Central London through the use of screening and brief interventions: 1. To ensure the consistent offer of effective, evidence-based screening for increasing risk (hazardous) and high risk (harmful) alcohol consumption to patients presenting with selected conditions in EDs, UCCs, Community and Mental Health Services. 2. To ensure patients screening positive are provided with a brief intervention and information concerning sensible/safer drinking; 3. To ensure communication with the GP concerning positive screens for all patients registered with NCL GPs; 4. To ensure referral to alcohol liaison services for patients where indicated; 5. To ensure that identified frontline staff in ED, UCC settings are trained to be able to confidently screen, provide brief intervention and refer where necessary as part of their routine clinical practice. 6. To record and report incidents related to alcohol violence as part of an anonymised dataset to local crime reduction partnerships (the 'Cardiff Page 25
26 model'). Numerator Denominator Rationale for inclusion Number of patients screened using the screening tool Number of patients presenting 14+ (universal screen) excluding the following: those that leave on their own accord without waiting to receive medical attention; those that are unconscious or lack capacity; ambulance cases that do not come through to triage. Alcohol-related problems represent a significant cause of potentially preventable disease, emergency admissions and attendances at EDs and UCCs. Screening for alcohol risk (hazardous and harmful drinking) can be provided effectively in routine patient contact and has been shown to reduce subsequent attendances and alcohol consumption. The FAST and Audit C models of screening and brief intervention and advice has been shown to be the most effective for routine screening. Trusts should be encouraged to work closely with GPs and their local alcohol liaison services in the implementation of this CQUIN. NCL Commissioners wish to adopt a whole systems integrated approach. This CQUIN will ensure that patients who test positive during the screening process will receive a brief intervention and that their registered GP will be made aware of the result. This will promote clinical reinforcement, continuity and clarity of advice. Immediate and brief intervention will be, where appropriate, the precursor to a long term approach to preventing the misuse of alcohol which may lead to or contribute to a range of serious chronic conditions (e.g. Diabetes, CVD, Liver Disease, cancer, mental health problems) as well as a range of acute conditions. The British Medical Association estimates that there are at least a million acts of violence a year which result in injury. Alcohol is a factor in a significant proportion of these violent incidents: 60-70% of homicides; 75% of stabbings; 70% of beatings; and 50% of fights and domestic assaults. It is estimated that substantially less than half of violencerelated attendances seen at EDs are ever reported to the police. EDs are therefore well placed to provide information in an anonymised format that would otherwise be unavailable to Community Safety Partnerships to assist with targeting of preventive actions to reduce alcohol related and other violence in the community. The College of Emergency Medicine Clinical Effectiveness Committee s Guideline for Information Sharing to reduce community violence (2009) recommends that in order to reduce community violence EDs should routinely collect data about assault victims at registration and have produced guidelines on the suggested process. This states that three additional items of information should be Page 26
27 collected incident type, assault type and location. The data should then be shared with the local Community Safety Partnership and crime analysts in an anonymous format (see Figure for dataset items). Data source Frequency of data collection Organisation responsible for data collection Frequency of reporting to commissioner Baseline period/date Baseline value Final indicator period/date (on which payment is based) Final indicator value (payment threshold) Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Final indicator reporting date Are there rules for any agreed in-year milestones that result in payment? Are there any rules for partial achievement of the indicator at the final indicator period/date? ED and UCC services, Community and Mental Health services to collect data using the FAST or Audit C screening tools. Trusts responsible for ED and UCC services to provide information for their local Community Safety Partnerships in an agreed reporting format. On-going, real time data collection through trust recording systems. BEHMHT Acute trusts to provide monthly dataset reports on alcohol-related violence/trauma to Crime Reduction Partnerships. Acute, Community and Mental Health trusts to report results of screening programme quarterly. Q4 2015/16 Payment based on results at end of each quarter against quarterly milestones. 19 th May 2016 (at CQRG) Yes No Page 27
