HEALTHCARE QUALITY IMPACT ASSESSMENT FOR SERVICE REDESIGN TEMPLATE How will the project achieve this health impact? What is the evidence base for this? Is it possible to define the improved health outcome for the patient Are there key dependencies in achieving the health impact? What measures of health impact could be used? INDIRECT HEALTH IMPACTS Safer condition or age, will receive a specialist initial assessment and be treated accordingly. Formal specialist clinical assessments undertaken; patients will require and receive a diagnosis; patients receive appropriate equipment (cylinder, concentrator, etc.) For example, Type 2 respiratory failure and smokers: There is clinical evidence that O2 carries a risk for some patients (i.e. smokers). Smokers may not be prescribed O2 but will be offered smoking cessation therapy in the first instance. Reduction of risk for certain patients (Type 2, respiratory failure patients). Confirmed diagnosis. Accuracy of diagnosis. Local measurement of patients who have an O2 alert card (patients for whom O2 can be dangerous at certain levels). Safety of Type 2 (respiratory failure) patients (clinical safety improvements). All patients will receive a similar (i.e. consistent) standard of service in relation to clinical follow-up and review. ScotPHN report; QIS COPD Oxygen Standard. Patient getting a dedicated assessment and receiving visits by a respiratory nurse specialist to assess condition, appropriateness of diagnosis (i.e. Respiratory nurse specialist capacity on a Health Board level; unknown amount of additional specialist time needed. Number of respiratory nurse lists. Health Boards would have to provide data per NAG Guidelines (i.e.
opportunity for wider health improvements). Proper correction of patient hypoxaemia. local audit trail). It is known that there is no standard risk assessment used by Community Pharmacy and firebreaks are not used. There is no standardisation of educational materials. It is anticipated that there will be fewer serious fire incidents in patients homes. Patients will be better educated and will therefore be better placed to understand risks and how to prevent them. All Health Boards must assess and diagnose their pharmacy cylinder patients so that these patients can then be migrated to the new service. Education to required standard is part of NSS national contract. Fewer serious fire incidents. Fewer patients changing oxygen regulators (thereby reducing the fire/explosion risk associated with changing regulators). More effective Better access to portable O2 condition or age, will receive a specialist initial assessment and be treated accordingly. The HomeFill trial, ScotPHN report, identification of under-provision of portable oxygen, and general feedback from patients. NAG (National Advisory Group for Respiratory MCNs Managed Clinical Networks) Guidance. ScotPHN report. Better compliance with LTOT prescription and associated health benefits. Less patients receiving inappropriate diagnosis and treatment. Appropriate use of LTOT in COPD improves survival, improves sleep, improves exercise capacity; reduces Availability of HomeFill systems, Health Board compliance with Home Oxygen Service Project, and patient cooperation. All health care professionals need to recognise their responsibilities/roles. Number of HomeFill is increased and portable oxygen is increased as well. Increased patients through assessment for LTOT service; overall decrease of O2. Decrease of
unneccesary hospital admissions. SBOT. HFS HomeFill trial (document currently in draft form). Single national contract in place, providing same level of service across Scotland Patients have greater mobility as a result of increased portable O2 supply. Patients better able to receive the maximum benefit from their oxygen prescription through compliance with their prescription. (plus all other benefits associated with LTOT in COPD) All health care professionals need to recognise their responsibilities/roles. Effective operation of the national contract (training and education of engineers; ongoing monitoring of service by HFS). Monitor the rollout of portable oxygen modalities. HFS trial (document currently in draft form). Ad hoc face-to-face visits by HFS of patients, joint visits of patients by HFS with respiratory nurses. HFS monitoring of modality numbers in use More efficient condition or age, will receive a specialist initial assessment and be treated accordingly. NAG (National Advisory Group for Respiratory MCNs Managed Clinical Networks) Guidance. Less patients receiving inappropriate diagnosis and treatment. Appropriate use of LTOT in COPD improves survival, improves sleep, improves exercise All health care professionals need to recognise their responsibilities/roles. Implementation and adoption of NAG guidance Increased patients through assessment for LTOT service; overall decrease of O2. Decrease of
capacity; reduces unneccesary hospital admissions. SBOT. More equitable condition or age or geographical location, will receive a specialist initial assessment and be treated accordingly. Approval by NHS Directors of Finance Oxygen Sub-Group. Board papers produced and agreed. HomeFill: less need for transportation and logistics; patients in charge of their own oxygen supply. Subject to service standards within the National Contract from sole supplier. Subject to internal and external audit. Right treatment, right time, by the right person and delivered by the right person. Able to make more HomeFill available; therefore patients more mobile. Oxygen conservers conserve gas and enable patients to use their cylinders for a longer time period. Reduced patient anxiety over cylinder oxygen supplies. Access to specialist respiratory physicians rather than a GP. Increased rural patients being seen by a respiratory consultant. Patients will receive appropriate treatment regardless of age or other considerations. Discouraging GPs from prescribing SBOT, thereby reducing SBOT. Local HBs give guidance/training for GPs across Scotland. NAG Guidelines to be part of training package. Having sufficient time remaining in contract to allow new equipment to be introduced. Dependent on better outreach services so patients can receive O2 at local hospitals, for example. Logistics (applies to Dolby and Health Boards). More capacity for secondary care to deal with more patients. Monitoring the oxygen conservers and HomeFill systems in use. Audit of delivery should be able to prove equity of provision of O2: new service should attempt to demonstrate increased rurality of provision via comparison of old data to new data (before new
