National Clinical Audit & Patient Outcome Programme: An update Jenny Mooney Director of Operations www.hqip.org.uk
Healthcare Quality Improvement Partnership
Our structure and funding
The National Clinical Audit & Patient Outcome Programme (NCAPOP) National Clinical Audit Programme 34 national audits covering: Acute Cancer Children and Women's Health Heart Long-term Conditions Mental Health Older People Other National Programmes National Learning Disability Mortality Review Programme National Case Record Review Programme National Perinatal Mortality Review Programme Child Death Database Project National Joint Registry Collects joint replacement information, monitoring implant, hospital and surgeon performance: Clinical Outcome Review Programmes 4 national programmes: Maternal, Newborn and Infant Medical & Surgical Mental Health Child Health Programme
Adult Cardiac Intervention Adult Cardiac Surgery Cardiac Ambulance & MINAP Cardiac Rhythm Management Heart Failure Congenital Heart Disease Sentinel Stroke Vascular Registry Bowel Cancer Head and Neck Cancer Lung Cancer Cancer OGC Prostate Cancer Breast Cancer Care Asthma End of Life Care KEY Women and Children Mental Health Cancer Long term conditions Acute Cardiovascular Domain 1 Dementia Anxiety & Depression Domain 2 Psychosis Mental Health CORP Diabetes (Adult) Inflammatory Bowel Disease Chronic Obstructive Pulmonary Disease Chronic Kidney Disease in Primary Care Rheumatoid and Early Inflammatory Arthritis National Ophthalmology Database National STI Management with Healthcare for Adults with HIV Diabetes (Paediatric) Neonatal Domain 3 Paediatric Intensive Care Epilepsy 12 Maternity & Perinatal Audit Maternal & Newborn CORP Child Health CORP CDOPS Database Specialist Rehabilitation for Patients with Complex Needs Falls & Fragility Fracture Audit Programme Emergency Laparotomy Medical & Surgical CORP
Role of NCAPOP Team Schedule and manage all commissioning and performance management activity relating to the national programme Specification development Procurement Performance Contract Management Managing requests for new topics
Colour code Spec development Tender launched Procurement underway Contract award Extension Project Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 RCCR Lot 2 (re-tender) DH Maternal & Perinatal Mortality Review Programme Psychosis Anxiety & Depression Diabetes: Adult & Paed NICOR Chronic Kidney Disease Dementia Bowel Cancer Child Health CORP Falls & Fragility Fracture Audit Sentinel Stroke HIV End of Life Emergency Laparotomy (NELA) Rheumatoid Arthritis National Vascular Registry COPD Prostate Cancer Lung Cancer Medical & Surgical CORP Mental Health CORP Opthamology Specialist rehab OGC Learning Disability CORP Asthma Maternal and Child Health Framework Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Framework Communication Framework launched Procurement underway Contract award MNI- CORP mini competition NNAP mini competition PICANET mini competition Epilepsy 12 mini competition Child Death Database MC
The Team
Improving care for patients
Using Audit to understanding the care that is being delivered Care Processes, Type 1 Diabetes Key Finding For people with Type 1 diabetes there is a large variation in care process completion performance between CCGs or LHBs. Figure 5: The range of CCG/LHB care process completion for people with Type 1 diabetes in England and Wales, 2014-15 Care process HbA1c Blood pressure Cholesterol Serum creatinine Urine albumin Foot surveillance BMI Smoking All eight care processes 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of patients 3. Please see full list of footnotes in the definitions and footnote section (page 36) 10
Understanding variation BMI measurement fell in 2013-14 and urine albumin checks dropped in 2014-15. These changes may reflect retirement of the respective QOF indicators and a consequent change in focus for GP practices. Care process completion rates still vary appreciably between localities, between practices within localities, between Type 1 and Type 2 diabetes and by age. Recommendations: CCGs and LHBs should network and learn about which systems best support high levels of care process delivery Within localities practices should be encouraged to share successful care process delivery systems Commissioners should consider the impact on core diabetes care of changing pay for performance mechanisms such as QOF 11
What needs to improve and how? This slide has been left blank for CCG/LHB or GP Practices to insert CCG/LHB or GP level information from the GP level excel spreadsheet. For example: You may choose to show two contrasting GP practices in your area from the spreadsheet You may want to add here the differences in the processes for the two practices and any improvements made. 12
Audits working in partnership with patients & families What will be done to relieve my pain? What will be done to help me if I have memory problems or become confused? When will I meet a geriatrician to plan my care and rehabilitation? Will I have surgery on my first or second day in hospital? Will a senior surgeon and anaesthetist be in charge of my operation? What will be done to help me if I have difficulty with eating or drinking? How soon after surgery will I get out of bed and start physiotherapy? Will I be able to go home and if so how soon? How will I be kept informed of my progress, so that my family and carers can make arrangements for me when I leave hospital? What will be done to try and reduce my risk of falling in the future? What will be done to see if I need bone strengthening treatment? Will you check up on me after I leave hospital?