28 Date/period milestone relates to Rules for achievement of milestones (including evidence to be supplied to commissioner) Quarter 1 1. Develop a training package for staff on the use of the FAST tool Quarter 2 1. Deliver FAST tool training to all relevant staff (front facing staff who undertake clinical assessments) Quarter 3 1. Baseline, the numbers of patients (universal or targeted) screened during quarter 2. Baseline of patients screened positive receiving brief intervention and information during quarter. 3. Baseline of patients screened positive and registered with a GP where communication of result is sent (within 24 hours) during quarter. 4. A report detailing screening results and brief interventions delivered, GP communication and onward referral with accompanying demographic and attendance details for period Quarter 3. Report to provide recommendations on healthcare needs and to be presented by the Trust at CQRG meeting. Quarter 4 1. Using Q3 2015/16 as the baseline, a 5% increase on the numbers of patients (universal or targeted) screened during quarter 2. 95% of patients screened positive receiving brief intervention and information during quarter % of patients screened positive and registered with a GP where communication of result is sent (within 24 hours) during quarter. 4. A report detailing screening results and brief interventions delivered, GP communication and onward referral with accompanying demographic and attendance details for period Quarter 4. Report to be presented by the Trust at CQRG meeting. Date milestone to be reported 20 August 2015 at CQRG 19 November 2015 at CQRG 18 February 2016 at CQRG 19 May 2016 at CQRG Milestone weighting (% of CQUIN scheme available) 25% of *% 25% of *% 25% of *% 25% of *% Page 28
29 Indicator number L4.3 Local NCL CQUIN - Prevention Indicator name Prevention - Domestic Violence-Year 1 Indicator weighing 10% Description of indicator Numerator Denominator Rationale for inclusion Data source Frequency of data collection Organisation responsible for data collection Frequency of reporting to commissioner Baseline period/date Baseline value Final indicator period/date (on which payment is based) Final indicator value (payment threshold) Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Final indicator reporting date Are there rules for any agreed in-year milestones that result in payment? Are there any rules for partial achievement of the indicator at the final indicator period/date? To introduce and/or develop existing measures that will help to identify, assess and advise patients where there is evidence of domestic violence. To encourage the provision of specialist advice, information and support services as well as mechanisms for further referral where domestic violence has been identified. SUS Monthly BEHMHT Quarterly M12 SUS Page 29
30 Date/period milestone relates to Quarter 1 Quarter 2 Quarter 3 Quarter 4 Rules for achievement of milestones (including evidence to be supplied to commissioner) 1. Evidence of implementation of a domestic violence policy that includes a. A domestic violence lead in place b. A domestic violence programme established at the Trust c. The domestic violence programme is supported by a trust wide multi disciplinary steering group d. Training on Domestic Violence awareness is included in Induction training and as part of safeguarding training (Adults and Children) 1. Evidence provided of a systematic approach to the identification of domestic violence, support and referral to appropriate services for all patient groups. 2. Training programme devised for front line staff on awareness, identification, support and prevention to be presented to CQRGtraining programme to be rolled out in Q3 and Q4 3. Information (Leaflets) for staff developed a. Supporting service users/ patients at risk of Domestic Violence b. Support for staff at risk of Domestic Violence 1. Evidence of roll out of training programmes to front line staff in the identified cohorts. 2. Business case on more targeted interventions developed to feed into the 2016/17 contracting round Further in Q4 with further identification. 1. Evidence of roll out of training programme to front line staff in the identified cohorts. 2. Evidence that cases that have been referred to MDT have been followed up and monitored Date milestone to be reported 20 August 2015 at CQRG 19 November 2015 at CQRG 18 February 2016 at CQRG 19 May 2016 at CQRG Milestone weighting (% of CQUIN scheme available) 10% of *% 40% of *% 25% of *% 25% of *% Page 30
31 Date/period milestone relates to Rules for achievement of milestones (including evidence to be supplied to commissioner) 3. A report to be presented by the Trust at CQRG meeting to include a. Evaluation of training programme. b. How the learning from Domestic Violence programme and from Domestic Homicide reviews has been incorporated into Trust policy and training prohgrammes Date milestone to be reported Milestone weighting (% of CQUIN scheme available) Page 31
32 Goal L5: Safe and timely discharge L5 Safe and timely discharge 0. %.00% L5.1 Safe and timely discharge Effective Discharge Arrangements 0. 00% 0% L5.2 Medicines on discharge 0. 0% 0% L5.3 Discharge information for GPs 0. 0% 0% Page 32
