Using Data to Evidence EIP Service Quality Nick Gitsham and Michael Watson Intensive Support Team Mental Health 2 nd March 2017
Overview 1. Measuring the EIP standards: Data sources NICE-concordant care SNOMED-CT Waiting times Local data 2. Changes to EIP reporting 2
Measuring the EIP Standards
EIP Standards By 1 April 2016, more than 50% of people experiencing a first episode of psychosis will be treated with a NICE-approved care package within two weeks of referral 1. Treatment delivered in accordance with NICE guidelines for psychosis and schizophrenia either in children and young people or in adults 2. A maximum wait of two weeks from referral to treatment Most initial episodes of psychosis occur between early adolescence and age 25 but the standard applies to people of all ages 4
Data sources Mental Health Services Dataset (MHSDS) is the repository: http://content.digital.nhs.uk/mhsds All data is submitted by providers Mental Health Five Year Forward View Dashboard: https://www.england.nhs.uk/mentalhealth/taskforce/imp/mh-dashboard/ 5
NICE-Concordant Care
NICE-Concordant Care NICE clinical guideline 155 (2013) Psychosis and schizophrenia in children and young people NICE quality standard Bipolar Disorder, Psychosis and Schizophrenia in Children and Young People NICE clinical guideline 178 (2014) Psychosis and schizophrenia in adults: treatment and management NICE quality standard Psychosis and schizophrenia in adults It is planned to use Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to assess this 7
NICE-Recommended Treatments Early intervention in psychosis services should aim to provide a full range of pharmacological, psychological, social, occupational and educational interventions for people with psychosis, consistent with this guideline. For people with first episode psychosis offer: oral antipsychotic medication in conjunction with psychological interventions (family intervention and individual CBT) 8
SNOMED CT The most comprehensive and precise clinical healthcare terminology product in the world Allows healthcare observations and interventions to be recorded consistently using a logical structure that supports data analysis better decision making and improvements in care Being implemented across all NHS care settings Interventions and outcome tools should be recorded (by clinicians) in the MHSDS using SNOMED CT codes Assessments, reviews, tests, therapies etc. can all be submitted as a Care Activity using the Coded Procedure item 9
EIP SNOMED Overview NICE Intervention SNOMED-CT description SNOMED-CT ID CBT for psychosis CBT for psychosis 984091000000108 Family intervention Family intervention for psychosis 985451000000105 Antipsychotic medication Medication monitoring 395170001 Physical health interventions and monitoring Assessment of physical health 705139001 Diabetic care 385804009 Weighing patient 39857003 Weight management programme 990121000000104 Cardiovascular therapy 309513005 Combined healthy eating and physical education programme 967251000000101 Referral to smoking cessation service 871661000000106 Supported employment programmes and vocational rehabilitation Educational rehabilitation 183339004 Vocational rehabilitation 70082004 Carer-focused education and support programmes Carer-focused education and support programme 985651000000108 Care Planning Provision of information about psychosis 985681000000102 Mental health care and treatment planning 861361000000109 Substance misuse Substance misuse assessment 777041000000105 Substance use therapy 385989002 10
SNOMED Status No reports using SNOMED codes have yet been produced nationally No precise definition of which codes would stop the clock, or how, has yet been issued But Accurate treatment recording is still clinically important Used for clustering and, in the future, payments Several DQ items to monitor use: MHS-DQM23 shows valid SNOMED procedure codes used MHS-DQM27 shows valid SNOMED finding codes used MHS-DQM30 shows valid SNOMED observation codes used But only shows the number of valid codes, not how many times the codes should have been used! 11
Systems used by providers submitting SNOMED codes to MHSDS ACS Care Notes EPEX Lorenzo Paris RiO Silverlink 12
