WSHT CQUIN schemes in national contracts Coordinating Commissioner Associate Commissioners Expected financial value of Scheme NHS West Sussex NHS Hastings & Rother, NHS East Sussex Downs & Weald, NHS Brighton & Hove 3.973m estimated (subject to activity) Goals and Indicators Goal no. Description of goal Quality Domain(s) 1 Indicator Indicator name National or number 2 Regional indicator 3 Indicator weighting on total contract value 1 Reduce avoidable death, disability and chronic ill health from Venousthromboembolism (VTE) Safety 1 VTE risk assessment Nationally mandated 0.15% 2 To improve responsiveness to personal needs of patients Patient experience 2 Composite indicator on responsiveness to personal needs from the Adult Inpatient Survey Nationally mandated 0.15% 3 Improved patient safety by implementation of electronic discharge summaries Safety 3 Electronic Discharge Summary Regionally suggested 0.15% 4 Improve timeliness of all outpatient communications Safety 4 Outpatient communications sent within 5 working days Regionally suggested 0.15% 5 Improving timeliness of request to receipt of nonurgent radiology diagnostics reporting via PACS or nhs mail Effectiveness 5 Radiology Diagnostic Reporting nonurgent Regionally suggested 0.1% 6 Improving timeliness of request to receipt of urgent radiology diagnostics reporting via PACS or nhs mail Effectiveness 6 Radiology Diagnostic Reporting - urgent Regionally suggested 0.1% 7 To improve patient safety culture within acute trust setting Safety Experience 7 Patient Safety Culture Assessment Regionally suggested 0.05% 8 Improved patient clinical outcome by early detection of any nutritional issues Effectiveness 8 Nutritional assessment within 24 hours of admission Regionally suggested 0.15% 1 Safety / Effectiveness / Experience / Innovation 2 May be several for each goal 3 Nationally mandated / Regionally mandated/ Regionally suggested/ No 1
9a Improve the quality of patient care by delivering the process defined measures and success for the five patient specific pathways as part of the Enhancing Quality Programme (EQ). Safety and Effectivene ss 9a Acute patient specific pathway process development Yes 0.5% (85% of total EQ CQUIN) 9b Improve performance against established baseline of the four Acute patient specific pathways as part of the Enhancing Quality Programme. Safety and Effectivene ss 9b Acute patient specific pathway baseline improvement Yes (15% of total EQ CQUIN) 2
Indicator 1 VTE risk assessment Baseline period / date 90% of all adult inpatients who have had a VTE risk assessment on admission to hospital using the national tool. Number of adult (18 years or older) inpatient admissions reported as having had a VTE risk assessment on admission to hospital using the national tool. Number of adults who were admitted as inpatients (includes day cases, maternity and transfers; both elective and non-elective admissions). Need to define exclusions as above VTE is a significant patient safety issue, however outcome data on VTE is poor post mortem studies suggest that only 1-2 in every 10 fatal pulmonary emboli is diagnosed. Whilst work is underway to improve reliability of outcome data, the process measure of VTE risk assessment will set an effective foundation for appropriate prophylaxis. This gives the potential to save thousands of lives each year. Monthly return through Unify. WSHT developing processes to do this effectively, and the part to be played by the EQ reporting tool. Local code has been established for Unify reporting. West Sussex Hospitals NHS Trust Monthly - Unify 2 reporting Baseline measurement in June Baseline measurement in June Final indicator period / date (on which payment is based) 31 st March 2011 Final indicator value (payment threshold) 397,000 Final indicator reporting date 31 st March 2011 Rules for any agreed in-year milestones that result in payment Rules for delayed achievement against final indicator period/date and/or 90% or higher to achieve full payment, between 75% and 90% payment for 75% payment, 50% payment for 50% to 75% compliance. No payment for lower than 50% compliance. No in year milestones. Payment relates to compliance position at 31 March 2011. 1 month tolerance 3
in-year milestones 4