Audits working with Best Practice Tariff to help drive improved outcomes for patients Quarter by quarter BPT criteria compliance and BPT achievement: 2010 2013
Driving improvement through Confidential Enquiry Methodology Maternal, Newborn & Infant Clinical Outcome Review Programme 1in 200 births end in a stillbirths. I in 3 stillbirths occurs at term Every day in the UK three families are devastated by the death of their baby before labour.
Supporting Audit Reports 1. Audiences People who deliver care People who receive care People who commission care People who assure/regulate care 2. Scheduling 3. Language and tone 4. Report structure 5. Communications planning 6. Dissemination
National Emergency Laparotomy Audit Full Report: Standards Findings Audit Questions Specific Recommendations Best Practice Patient Story
National Neonatal Audit NNAP audit measure: Do all babies <1501g or a gestational age of <32 weeks at birth undergo the first Retinopathy of Prematurity (ROP) screening in accordance with the current guideline recommendations?
Maximising the use of audit data to support quality improvement measures at Trust level and support the CQC regulatory process
Finance Challenges New topics? Step down?
NCAPOP Commissioning for Improvement Dr Yvonne Silove Associate Director, NCAPOP, HQIP www.hqip.org.uk
Commissioning for Improvement a) Topic selection b) Specification development c) Contractual expectations d) Facilitation, guidance and support e) What matters most and where to next?
a) Topic Selection Twice yearly topic prioritisation using NCAPOP Eligibility Criteria: Includes specific review of evidence of: Poor or variable care / outcomes Disease burden Availability of national standards and appropriateness of methodology Professional and patient topic support
b) Specification Development Service commissioners NAGCAE SDM Proposal lead Clinical lead Patient representatives National Quality Improvement and Clinical Audit Network (NQICAN) Policy leads Experts in the clinical area Experts in the relevant methodology Self-nominated experts
Specification development meeting: what is discussed? Included patient groups Excluded patient groups Risks Audit elements Methodology Relevant policies and quality drivers Cost / benefit SDM Data collection burden Data linkage and sharing Quality improvement Current landscape Stakeholder needs
Specification development meeting: what is discussed? Included patient groups Excluded patient groups Risks Audit elements Methodology Relevant policies and quality drivers Cost / benefit SDM Data collection burden Data linkage and sharing Quality improvement Current landscape Stakeholder needs
Commissioners meeting Review of discussions at SDM Benefits, risks, local burden NAGCAE Additional information required? Agreement of commissioning brief
c) Contractual expectations Clinical leadership and patient engagement Improvement led design Data entry burden and duplication of effort Robust, focussed analysis Timely reporting for all audiences
d) Facilitation, guidance and support NCAPOP seminars Several times each year Talks and workshops linking NCAPOP methodology to impactful reporting March 2016 Maximising the impact of audit reports Ad Hoc: sharing best practice, linking projects with similar reporting challenges etc.
AUDIENCE d) Facilitation, guidance and support Reporting for Impact and Pre-publication report review FINDINGS RECOMMENDATIONS
e) What matters most and where to next? Timely Clear (in derivation and reporting) Show results over time and against standards Easily accessible and digestible Actionable And increasingly Interactive / customisable reporting Infographics and patient narratives Accompanied by toolkits, templates and other resources Engaging Clinicians in Quality Improvement through National Clinical Audit Dominique Allwood, ISL, Oct 2014
e) What matters most and where to next? How big is best? Clarity of message, vs. sensitivity and detail to guide improvement Time- limited vs continual? Is there still a role for intermittent data collection for national audits? When to report? More timely or wait for definitive outcomes? The best report format? Role for a more uniform output do we know yet what that should be?
e) What matters most and where to next? Limited research evidence to date AFFINITIE: The development and evaluation of enhanced audit and feedback interventions to increase the uptake of evidence-based transfusion practice (2013-18, U of Leeds, NIHR funded) Current research calls: NIHR: Improving the outputs of National Clinical Audits to support organisations to improve the quality of care and clinical outcomes MRC Highlight Notice: Using multiple audits to look at a provider s overall performance.
Thank you Jenny.Mooney@Hqip.org.uk Yvonne.Silove@Hqip.org.uk