Understanding patient pathways and the impact of emergency admissions in MS & Parkinson s disease

Transcription

1 Understanding patient pathways and the impact of emergency admissions in MS & Parkinson s disease Sue Thomas Chief Executive NHiS Commissioning Excellence

2 Aim Highlight from national and local statistics the impact MS and Parkinson s has on the NHS Explain how integrated pathways can support better care Illustrate which pathways might bring improved patient outcomes and service efficiencies Clarify steps to achieve change

3 Top 10 neurological conditions requiring hospital admission (data from 9 Clinical Networks) 600, , , , , ,000 - Motor neurone diseasespinal cord injury Migraine CNS infections Hydrocephalus Acquired brain injury Multiple sclerosis Parkinson s Neuropathies Epilepsy Data source NHiS 2014

4 Neurological Emergency Admissions lowest spending CCGs ( per 1000 population per year) Source NIN NHS WOKINGHAM CCG 9,514 NHS KINGSTON CCG 10,067 NHS NORTH & WEST READING CCG 10,684 NHS NEWBURY AND DISTRICT CCG 10,751 NHS RICHMOND CCG 10,808 5 highest spending CCGs NHS NEWCASTLE WEST CCG 27,915 NHS KNOWSLEY CCG 29,021 NHS SOUTH SEFTON CCG 29,037 NHS CENTRAL MANCHESTER CCG 30,450 NHS DONCASTER CCG 32,398

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6 Total number of admissions per 1,000 population Secondary care data is taken from the English Hospital Episode Statistics (HES) database produced by the Health and Social Care Information Centre (HSCIC, Copyright

7 Number of elective and non elective admissions for pwms per 1,000 population Elective admissions grew by 11% Non-elective admissions grew by 0.6% Secondary care data is taken from the English Hospital Episode Statistics (HES) database produced by the Health and Social Care Information Centre (HSCIC, Copyright

8 Overall costs MS admissions 2013/14 Admission type Total Cost Average cost per admission Non-elective 43,051,255 1,820 All elective 50,433, Day case 31,578, Elective (excluding day cases) 18,855,281 1,819 Secondary care data is taken from the English Hospital Episode Statistics (HES) database produced by the Health and Social Care Information Centre (HSCIC, Copyright

9 Non-elective care accounted for 46% of overall spend on people with MS in hospital whilst accounting for only 27% of hospital admissions and represents a huge opportunity to reduce costs in the NHS

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12 Percentage compared to whole population non-elective admissions Secondary care data is taken from the English Hospital Episode Statistics (HES) database produced by the Health and Social Care Information Centre (HSCIC, Copyright

13 Greater Manchester and Lancashire

14 HEADACHE, EPILEPSY MOVEMENT DISORDERS, MS, NEUROMUSCULAR high admission rates shorter length of stay (LOS) high zero bed day rates (ZBD) low excess bed days (EBD) high readmission rates lower admission rates longer length of stay low zero bed days high excess bed days low readmission rates Put effort into front door emergency presentations education referrers & emergency staff rapid review (neurology) Put effort into early supported discharge admission prevention enhanced primary care management of prominent neuro LTC co-morbidities

15 Parkinson s Parkinson's disease patients in England have higher rates of emergency admissions with longer hospital stays, higher costs and in-hospital mortality Urgent attention should be given to developing costeffective interventions to reduce the burden of hospitalisation for patients, carers and healthcare systems Top reasons for admission are pneumonia, motor decline, UTI s and fractures

16 Non- elective admission by diagnosis & CCG Non-elective Admissions by CCG and Broad Diagnosis Group in Greater Manchester, 2014/2015 Non-elective Admissions % of Non-elective Admissions in Greater Manchester CCG Diabetes Dementia Stroke Falls Epilepsy Parkinson's Diabetes Dementia Stroke Falls Epilepsy Parkinson's NHS Bolton CCG 3,973 1, , % 9% 23% 9% 8% 10% NHS Bury CCG 2, % 5% 7% 6% 6% 6% NHS Central Manchester CCG 2, % 4% 4% 4% 5% 7% NHS Heywood, M & R CCG 2,984 1, , % 7% 8% 7% 8% 8% NHS North Manchester CCG 2, % 6% 5% 6% 7% 6% NHS Oldham CCG 3,040 1, , % 9% 8% 9% 9% 7% NHS Salford CCG 3,304 1, , % 11% 1% 11% 10% 9% NHS South Manchester CCG 2, % 4% 3% 5% 6% 5% NHS Stockport CCG 3,883 2, , % 14% 17% 14% 12% 12% NHS Tameside and Glossop CCG 3,385 1, , % 11% 11% 8% 10% 8% NHS Trafford CCG 2,822 1, , % 7% 6% 8% 7% 9% NHS Wigan Borough CCG 4,126 2, , % 13% 9% 12% 11% 13% Greater Manchester Total 36,605 16, ,544 4,980 2, % 100% 100% 100% 100% 100%

17 Avoiding hospital admissions 1. Identify which admissions are avoidable and which interventions are effective 2. Look for primary care sensitive conditions 3. Lower socio-economic groups are more likely to be admitted (for all conditions) 4. Higher continuity of GP care and self-management helps 5. Early review by senior clinician in emergency department may help (12% reduction in admissions) Sarah Purdy, Kings Fund, 2010

18 Richmond gold standard - example

19 UTI Pathway

20 Sue Thomas LinkedIn The MS report is