Indicator 2 Patient Experience Baseline period / date The indicator will be a composite, calculated from 5 survey questions. Each describes a different element of the overarching theme: responsiveness to personal needs: Involved in decisions about treatment/care. Hospital staff available to talk about worries/concerns. Privacy when discussion condition/treatment. Informed about medication side effects. Informed w ho to contact if worried about condition after leaving hospital Index-based score reflecting positive responses to the 5 questions within the composite indicator. The indicator incorporates questions which are known to be important to patients and where past data indicates significant room for improvement across England. Adult inpatient survey, from the CQC nationally coordinated patient survey programme. The survey is conducted annually between October and January for patients who had an inpatient episode between July and August. Western Sussex Hospitals NHS Trust Annually: 1. Early local data (mid-january 2011) 2. Published data (April-May 2011) Adult inpatient survey 2009/10 (based on inpatient episodes between July and August 2009) To be confirmed - awaiting 09/10 data and SHA planned trajectory. Final indicator period / date (on which payment is based) 31 st March 2011 Final indicator value (payment threshold) 397,000 Final indicator reporting date Adult inpatient survey 2010/11 (based on inpatient episodes between July and August 2010. Target to be confirmed. SHA target will based on improvement on published 09/10 score set in line with SEC median. 50% of CQUIN payment to based on the results of the National Inpatient Survey (April-May 5
2011) Rules for any agreed in-year milestones that result in payment Rules for delayed achievement against final indicator period/date and/or in-year milestones 50% of CQUIN payment to be based on the results of the local survey results (mid January 2011) 6
Indicator 3 Electronic Discharge Summaries Baseline period / date Final indicator period / date (on which payment is based) 85% of all electronic discharge summaries produced on day of discharge in specialties as per the action plan and trajectory. Number of electronic discharge summaries produced in pilot areas from start date Number of inpatient admissions discharged in pilot areas from start date. Information on diagnosis and medication is required by primary care to ensure patient safety once discharged from hospital. Quarterly check date of discharge against sent on electronic system by WSHT/PBC in agreed specialties as per action plan. WASH and PBC Quarterly Agreed trajectory for implementation of pilots Based on specialty implementation and project plan Compliance at 31 st March 2011 in agreed delivery areas. Final indicator value (payment threshold) 397,000 Final indicator reporting date Audit of Q4 data 2010/11 Rules for any agreed in-year milestones that result in payment Rules for delayed achievement against final indicator period/date and/or in-year milestones Semi linear from 0-100% of eligible discharges as per trajectory 1 month tolerance with joint agreement with NHS West Sussex at time of writing that further contingency will be required if schedule slips or event out of WSHT control (NHS Net emailing) 7
Indicator 4 Outpatient Communications Baseline period / date Percentage of outpatient appointments (which need a letter) sent electronically within 5 working days. Number of relevant outpatient communications sent electronically to primary care as per agreed trajectory. Number of relevant outpatient communications sent electronically to primary care within 5 working days. Information on diagnosis and medication is required by primary care to ensure patient safety once discharged from outpatient department. Quarterly check date of discharge against sent on electronic system by WSHT/PBC in agreed specialties as per action plan. WSHT and PBC Quarterly Based on specialty implementation and project plan Based on M12 audits agreed at CQRG Final indicator period / date (on which payment is based) 31 st March 2011 Final indicator value (payment threshold) 397000 Final indicator reporting date Audit of Q4 data 2010/11 Will require initial audit to establish a baseline before any trajectory can be developed. Subject to testing via audit, proposed targets are: a) Over 85% WSHT to receive ¾ payment. 100% full payment b) % to be set once baseline trajectory received. Trajectory and confirmation of thresholds to be agreed via Clinical Quality Review Group Rules for any agreed in-year milestones that result in payment Rules for delayed achievement against final indicator period/date and/or in-year milestones 1 month tolerance 8