33 Indicators Indicator number Indicator name Local NCL CQUIN Safe and timely discharge L5 Indicator weighing 40% Description of indicator Numerator Denominator Rationale for inclusion Summary of CQUIN objectives Data source Frequency of data Ongoing collection Organisation responsible BEHMHT for data collection Frequency of reporting to Quarterly commissioner Baseline period/date 2014/15 Baseline value Final indicator period/date Quarter /16 (on which payment is based) Final indicator value (payment threshold) Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Final indicator reporting April 2016 (at CQRG) date To ensure appropriate arrangements are in place for the safe and timely discharge of patients, avoiding the risk of unnecessarily long length of stay in hospital, minimising the risk of re-admission and ensuring patient safety on discharge. The CQUIN focuses on: - *Discharge on planned date with support in the community where appropriate. *Patients' understanding of their medication *Discharge information sent to GPs See templates The purpose of this CQUIN is to improve patients' experience and safety by ensuring that acute, community and social services operate in a seamless manner and that there is effective communication between each of the agencies contributing to patients' care. By ensuring that effective discharge arrangements are in place for all patients, Commissioners will ensure that acute and community service providers and primary care will all be used to greatest benefit and that waste of resources caused by delays and duplicated effort can be avoided. For elderly and or vulnerable patients in particular, the risks associated with readmissions will be minimised. Page 33
34 Are there rules for any agreed in-year milestones that result in payment? Are there any rules for partial achievement of the indicator at the final indicator period/date? Areas to be reported. Effective discharge plans in place 20% Patients' understanding of medication (over 75s) 20% Discharge letters for GPs 60% Total 100% Page 34
35 Indicator number L5.1 Indicator name Indicator weighing 20% Description of indicator Numerator Denominator Rationale for inclusion Data source Frequency of data collection Organisation responsible for data collection Frequency of reporting to commissioner Baseline period/date Baseline value Local NCL CQUIN Safe and Timely Discharge Effective Discharge Arrangements This CQUIN applies to inpatient services within Enfield Community Services (ECS) and to wards for the care of older adults with mental illness. Within 72 hours of admission, a pre-discharge plan to be completed which identifies: *Patient's carer and his/her ability to manage the patient at home or *Residential or nursing home to which patient will be admitted on discharge, and any identified barriers to return to that care setting *Named person from provider trust responsible for overseeing/ implementing discharge arrangements *Patient's GP For frail elderly patients, discharge is to take place before 4pm. 50% of all patient discharges to take place before 2 pm. Patient to be discharged with 14 days' medicines and carer and patient to be given clear instructions for care during recovery period and hospital contact details in case of emergency. Number of pre-discharges and care plans each quarter in sample fully meeting the above requirements and in place within 24 hours of admission. Random sample of 50 discharges and care plans taken each quarter The purpose of this CQUIN is to improve patients' experience and safety by ensuring that acute, community and social services operate in a seamless manner and that there is effective communication between each of the agencies contributing to patients' care. By ensuring that effective discharge arrangements are in place for all patients, Commissioners will ensure that acute and community service providers and primary care will all be used to greatest benefit and that waste of resources caused by delays and duplicated effort can be avoided. For elderly and or vulnerable patients in particular, the risks associated with readmissions will be minimised. Manual sampling of patient notes and discharge plans Routine collection reported quarterly BEHMHT community services/ mental health services Quarterly NA NA Page 35
36 Final indicator period/date (on which payment is based) Final indicator value (payment threshold) Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Final indicator reporting date Are there rules for any agreed in-year milestones that result in payment? Are there any rules for partial achievement of the indicator at the final indicator period/date? Q4 2015/16 50% or more of all discharges to take place before 2 pm 90% of all discharge plans meeting specification 95% of patients over 75 discharged before 4 pm All patients discharged from hospital or community services/ mental health services in Q1, Q2, Q3 and Q4. - Random sample of 50 sets of patient notes and discharge plans to be reviewed each quarter. Quarter 4-19 May 2016 at CQRG Yes No Date/period milestone relates to Quarter 1 Quarter 2 Quarter 3 Quarter 4 Rules for achievement of milestones (including evidence to be supplied to commissioner) 40% or more of all discharges to take place before 2 pm 50% of all discharge plans meeting specification 90% of patients over 75 discharged before 4 pm 50% or more of all discharges to take place before 2 pm 70% of all discharge plans meeting specification 95% of patients over 75 discharged before 4 pm 50% or more of all discharges to take place before 2 pm 80% of all discharge plans meeting specification 95% of patients over 75 discharged before 4 pm 50% or more of all discharges to take place before 2 pm 90% of all discharge plans meeting specification 95% of patients over 75 discharged before 4 pm Date milestone to be reported 20 August 2015 at CQRG 19 November 2015 at CQRG 18 February 2016 at CQRG 19 May 2016 at CQRG Milestone weighting (% of CQUIN scheme available) 25% of 20% 25% of 20% 25% of 20% 25% of 20% Page 36
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