System Suppliers Provider Bradford District Care Trust Community Links (northern) Ltd Humber NHS Foundation Trust Navigo Nottinghamshire Healthcare NHS Trust Rotherham Doncaster And South Humber NHS Foundation Trust Sheffield Health & Social Care NHS Foundation Trust South West Yorkshire Partnership NHS Foundation Trust Tees, Esk And Wear Valleys NHS Foundation Trust System supplier RiO Paris Lorenzo Silverlink RiO Silverlink Local solution RiO Paris 13
14 SNOMED Usage
15 SNOMED Usage
SNOMED Issues So Is your system compliant with SNOMED? Is the SNOMED assessment directly linked to the relevant appointment? Have staff been trained on how/which codes to use? Is the full list available e.g. RiO? Any other issues? Reference resources and webinars available at: https://digital.nhs.uk/snomed-ct 16
Waiting times Clock starts and stops Your data
Guidance documents https://www.england.nhs.uk/mentalhealth/resources/access-waiting-time/ 18
Waiting Times Principles Choice of the time of treatment by the person is important i.e. DNAs and cancellations do not stop the clock Al patients should be offered a timely appointment Measurements and monitoring of the standards should always keep the experience of the person at the centre Local areas are accountable for the information that they report and submit In addition to tracking compliance against clock stop standards, waiting times for incomplete referral pathways will be monitored both nationally and locally Proportion of people waiting more than two weeks following referral 19
Referral to Treatment All patients should: Have been assessed by the EIP service And, where appropriate: Have been accepted onto the EIP service caseload Have been allocated an EIP care coordinator who has actively engaged with the person to develop a plan of care and commence treatment in line with NICE recommendations 20
Clock Starts Referral received for a person with suspected first episode psychosis (FEP), or is recognised as such upon receipt. The primary reason for referral should be suspected FEP The clock start date is defined as the date referral received Where pathways start with an interface service, the clock start date is the date the interface service receives the referral not the date the referral is passed onto the relevant clinical team. Where a primary reason for referral is not recorded as suspected FEP but this is identified during triage/spa, the clock start date is the date of initial referral If this is not suspected during triage but at a subsequent assessment then the date the clock starts is when suspicion is first raised. If a person is already in the system the clock starts when suspicion of FEP is first raised 21
22 MHSDS
23 MHSDS
Clock Start Data MHS101 Service or Team Referral Primary reason for referral = 01 (Suspected) First Episode Psychosis Referral request received date Only referrals where Primary reason for referral is 01 (Suspected) First Episode Psychosis are included. People could have a co-existing problem and this might be recorded in Table MHS103 as Other Reason for Referral 24
25 FEP Referrals Received CCG
26 FEP Referrals Received Provider
Clock Stops The patient is confirmed as having FEP or suspected FEP following assessment or The patient is confirmed as requiring at risk mental state (ARMS) specialist assessment And NICE-approved package of care starts, this is when the person: 1. has been accepted on to the caseload of an EIP service, AND 2. has had an initial assessment, AND 3. has been allocated to and engaged with an EIP care coordinator 27
28 MHSDS
29 MHSDS
1. Accepted on to the caseload of an EIP service MHS102 Service or Team Type Referred To Care Professional Team Local Identifier = links to MHS201 (Care Contact) Service or Team Type Referred to = A14 Early Intervention Team for Psychosis 30
31 MHSDS
32 MHSDS
2. Initial assessment MHS201 Care Contact Care Professional Team Local Identifier = link to MHS102 Consultation Medium Used = 01:Face to face communication 02:Telephone 03:Telemedicine web camera 04:Talk type for a person unable to speak Attended or did not attend code = 5 Attended on time or, if late, before the relevant professional was ready to see the patient 6 Arrived late, after the relevant professional was ready to see the patient, but was seen 33
