Understanding patient pathways and the impact of emergency admissions in MS & Parkinson s disease Sue Thomas Chief Executive NHiS Commissioning Excellence
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
Top 10 neurological conditions requiring hospital admission (data from 9 Clinical Networks) 600,000 500,000 400,000 300,000 200,000 100,000 - Motor neurone diseasespinal cord injury Migraine CNS infections Hydrocephalus Acquired brain injury Multiple sclerosis Parkinson s Neuropathies Epilepsy Data source NHiS 2014
Neurological Emergency Admissions 2011-2 5 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
Total number of admissions per 1,000 population 2009-2014 Secondary care data is taken from the English Hospital Episode Statistics (HES) database produced by the Health and Social Care Information Centre (HSCIC, www.hscic.gov.uk/hes) Copyright
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, www.hscic.gov.uk/hes) Copyright
Overall costs MS admissions 2013/14 Admission type Total Cost Average cost per admission Non-elective 43,051,255 1,820 All elective 50,433,857 798 Day case 31,578,576 598 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, www.hscic.gov.uk/hes) Copyright
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
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, www.hscic.gov.uk/hes) Copyright
Greater Manchester and Lancashire
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
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
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 1,445 122 1,351 418 279 11% 9% 23% 9% 8% 10% NHS Bury CCG 2,134 879 36 920 298 180 6% 5% 7% 6% 6% 6% NHS Central Manchester CCG 2,247 642 20 638 265 188 6% 4% 4% 4% 5% 7% NHS Heywood, M & R CCG 2,984 1,153 42 1,164 387 232 8% 7% 8% 7% 8% 8% NHS North Manchester CCG 2,630 898 26 937 350 185 7% 6% 5% 6% 7% 6% NHS Oldham CCG 3,040 1,461 43 1,374 465 209 8% 9% 8% 9% 9% 7% NHS Salford CCG 3,304 1,852 7 1,750 507 269 9% 11% 1% 11% 10% 9% NHS South Manchester CCG 2,077 648 17 802 319 143 6% 4% 3% 5% 6% 5% NHS Stockport CCG 3,883 2,212 92 2,174 610 342 11% 14% 17% 14% 12% 12% NHS Tameside and Glossop CCG 3,385 1,703 57 1,261 480 232 9% 11% 11% 8% 10% 8% NHS Trafford CCG 2,822 1,205 31 1,263 354 247 8% 7% 6% 8% 7% 9% NHS Wigan Borough CCG 4,126 2,045 49 1,910 527 384 11% 13% 9% 12% 11% 13% Greater Manchester Total 36,605 16,143 542 15,544 4,980 2,890 100% 100% 100% 100% 100% 100%
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
Richmond gold standard - example
UTI Pathway
Sue Thomas sue.thomas@nhis.com Twitter @Sue_NHiS LinkedIn The MS report is available @ www.nhis.com