Atrial Fibrillation Collaborative. Thursday 7 May 2015

Transcription

1 Atrial Fibrillation Collaborative Thursday 7 May 2015

2 Welcome and introductions Peter Carpenter KSS AHSN

3 Nicky Jonas SEC CVD SCN AF Project Support

4 KSS Academic Health Science Network & South East Cardiovascular Strategic Clinical Network ATRIAL FIBRILLATION COLLABORATIVE Nicky Jonas 7 th May 2015

5 Why Atrial Fibrillation? SE CVD SCN established in 2013 Baseline needs assessments conducted to establish priority areas Why was atrial fibrillation chosen? SCN Cardiac Clinical Director appointed Adam Jacques Project Support appointed: Liz Davis then me! AF task and finish group established: first meeting May 2014 NICE CD180. Management of Atrial fibrillation published June 2014 Partnership working with ASHN agreed in early 2015 First ASHN/SCN Collaborative - today

6 What are we aiming for? Greater number of SE population detected with AF Increase in the number of patients anticoagulated following CHA2DSVasc assessment Reduction in (hospital admission of) AF strokes Reduction in readmissions of AF strokes Reduction in death as a result of AF stroke (The AF project will develop a monitoring tool using data from various national sources to monitor changes across SE)

7 How the SCN AF Project has supported implementation of NICE 180 Develop primary and secondary care atrial fibrillation pathways Produce a best practice model for earlier detection and management of AF Provide guidance and quality/outcome standards for CCG Commissioners Provide costs/costing model for SE CCGs for the implementation of NICE AF guidance Promote the use of the GRASP AF tool Exploration with AHSN on how to improve anticoagulation in secondary care and through to primary care Project overseen by Task to Finish Group

8 Primary care atrial fibrillation pathway

9 Secondary care anticoagulation in atrial fibrillation pathway

10 Provide guidance and quality/outcome standards for CCG Commissioners Information packs QOF and AF stroke data Infographics GRASP AF data Commissioners Forum Top Commissioning tips drafted AF dashboard

11 AF dashboard

12 Provide costs/costing model for SE CCGs for the implementation of NICE AF guidance Produced at a national level by NHSIQ Produce a best practice model for earlier detection and management of AF AF pathways Earlier detection model not started

13 SE CVD SCN and AHSN working together AHSN Innovation Clinical networks Expertise in EQR programmes SCN Networks: patients, commissioners, PHE, LA, and voluntary sector Lead complex whole system change Improve quality and outcomes for commissioners

14 Atrial Fibrillation Collaborative Representation from provider clinicians, commissioners, public health, patient, carer and third sector members Kent, Surrey and Sussex It will act as a clinical group to develop and oversee plans for the Atrial Fibrillation (AF) Project and monitor progress.

15 AHSN/SE Collaborative Workstreams Improving anticoagulation and discharge planning in secondary care : considering an EQ pathway Improving anticoagulation of people in atrial fibrillation in primary care: considering partnership working with the pharmaceutical industry

16 Future work for the Collaborative Health Foundation Grant Application accepted for second round???

17 Get in touch South East Strategic Clinical Networks Academic Health Science Network

18 Dr Adam Jacques SCN & AHSN AF Clinical Lead

19 Dr Richard Blakey Primary Care Heart Failure Lead, Enhancing Quality Lead for KSS

20 Introducing a new EQ Pathway Dr Richard Blakey EQ Heart Failure lead for primary care KSS AHSN GPwSI Cardiology ESH NHS Trust / EHSCCG HWLHCCG CVD and Renal Lead EHS CCG GP

21 Why Do we need Quality Improvement? Patient Safety Reducing/eliminating avoidable harm Patient Centred Care Expectations to give the best treatment there is Innovation Keeping pace with healthcare advances in knowledge and treatment

22 Who should improve quality? No single majority organisation A coalition of the willing: Primary Care Community Care Secondary Care Commissioners Third sector organisations Industry Patients

23 What is Enhancing Quality? Clinically effective pathway delivering return on investment Patient Reported Outcome The best Patient journey Clinical Indicator Patient Experience A Clinical Change Programme

24 EQ AIM Transformational vehicle delivering Quality Assurance - commissioning and delivering excellent care every patient every time Clinical culture shift into sustainable quality improvement and pathway change Improving Outcomes

25 Lighting the clinical torch - Whole system / whole pathway Collaborative learning Improving Care / focus on my service Executive buy-in Competition / benchmarking confidence in apples to apples Repeated measurement Reliable clinically valid data Clinical Evidence

26 EQ EQ E Q E Q E Q E Q E Q Overarching Indicators E Q E Q Improvement areas E Q E Q

27 Heart Attack Pneumonia Hip and Knee Dementia Heart Failure whole pathway AKI

28 What do you need for an EQ pathway? A condition / pathway / technique that could be improved A measure of current quality Treatment / process that can lead to improvement A way to measure the improvement A mechanism to share and learn collaboratively An incentive for improvement or disincentive for lack of improvement A clinical lead across the region and at local level (trsut / CCG)

