Developing a minimum Quality Standard for non- routine Audiology services

Transcription

1 Developing a minimum Quality Standard for non- routine Audiology services Routine pathway Complex Blockage Satisfactory outcome Michelle Booth BAA Board Director Publicity, Communications and Conference March 2014

2 Overview BAA Perspective With the introduction of AQP members raised doubts about how patients with more complex needs would be managed by services and where funding would come from BAA Board requested that the BAA Service Quality Committee look at this and prepare a minimum quality standard document to assist services in negotiation with commissioners around complex cases This is ongoing work commenced in October 2013 by Michelle Booth and Laura Turton Will be taken forward by Laura Turton (Chair of BAA SQC) and Rosemary Monk (BAA Board Director Service Quality)

3 Introduction What makes a patient complex? Can we pre-empt what might be a complex case? Can a complex case fit into a standard model of care i.e AQP pathway? How do we measure whether we have achieved that standard model and what constitutes a failure? How do we use patient/clinical outcomes to measure failure and when does a patient no longer fit on a routine pathway?

4 Definitions of complex By definition the term complex means: not easy to analyse or understand; complicated or intricate BUT What does it mean in relation to patient care and more specifically Audiology?...

5 How do we define a complex hearing need? NOHL Dementia or Memory problems Ski Slope HL Unilateral HL Poor outcome measures Severe/Profound HL Requires frequent Follow ups Learning Disability Fluctuating Hearing loss NOHL APD Additional Sensory Impairment Neurological disorder Mixed/Conductive HL Poor speech discrimination

6 IQIPS definitions 'complex audiology services' or 'complex hearing services' is defined as being anything outside of routine adult hearing care pathways for age-related hearing loss which make up the vast majority of AQP pathways. Whereas 'complex needs' relates to the patient - either those with complex hearing/balance needs (e.g. outside of the above pathways) OR patients with co morbid hearing difficulties and other health needs together. Most of these will be seen by a 'complex audiology service'.

7 AQP guidance Does make a vague attempt to differentiate between complex and non-complex patients Excludes those patients with potential conditions that require ENT assessment However: What about those patients who would not routinely be excluded due to the contraindications specified, but may have complex hearing needs. How would /could a referring GP recognise this and ensure the patient is referred appropriately? Can, in fact, the GP be an appropriate gatekeeper?

8 Risks of AQP for those patients with complex needs These patients may not necessarily be excluded due to prescriptive guidelines and referral procedures These patients may not get an optimum service via an AQP pathway Is there provision for these patients to move from an AQP routine pathway if they are identified to require specialist support?

9 Tariff The AQP pathway includes: Assessment Fitting of 1 or 2 hearing aids Follow up Aftercare 3 years 3 rd year review BUT Where is provision for multiple F/Us, hearing therapy, further rehabilitation, etc.. If such patients are left on an AQP pathway, providers will not receive the necessary income to support long term management of these patients and the appropriate care/level of support will not be provided

10 Clinical Outcomes The AQP service specification requires the use of the GHABP/ COSI/IOI-HA patient outcome measures as preferred outcome measures to assess the effectiveness of the intervention What constitutes a failure? The AQP specification requires measurements against: reduced social isolation and consequent mental health Improved quality of life However the quality requirement is: 90% of patients show improvement in GHABP/COSI/IOI-HA outcome measures There is no financial consequence for not achieving this requirement and what constitutes an improvement? Who will police compliance??

11 Possible recommendations. Do we require standard outcome measures across all providers? Can we determine a definition of failure in terms of the AQP pathway and determine how outcome measures can be effectively used to measure failure Can we develop a complex needs pathway with national guidelines, referral criteria and a national tariff?

12 Thank you for listening Anyone who wishes to contribute to BAA s work around the minimum standard document should contact either myself, Laura Turton or Rosemary Monk on the s below: michellebooth1@hotmail.com laura.turton@hearinglink.org r.d.monk@aston.ac.uk