service/after new service). More timely condition or age or geographical location, will receive a specialist initial assessment and be treated accordingly. (Less wait times on clinical respiratory specialist assessment to achieve diagnosis.) More people have HomeFill; therefore increase in patient mobility. Monitoring of rollout of new equipment to ensure sensible distribution of available systems, ensuring fair access to services across Boards Today s service vs. future service. Increased provision of oxygen in rural areas. With HomeFill, easier access to oxygen without having to travel long distances. Patients will have better access to engineers and support. Right diagnosis, right treatment, right time, by the right person and delivered by the right person. Service is consistent in both rural and urban areas. It is crucial that the estimated 400 HomeFill systems be enough to meet the demand across the country. (If not, there would be a need to understand the reason behind the increase in demand and to ensure that the appropriate prescribing practies are being adhered to. Additional equipment can be sourced if required.) Ability of local HBs to organise resources/time to perform assessments. Analysis of use of oxygen systems following on from completion of project. Waiting times are lessened. One possible measure may be a step increase in COPD diagnosis.
New service contract stipulates a certain standard that staff will be expected to adhere to. Patients over time will gain greater confidence in the new service which has contractual standards compared to the current provision which may vary from community pharmacist to community pharmacist. Dolby recruit staff across Scotland who are able to deliver on the contract. Cooperation from key sub contractors of Dolby Medical, including BOC Direct feedback from patients to HFS on the service they receive. More person centred condition or age or geographical location, will receive a specialist initial assessment and be treated accordingly. NAG (National Advisory Group for Respiratory MCNs Managed Clinical Networks) Guidance. NICE Guidelines (Natl Institute for Clinical Excellence); QIS Guidelines for COPD; ScotPHN Report This should reduce patient anxiety over oxygen supplies. There is no restriction in supplies that are currently in place through pharmacy. Reduced unnecessary hospital admissions due to prevention of exacerbated symptoms by initial appropriate preventative/anticipatory care. Capacity in secondary care; dependency on cooperation of GPs in referring patients to the service and stop prescribing O2; NAG Guidance to be enforced and locally disseminated by MCNs Increased patients through assessment for LTOT service; overall decrease of O2. Decrease of SBOT. Each patient will have an Right diagnosis, right treatment, right time, by Accurate diagnosis and proper risk Reduced
All patients will receive individual support from contractor 24/7 365 days, have all supplies delivered to their home rather than have to collect them, and generally have better access to supplies. This should enable better compliance with prescription (usually 15 hours per day) by allowing greater flexibility in how oxygen is used. assessment in secondary care based on their individual diagnosis they will then receive a visit by Dolby in their home for an individual risk assessment. ScotPHN report reference to ratio of portable oxygen supplies/static oxygen supplies. 70% in England and Wales and 40% in Scotland. the right person and delivered by the right person. This will lead to reduction in unnecessary hospital. Better compliance with prescription means greater survival, sleep, exercise capacity and reduced hospital admission. assessment. Effective operation of the new contract hospital admissions and GP appointments by oxygen at home. Improvement in ratio of ambulatory/static modality; is likely to improve in Scotland to above 40%.
What health outcomes could the project achieve? How will the project achieve these health outcomes? What is the evidence base for this? Are there key dependencies in achieving the health outcome? What measures of health outcomes could be used? DIRECT HEALTH IMPACT (to be used for direct patient care)
DESCRIPTIONS OF INDIRECT HEALTH IMPACTS - CONTRIBUTIONS TO THE QUALITY OF CARE Safe Effective Efficient Equitable Timely Person centred avoiding injuries to patients from care that is intended to help them; providing an appropriate, clean and safe environment; reducing harm from infectious and environmental hazards providing the most appropriate treatments, interventions, support and services avoiding waste, including waste of equipment, supplies, ideas and energy providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or socio-economic status reducing waits and sometimes harmful and distressing delays for both those who receive care and those who give care providing care that is responsive to individual preferences, needs and values and assuring that patient values guide all clinical/health related decisions