Effective information and learning from data the East London Approach

Transcription

1 Effective information and learning from data the East London Approach Dr Kambiz Boomla GP and Clinical Senior Lecturer Queen Mary University of London and Clinical IT lead for east London CCGs Dr John Robson and Dr Sally Hull, Readers

2 Our learning health system RAG chart showing practice current performance Consultant diabetologist Guideline

3 Welcome to East London

4 East London Diabetes belt Hackney Waltham Forest Redbridge 1 in 20 have T2 diabetes Tower Hamlets Newham Barking

5 Good ordinary earnings Whats new? Lowest class vicious semi- criminal Very poor, casual. Chronic want

6 NHS Tower Hamlets networks Where we are today Male life expectancy Japan UK United Kingdom USA Albania East India Tower Hamlets Iraq

7 National QOF Performance no exceptions. 2014/15 C&H 1 st BP Target CHD, stroke, PAD 1 st CKD BP 3 rd Hyptn 1 st AF anticoagulated (with exceptions) 1 st COPD x spiro;mrc;fev1 1 st Asthma review 1 st Diabetes exam; 2 nd Diabetes education; 3 rd Diabetes BP; 4 th Diabetes cholesterol 2 nd Dementia review Tower Hamlets 1 st Hyptn BP target; 1 st BP recorded in people >45 yrs 1 st Diab BP 2 nd CHD BP target 1 st Diab cholesterol 3 rd COPD spirometry Newham 3 rd BP recorded >45 years; 3 rd Diab Eductn 5 th Asthma review 6 th DM BP 9 th Diab exam Source: 204/15 QOF data

8 Diabetes QOF BP control % <145/85 to 2011 and <150/90 after (no exceptions) 95 % /85 150/90 England London TH NH CH 55

9 90 % Diabetes QOF cholesterol <5mmol/l No exceptions 85 % Cholesterol<5mmol/l England London TH NH CH 50

10 100 % CHD Cholesterol <5mmol/l QOF No exceptions Eng Lond TH H N 55 50

11 100 % CHD with BP<150/90mmHg QOF No exceptions Eng Lond TH H N 75

12 160 Male Acute MI DSR mortality/ DSR mortality/ England Inner London Hackney Newham Tower Hamlets

13 CHD % BP <150/90mmHg Practice IMD scores practice 2014/15 QOF data % % CHD with BP <150/90mmHg without exceptions QOF 2014/15 CCGs in England Cd Tower Hamlets WF I Hg Enf Liverpool Sandwell Manchester City & Hackney Newham Bradford City Deprivation score

14 85 % % Diabetes BP <140/80mmHg QOF 2014/15 no exceptions. CCGS in England % Diabetes BP <140/ Stafford Slough C E WF I B&D HG C Manch THamlets Liverpool Sandwell N Manch C&Hackney Newham Bradford Cty 60 Practice IMD scores practice 2014/15 QOF data IMD Deprivation score

15 90 % % COPD with FEV1 in 12m QOF 2014/15 CCGs in England 85 C&H WF T Hamlets Newham 70 N Manchester 65 Liverpool IMD deprivation score

16 Hypertension: best control in England at lowest cost TH WF Source:

17 MMR2 by age 5 years 2013/14

18 Flu vaccination 1 st and 2 nd best in London. In 2011/12 Newham 18/31 THamlets 9/31

19 x

20 Achieving Successful improvement

21 Single systems for IT Web enabled Central (& local) IT search and analysis capability Locally engineered and responsive CCG, GP provider and public health facing (Academically supported)

22 Brain and spinal cord Clinically led Facilitators connect KPIs to practice implementation Iterative work connecting analysts/facilitators/clinicians with CCGs/practices/public health Choose wisely

23 3 ducks in a row

24 Belief Act Motivate Evidence Stakeholders Consensus Guidance and KPIs Education IT support On screen prompts Script switch Trigger tools Patient recall and review lists Financial targets Dashboards Peer performance