29 Kent Surrey Sussex Academic Health Science Network Enhancing Quality & Recovery (EQR) E Q R EQR: Clinically led, evidence based. Every Patient, Every Time. Monthly Bi-Annually E Q R P R O C E S S Evidence Base Measures Audits Commissioners Benchmark Regular Reports Providers Collaborative learning P R O C E S S CCG Packs CCG Packs CEO Packs NHSE CCGs SCNs

30 HEART FAILURE WHOLE PATHWAY MEASURES Primary/Community Acute Primary/Community Diagnosis Management Personalised Care Plan Diagnosis Prescribing Smoking cessation Discharge information Diagnosis Management Personalised Care Plan End of Life Care Transfer of care Transfer of care OUTCOMES Rapidly diagnosed Reduced morbidity Reduced admissions Improved experience Reduced mortality Reduced LOS Reduced readmissions Reduced complications Improved experience Reduced mortality Reduced morbidity Reduced readmissions Preferred place of care Improved experience

31 Challenges Reducing variation in quality and outcomes (HF mortality 10% - 24%, readmissions 12% - 31%) (PN mortality 18% - 32% los 8 12 days ) Primary Care variation and data Joining up pathways through NHS number

32 Kent Surrey Sussex Academic Health Science Network The process Set-up a Regional Project Team Identify Clinical & Programme leads in each Trust Agreement on denominator population for each pathway Agreement on best practice measures for each pathway Project Team Trust Team Pathways Measures Online data collection Reporting Benchmarking Collaborative Learning Events Peer Reviews Sharing good implementation practices collaboratively between all organisation Website / Forum Reports Spread Learning Supporting Access to Info

33 Variation CCG Natriuretic Peptide GPs Testing Rate Per 1000 / year. GP Testing Rate Per 1000 Normal Low Testing Rate

34 Variation Heart Failure In Primary Care ACE & BB dose-proportion of maximum doses. by surgery v nurses ACE BB SPECIALIST NURSES SURGERY SURGERY SURGERY SURGERY SURGERY SURGERY SURGERY SURGERY SURGERY SURGERY

35 % Atrial Fibrillation % of Population Prevalance - Observed QOF 13/14 vs Expected Source: National Cardiovascular Intelligence Network Kent QOF Surrey QOF Sussex QOF Expected England Expected 2.5 England QOF

36 AF004 - In those patients with atrial fibrillation whose latest record of a CHADS2 score is greater than 1, the percentage of patients who are currently treated with anti-coagulation therapy - QOF 13/ Kent Surrey Sussex KSS England

37 Collaborative Working and Spreading Innovation Steering groups Clinical reference groups Collaborative learning days Working with industry Sharing good practice and results

38 Innovation

39 ASPH DVH FPH MFT RSCH EKHT BSUH WSHT SASH ESHT MTW DVH MFT MTW ESHT WSHT FPH RSCH BSUH SASH EKHT ASPH RSCH FPH MFT DVH MTW EKHT SASH ASPH ESHT BSUH WSHT EKHT ESHT SASH BSUH RSCH ASPH FPH MFT DVH MTW WSHT EKHT ASPH FPH BSUH MTW DVH RSCH WSHT SASH MFT ESHT SEC Median 11/12 - To 11/12 - To Baseline - 10/11 Enhancing Quality Baseline Outcomes Data Heart Failure Calendar or Financial Year Highlight Trust Anonymised SOTC+BSUH Hip&Knee Financial Year - 11/12 - To date Baseline - 10/11 9 Admits / 1000 Trust Admits 30.0% In Hospital Mortality (Crude) 16 Average Length of Stay % 20.0% 15.0% 10.0% 5.0% % 0 2.5% Complications Rate 35.0% 30 Day Readmissions 2.0% 30.0% 25.0% 1.5% 20.0% 1.0% 15.0% 0.5% 10.0% 5.0% 0.0% 0.0%

40 Anonymised 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Appropriate Care Score (ACS) Composite Quality Score - (CQS) SEC CQS SEC ACS Sort by CQS? MFT SASH RSCH BSUH DVH AMI Hip&Knee Enhancing Quality Performance Report FPH ASPH ESHT EKHT MTW WSHT FPH EKHT RSCH MFT WSHT SASH BSUH DVH ASPH MTW ESHT Period: Jul To date 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% SASH RSCH BSUH DVH ESHT RSCH FPH WSHT Heart Failure WSHT Pneumonia MFT MTW FPH EKHT ASPH MFT BSUH SASH ASPH ESHT DVH EKHT MTW

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42 Diagnosis

43 AF not confirmed on ECG

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46 Who to refer?

47 Pathway priorities Focus on detection / timely review and anticoagulation What are the best ways to improve detection? Who should be reviewing? How can we ensure it happens? Barriers to implementation? How to improve anticoagulation? Not just rate but quality and safety.

48 AF coalition pledge Our three priorities are: Anticoagulation Anticoagulation Anticoagulation

49 Refreshment break

50 Peter Carpenter Director of Improvement KSS AHSN

51 Group work and discussion

52 Room discussion and feedback

53 Wrap up and close