Western NSW Medicare Local Quality Health Information Program May 2015 Stephen Jackson interim WML CEO Stephen Mann interim Exec. Mgr of Primary Care WNSW PHN
STEPHEN JACKSON What WNSW did well & what we needed to do better (1) HOW QHIP CAME ABOUT
WNSW Barriers Environment Distance Limited bandwidth & availability General Practices Small practices Stretched support Low IT skills Old equipment Distances
National, LHD & ML Population Data
Regional Measures of Clinical Quality? Goal 1 Goal 2 Goal 3 Goal 4 Goal 5 Indicator Childhood immunisations 8mths old - High needs Childhood immunisatoins 8mths old - Total population Childhood Immunisations 24 mths old - High needs Childhood Immunisations 24 mths old - total population Fluc vacc >=65 yrs - high needs Fluc vacc >=65 yrs - total population Fluc vacc <=65 yrs - Diabetes high needs Fluc vacc <=65 yrs - Diabetes - total population Cervical smear within 3 years - high needs Cervical smear within 3 years - total population Smoking status coded - High needs Smoking status coded - Total population Smoking given brief advice - high needs Smoking given brief advice - total population Smokers referred to cessation - high needs Smokers referred to cessation - total population HbA1c=<64 mmol/mol - high needs HbA1c=<64 mmol/mol - total population Microalbuminuria and ACEI/ARB - High needs Microalbuminuria and ACEI/ARB - total population CVRA >=20% and Statin - High needs CVRA >=20% and Statin - total population CVRA >=20% and BP<= 130/80 - high needs CVRA >=20% and BP<= 130/80 - total population Diabetes Management - High needs Diabetes Management - Total population CVRA within last 5 years - High needs CVRA within last 5 years - total population
How QHIP works now in WNSW (2) PROGRAM OVERVIEW
Program Objectives Form a database of GP data for the region Initially de-identified & aggregated Then identified Finally identified and data matched with hospital et al data & analysed for unwarranted variation Analysis and reporting both to GPs and LHD for planning, forecasting, and identification of key indicators.
What is QHIP 1. A process to aggregate patient data For planning & systems oversight / redesign For academic research and evaluation 2. A program for improving clinical and operational systems Focus on data quality & clinical/business risk mgmt Aligns regional ML practice support with local clinical leadership & benchmarked quality goals A platform to reorient episodic process funding into a continuum of care outcomes focus
How does it work? WML provides Pen CAT & qiconnect Eg: WNSW ICS demonstrator sites use the tools for the risk stratification of their practice populations, clinical data cleaning, and for evaluation University of Sydney to develop the DROP project to assist clinicians manage the 8 in 10 obese/overweight patients they see
qiconnect QAIHC-807 No waist Measurement 0.99 0.99 0.99 0.99 0.99 0.98 QAIHC-808 Waist Recorded 0.01 0.01 0.01 0.01 0.01 0.02 QAIHC-809 (a) 80cm - 88cm 0.09 0.08 0.09 0.08 0.07 0.12 QAIHC-810 (b) > 88cm 0.91 0.92 0.82 0.77 0.79 0.65 QAIHC-811 Male Total 774 761 751 730 726 718 QAIHC-812 Height and/or Weight Not Recorded QAIHC-813 Height and Weight Recorded 0.88 0.88 0.86 0.82 0.81 0.8 0.12 0.12 0.14 0.18 0.19 0.2 QAIHC-814 (a) < 20 0.08 0.08 0.07 0.06 0.05 0.05 QAIHC-815 (b) 20-25 0.13 0.12 0.13 0.15 0.15 0.16 QAIHC-816 (c) 25-30 0.27 0.27 0.3 0.32 0.33 0.33 QAIHC-817 (d) > 30 0.52 0.53 0.5 0.48 0.47 0.46 QAIHC-818 Female Total 1179 1170 1161 1158 1133 1130 QAIHC-819 Height and/or Weight Not Recorded QAIHC-820 Height and Weight Recorded 0.88 0.87 0.86 0.84 0.83 0.82 0.12 0.13 0.14 0.16 0.17 0.18 QAIHC-821 (a) < 20 0.06 0.07 0.07 0.08 0.08 0.08 QAIHC-822 (b) 20-25 0.17 0.18 0.17 0.17 0.18 0.21 QAIHC-823 (c) 25-30 0.27 0.27 0.28 0.28 0.27 0.25 QAIHC-824 (d) > 30 0.49 0.48 0.48 0.47 0.47 0.48 QAIHC-901 Male Total 774 761 751 730 726 718
Pen CAT
How does it work? Practice X Practice Y Practice/AMS (PENCAT) De-identified data QI Portal Health Intelligence Unit Consolidated WML and LHD population health data for service planning and analysis (Work-in-progress) Practice or GP specific De-identified profile Benchmarking WNSW LHD & the two MLs have supported the development of a shared HIU that will start to develop joined-up analysis and joint strategic development De-identified GP/practice profile benchmarked against others in WML
STEPHEN MANN How QHIP & the PHN can support WNSW data/systems (3) PHN DEVELOPMENT
Primary Health Information GP INFORMATION FLOW STATE & NATIONAL INFORMATION FLOW ARGUS CdmNet Care Plans MBS Episodic Care Practice Mgmt Systems Health-e-Net PenCAT GRHANITE CQI Canning Tool PCEHR Local utility: Useful set of GP KPIs/measures collected & reported (for local CQI and linked regionally and nationally for planning and population monitoring) Regional innovation flexible design & commissioning to improve KPIs & quality National accountability innovative delivery & accountable improvement
Clinical Variation The Kings Fund (2011)
Enablers for Primary Care
Data & Improvement
WNSW Joint Development
Improved Outcomes
QHIP & Service/System Integration Health in all policies + coherence of subsystem functions enterprise-wide How and where organisations/ providers are brought together Non-clinical support & back office functions to support integrated care Multi-professional teams/networks with the right skill-mix Care from a range of providers that is integrated into a coherent process / KPI s Personal integration Bio-psycho-social approach starting from needs of service users Adapted from Pim Valentijn et al (2013)
PHN Collaborative Activities PHN Data, Practice Support & Commissioning Triple Aim PATIENT EXPERIENCE COST /QUAL. COVERAGE/ EQUITY Three Levels QHIP PHN HIU / DoH QHIP /CdmNet PHN HIU / DoH LLG PHN HIU / DoH LLG Local Leadership Group Research Partnerships CO-COMMISSIONING Outcomes, Value/Quality & Accountability
Philosophy of Kaiser Permanente: Unplanned hospital admissions are a sign of system failure Ham, C. (2006), Developing Integrated Care in the NHS: adapting lessons from Kaiser, Health Services Management Centre, Birmingham University
Questions?