Measuring the EIP Standards Michael Watson Improvement Manager Mental Health 17 th November 2016
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 2
Assessing NICE-Concordant Care Using SNOMED
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 4
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 6
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 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! 7
SNOMED Usage 180,000 160,000 SNOMED Procedure Codes August 2016 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 8
SNOMED Issues So Is your system compliant with SNOMED? Is the SNOMED assessment directly linked to the relevant appointment? Have you been trained on how/which codes to use? Is the full list available e.g. Rio? Any other issues? 9
Measuring Activity Clock starts and stops Your Data
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 11
Waiting Times Principles Choice of the time of treatment by the person is important i.e. DNAs and cancellations do not stop the clock 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 Any clock stops without treatment are made in the best clinical interest of the person and are not influenced by the impact of other factors 12
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 13
14 MHSDS
15 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 16
FEP Referrals Received 100 EIP Referrals Received June - August 2016 90 80 70 60 50 40 30 20 10 0 17
FEP Referrals Received 700 EIP Referrals Received June - August 2016 600 500 400 300 200 100 0 18
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 19
20 MHSDS
21 MHSDS
1. Accepted on to the caseload of an EIP service MHS102 Service or Team Type Referred To Care Professional Team Local Identifier = link back to MHS201 Service or Team Type Referred to = A14 Early Intervention Team for Psychosis 22
23 MHSDS
24 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 25
FEP First Contacts 60 First Contacts June - August 2016 50 40 30 20 10 0 26
FEP First Contacts 400 350 First Contacts June - August 2016 300 250 200 150 100 50 0 27
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 28
29 MHSDS
30 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 31
Care Coordinator Allocation 60 Allocated to Care Coordinator June - August 2016 50 40 30 20 10 0 32
Care Coordinator Allocation 180 160 Allocated to Care Coordinator June - August 2016 140 120 100 80 60 40 20 0 33
34 Summary
FEP Patients Treated 60 Patients Treated June - August 2016 50 40 30 20 10 0 35
FEP Patients Treated 180 160 Patients Treated June - August 2016 140 120 100 80 60 40 20 0 36
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 almost no SNOMED data SNOMED data is not reported except through data quality reports 37
Contact Michael Watson Improvement Manager Mental Health M 07879 113 249 E M.Watson@nhs.net W improvement.nhs.uk Follow us on: Twitter LinkedIn