Indicator 5 Radiology Diagnostics Reporting non-urgent 80% non-urgent tests to be sent to the GP within 5 working days from request to report by PACS or nhs mail by Q4 2010/11 Number of non-urgent test reports sent within 5 working days of test. Number of non-urgent tests carried out. Timeliness of radiology results improves timeliness of treatment of patients and therefore better outcomes. Report monthly (to be agreed) via clinical quality dashboard Western Sussex Hospitals NHS Trust and PBC Monthly (to be agreed) Baseline period / date Year end position 2009/10. Trajectory developed but dependant on introduction of PACS. Final indicator period / date (on which payment is based) 31 st March 2011 Final indicator value (payment threshold) 265000 Final indicator reporting date M12 data from 2010/11 Rules for any agreed in-year milestones that result in payment Rules for delayed achievement against final indicator period/date and/or in-year milestones 80% or higher to achieve full payment, between 75% and <80% compliance for 75% payment, >70% but <75% compliance for 50% payment. No payment for lower than 70% compliance. 1 month tolerance with joint agreement with NHS West Sussex at time of writing that further contingency will be required if schedule slips or event out of WSHT control (due to Sussex HIS slippage) 9
Indicator 6 Radiology Diagnostics Reporting urgent 80% urgent tests from request to report to be sent to the GP within 48 hours either by PACS or nhs mail in Q4 2010/11 Number of urgent tests received by the GP within 48 hours. Number of urgent tests carried out. Timeliness of radiology results improves timeliness of treatment of patients and therefore better outcomes. Report monthly (to be agreed) via clinical quality dashboard Western Sussex Hospitals NHS Trust and PBC Monthly (to be agreed) Baseline period / date Year end position 2009/10. Trajectory developed but dependant on PACS. Final indicator period / date (on which payment is based) 31 st March 2011 Final indicator value (payment threshold) 265000 Final indicator reporting date M12 data from 2010/11 Rules for any agreed in-year milestones that result in payment Rules for delayed achievement against final indicator period/date and/or in-year milestones 80% or higher to achieve full payment, between 75% and <80% compliance for 75% payment, >70% but <75% compliance for 50% payment. No payment for lower than 70% compliance. 1 month tolerance with joint agreement with NHS West Sussex at time of writing that further contingency will be required if schedule slips or event out of WSHT control (due to Sussex HIS slippage) 10
Indicator 7 Patient Safety Culture Assessment Trust to actively take part in agreed action plan by NHS West Sussex to carry out patient safety culture assessment using the Manchester Patient Safety Framework. Year 1 Trust to take part in review process. As above. The safety of both patients and staff in a healthcare organisation is influenced by the extent to which safety is perceived to be important across the organisation. The Manchester Patient Safety Framework was produced to help make the concept of safety culture more accessible. It uses 9 dimensions of safety, and for each of these describes what an organisation would look like at 5 levels of safety culture. Annual visit in year 1. NHS West Sussex/Western Sussex Hospitals NHS Trust Annually Baseline period / date 2010/2011 To be developed in year 1 Final indicator period / date (on which payment is based) 2010/2011 Final indicator value (payment threshold) 132000 Final indicator reporting date Annual report Not applicable in year 1 Rules for any agreed in-year milestones that result in payment Rules for delayed achievement against final indicator period/date and/or in-year milestones Clear evidence provided in report of Board support of action plan 11
Indicator 8 Patient Experience Local Nutrition Baseline period / date 80% of nutritional assessments (using MUST score) undertaken on all patients (where clinical appropriate) within 24 of admission set against baseline data 2009/10. Number of nutritional assessments undertaken on all patients (where clinical appropriate) within 24 hours of admission. Number of admissions of all patients (where clinical appropriate) Keeping patients nourished to encourage faster health improvements and stop inappropriate weight loss and dehydration in NHS care. Trust report quarterly via clinical quality dashboard. Western Sussex Hospitals Trust Quarterly on Quality dashboard Q1 audit of data Proposed 50% Q1 Final indicator period / date (on which payment is based) 31st March 2011 Final indicator value (payment threshold) 397,000 Final indicator reporting date 31st March 2011 Rules for any agreed in-year milestones that result in payment Rules for delayed achievement against final indicator period/date and/or in-year milestones 80% or higher to achieve full payment, between 75% and <80% compliance for 75% payment, >70% but <75% compliance for 50% payment. No payment for lower than 70% compliance. No in year milestones. Payment relates to compliance position at 31 March 2011. 1 month tolerance 12