34 FEP First Contacts CCG
35 FEP First Contacts Provider
Use of SNOMED for assessment To indicate allocation of a care coordinator and commencement of ARMS assessment table MHS202 Care Professional Team Local Identifier = link to MHS102 Procedure Scheme in Use = 06 SNOMED Coded Procedure = 802551000000107 Mental health risk indicator assessment 36
37 MHSDS
38 MHSDS
3. Allocated to and engaged with an EIP care coordinator The care coordinator actively attempts to form a therapeutic professional relationship with the person and offers treatment to them MHS006 Mental Health Care Coordinator Care Professional Service or Team Type Association (Mental Health) = A14 Early Intervention Team for Psychosis 39
40 Care Coordinator Allocation CCG
41 Care Coordinator Allocation Provider
42 Summary
43 FEP Patients Treated CCG
44 FEP Patients Treated Provider
Key Points Only patients treated in the period are counted, not patients stopped for nontreatment Only patients referred on or after 01/01/2016 are included in waiting times. Unify collection does not exclude these but this should be minimal by now The clock is not affected by patients who cancel and DNA ARMS is only identified after a contact and if a SNOMED code is recorded It is planned to use SNOMED to assess NICE-compliance Currently very little SNOMED data SNOMED data is not reported except through data quality reports 45
Changes in EIP reporting
Unify2 and MHSDS Unify2 submissions extended to June 2017 (submitted in August 2017) MHSDS will be primary source for performance information from April 2017, i.e. data submitted in June 2017 (preliminary) and July 2017 (refresh) Publication month Unify2 data MHSDS data April 2017 February 2017 (Final) January 2017 (Final) February 2017 (Provisional) May 2017 March 2017 (Final) February 2017 (Final) March 2017 (Provisional) June 2017 April 2017 (Final) March 2017 (Final) April 2017 (Provisional) July 2017 May 2017 (Final) April 2017 (Final) May 2017 (Provisional) August 2017 June 2017 (Final) May 2017 (Final) June 2017 (Provisional) September 2017 June 2017 (Final) July 2017 (Provisional) 47
48 Unify2 and MHSDS EIP data Submitted records in MHSDS Submitted EIP records in MHSDS Submitted records to Unify EIP open referrals (31/12/16) - MHSDS 1 EIP open referrals (31/12/16) - Unify EIP entering treatment (01/10/16-31/12/16) - MHSDS 1 EIP entering treatment (01/10/16-31/12/16) - Unify BRADFORD DISTRICT CARE Yes Yes Yes 30 29 80 69 COMMUNITY LINKS (NORTHERN) LTD Yes Yes Yes 20 19 60 50 HUMBER NHS FOUNDATION TRUST Yes Yes Yes 5 6 30 35 NAVIGO Yes Yes Yes 5 4 10 12 NOTTINGHAMSHIRE HEALTHCARE Yes Yes Yes * 13 15 105 ROTHERHAM DONCASTER AND SOUTH HUMBER Yes Yes Yes 35 2 * 124 SHEFFIELD HEALTH & SOCIAL CARE Yes No Yes * 13 * 43 SOUTH WEST YORKSHIRE PARTNERSHIP Yes Yes Yes 25 21 75 79 TEES, ESK AND WEAR VALLEYS Yes Yes Yes 105 90 160 148 1 Figures rounded to nearest 5 * Replaces values 0-4
October December Patients Treated 100% % Patients Treated Who Waited <=2 Weeks 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Sheffield Health & Social Care NHS Foundation Trust Rotherham, Doncaster and South Humber NHS FT Nottinghamshire Healthcare NHS Trust Community Links (northern) Ltd Tees, Esk And Wear Valleys NHS Foundation Trust South West Yorkshire Partnership NHS Foundation Trust Bradford District Care Trust Humber NHS Foundation Trust Navigo 49
Patients Waiting: 31/12/16 100% % Patients Not Yet Treated Who Have Been Waiting <=2 Weeks 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Rotherham, Doncsater and Humber NHS FT Sheffield Health & Social Care NHS Foundation Trust Nottinghamshire Community Links Bradford District Healthcare NHS Trust (northern) Ltd Care Trust South West Yorkshire Partnership NHS Foundation Trust Tees, Esk And Wear Valleys NHS Foundation Trust Humber NHS Foundation Trust Navigo 50
Contact Nick Gitsham Michael Watson Intensive Support Manager Intensive Support Manager M: 07730 376404 M: 07879 113249 E: nick.gitsham@nhs.net E: m.watson@nhs.net Follow us on Twitter @MH_ISTNetwork