25 Stakeholder consensus and guideline

26 Dashboards: near real time

27

28 Dashboard

29 Treatment for AF CHADSVASC 1 C&Hackney, Newham and Tower Hamlets CCGs NO EXCEPTIONS (n~4200) Pulse checks 65+ in 5yrs = 80% 80% 70% % on anticoagulants 69.7% 60% 50% 50.8% 40% 30% 38.9% % on antiplatelet Could do better 20% 10% 0% 10.3% % on neither 18.6% 11.7%

30 AF at Dec C&Hackney Newham and Tower Hamlets- no exceptions 90% 80% Pulse checks 65yrs in 5yrs 75% Pulse check 65yrs comorbid 1 yr 40% 40% 2013 Dec 2015 Anticoagulation CHADSVASC 1+ Antiplatelet CHADSVASC 1+ 75% 25% 65% 15%

31 Funnel plots showing improvement Tower Hamlets

32

33 Choose wisely SAFE NSAIDS, hypoglyaemia T2D 65yrs= 9% EFFECTIVE AF anticg, hypertensn, h/i statins EFFICIENT SMBG, LFTs, LAA insulin, antibiotic

34 A learning health system 2008 Diabetes Imms CVD COPD bottom quartile performance 4 yrs top in UK and London

35 Next steps for a learning health system People Trusted East London Responsive Health systems Data service Data Service 3 rd party uses Social services Effective

36 Commissioner provider patient Quarterly reports Historical reports Interactive Dashboards Record views Predictive scores Clinical Decision support Clinical data exchange Patient connected aps

37 EMIS CERNER Social Services HSCIC

38

39 Our Data Service (popn~2m) clinical driven but offering third party access Near real time reporting Outcomes relate to process bleeding in NOACs vs warfarin - hip replacement failure - safety hypoglycaemia; renal function Efficiency no duplicate tests Predictive scores Decision support Research Patient connection Social services, OOH, 111 etc.

40 East London Shared Record- Progress & Emerging Benefits HIE Upgrade v12 #CollectShareUse

41 Dataservice

42 What is Discovery? Gets all our data into one place, but under our local control as local clinicians and patients Joins it all up With patient consent, feeds it back into clinical systems Supplier neutral data not managed by EMIS, Cerner etc, but by us Open source software, so cheaper than commercial packages Managed by an NHS community interest company of local practices, NHS organisations and patients Funded by Endeavour Healthcare Charity (approx. 4m, and small contributions 75k from CCGs etc)

43 Benefits Unscheduled care Patients can access unscheduled care from a variety of services including network or locality hubs, GP out of hour s services, walk in centers and Accident & Emergency Departments. An integrated data service would analyse individual patient journeys through the entire health system, segmenting patients into categories in order to match evidenced based interventions that can favorably alter patterns of behavior or medical interventions.

44 Benefits Chronic Kidney Disease Population interventions which delay progression to CKD stages 4 & 5 are key to reducing the progressive rise in dialysis accruals. Combining laboratory data from primary and secondary care would enable population tracking to ensure diagnostic coding and support prompts to enable the effective primary care management of early CKD.

45 Benefits Gestational Diabetes Gestational diabetes is recorded as a problem in the hospital records. It is recognised that a proportion of these women will develop Type 2 diabetes related to weight gain or subsequent pregnancies. At CEG, we showed that only 50% of these data items are transferred to GP clinical systems. Consequently inadequate follow up occurs in general practice. A data service with population health analytics would ensure that these women are tracked and provided with high quality pre- diabetes and diabetes care These IT processes go hand in hand with transformation in the social organisation of care in both primary and secondary care settings, placing unprecedented information at the clinical coal face with potential for better patient self- monitoring and engagement.

46 Benefits Atrial fibrillation While the pathway can be described in detail the primary care, systems are unable to link the individual patient journey from anticoagulation to adverse outcome in terms of stroke or bleeds. (This functionality is simply not possible even in bespoke national registers such as the Sentinel Stroke National Audit Programme SSNAP). By linking the primary and secondary care pathway, this enables individual linkage of process and outcome data. This can use routinely collected data to show how many people on anticoagulants have a stroke or bleed which will inform risk profiles and optimal drug prescription.

47 May the ducks be with you