Indicator 9a - Acute patient specific pathways process development Baseline period / date Final indicator period / date (on which payment is based) Final indicator value (on which payment is based) Final indicator reporting date The indicator will be composite of the weighted process development milestones: defined measures defined success for the four Acute patient pathways that have been fully achieved within specified timeframe Number of process milestones achieved in full The Enhancing Quality Programme is a programme to incentivise improvements in the quality of patient care across all of the provider organisations in the South East Coast. The Enhancing Quality Programme will optimise the delivery of quality healthcare in the most appropriate setting and demonstrate that clinicians are delivering the most effective care to patients. The overarching aim is to improve quality in four focus areas of Myocardial Infarction, Community Acquired Pneumonia, Heart Failure, Hip and Knee Replacements. Monthly reporting Provider Monthly Based on local data available in April 2010 March 2011 Weighted milestone Based on reported data April 2010 March 2011 1,126,000 Weighted milestone: Acute A) 85% of 0.5% CQUIN contract value for all milestones achieved. B) 15% of the 0.5% CQUIN contract value. Improve performance against established baseline of the four Acute patient specific pathways Closed data 13
Rules for any agreed in-year milestones that result in payment Rules for delayed achievement against final indicator period/date and/or in-year milestones Full compliance with milestone objectives 14
Indicator 9b - Acute patient specific pathway baseline improvement % of patients receiving pathway metrics above initial established baseline which demonstrates improved performance from the baseline position Baseline period / date Final indicator period / date (on which payment is based) Final indicator value (on which payment is based) Final indicator reporting date Rules for any agreed in-year milestones that result in payment Rules for delayed achievement against final indicator period/date and/or in-year milestones All patients identified within the four patient specific pathways The number of patients diagnosed as participant in each specific pathway The Enhancing Quality Programme will optimise the delivery of quality healthcare in the most appropriate setting and demonstrate that clinicians are delivering the most effective care to patients. The overarching aim is to improve quality in four focus areas of Myocardial Infarction, Community Acquired Pneumonia, Heart Failure, Hip and Knee Replacements. SUS/QMR, monthly Provider Monthly Based on closed dataset December 2010 March 2011 Tbd from first QMR reports Based on closed dataset December 2010 March 2011 X% improvement in process and complete care scores from baseline. 199,000 Based on closed dataset December 2010 March 2011 Graduated payment for % of improvement from baseline Full compliance with pathway specific metrics 15
CQUIN Definitions: Scheme The agreed package of goals and indicators, which in total, if achieved, enables the provider to earn 1.5% of its contract value. Where the provider has multiple contracts, the scheme should be reflected within all contracts, (exceptions specified within guidance). Goal A description of the intended objective which is being incentivised by the CQUIN scheme eg. to improve patient satisfaction within maternity clinics, or to improve the health of the population by delivering effective stop smoking advice to smokers and ensuring referral pathways to the local NHS Stop Smoking Services. A goal may be measured using several indicators (see below). Indicator A measure which determines whether the goal or an element of the goal has been achieved, and on the basis of which payment is made. The achievement of one indicator should not be dependent on the achievement of a separate indicator within the scheme. Payment threshold The level of performance against the indicator which must be achieved to earn payment. This should be informed by available evidence, (eg. a NICE Quality Standard, a National Service Framework or benchmarking) and by the provider s own baseline. Where a baseline needs to be set in-year, the payment threshold may also need to be confirmed in-year. In addition to the final indicator value, it may also be appropriate to agree payment thresholds for a) partial achievement of the indicator and/or b) in-year milestones. However any locally agreed rules should comply with the national policy on rewarding measurement through CQUIN schemes; acute schemes cannot reward measurement in 2010/11, hence any payments for in-year milestones should reward real process or outcome improvements only. 16