Practical Application of a CQUIN Target for Smoking Cessation Referral at Medway Maritime Hospital

Transcription

1 Practical Application of a CQUIN Target for Smoking Cessation Referral at Medway Maritime Hospital Angela Green Project Officer (Tobacco Control) Medway Stop Smoking Service

2 Presentation Overview Provision of smoking cessation services at Medway Hospital The campaign for a CQUIN Target for smoking cessation referral Impact of the CQUIN Target at Medway Hospital Future health promotion work with Medway Hospital

3 Service History Pre-2006: No specialist service available. 2 or 3 referrals a month, mainly from acute cardiology team. Sept 2006: Smokefree Trust Policy Post Sept 2006: Staff Support Service (MSSS) Telephone Support Service (MSSS) Referrals increase to up to 10 per month 2008: Acute Project Officer role developed Introduction of a formal referral system and staff training package 2009: Acute Project Assistant employed staff training ward rounds/patient visits 2010/11: CQUIN!

4 Despite significant developments in the Acute Service since 2006, we knew that uptake of staff training and referral rates were much lower than they should be. We needed a new motivational tool to increase staff engagement with our service, uptake of training and referral rates.cquin!

5 And now for some maths! There were 68,000 adult admissions to MFT in 2008/09 27% smoking prevalence in Medway = 18,360 patients who smoke Research by ASH suggests 70% of smokers would like to quit = 12,852 patients who would like to quit.

6 Uptake of Referral Alcohol intervention study in A&E 35% of patients had accepted referral for help with their addiction. (Dr C. Haynes, Stockport NHS Foundation Trust) Preoperative smoking cessation study in Australia 64% of participants accepted offer of referral to Quitline. (Wolfenden et al, 2007)

7 12,852 Medway In-patients would like to quit smoking.. 35% = 4498 referrals 64% = 8225 referrals! We had actually received approximately 380 referrals from MFT in 2008/09. We went with a conservative estimate of 30% uptake = 3855 referrals. Thousands of patients were not being given the help they needed to quit smoking!

8 Other Considerations MSSS Capacity Current referral activity at MFT Balancing challenge with achievability Origin of patients (70% Medway, 25% EK, 5% WK)

9 The Proposal Medway Foundation Trust should be tasked with referring 600 Medway patients to Medway Stop Smoking Service in 2010/11

10 The Next Steps Proposal and evidence passed to Director of Public Health Proposal negotiated with Medway Foundation Trust along with all other CQUIN proposals from Public Health and Commissioning Teams. Prevention of ill health had been made a priority through Medway s Choosing Health programme, so priority was given to CQUINs supporting this programme. Process was led by Medway PCT Director of Nursing and Quality

11 2010/11 CQUIN Target Description of indicator 8a Number of patients referred to the Stop Smoking Services (Medway, ECK and West Kent providers) during an admission episode. Excludes maternity. Numerator Denominator Rationale for inclusion Data source and frequency of collection 8a Number of patients referred to the Stop Smoking Services (Medway, ECK and West Kent providers) Excludes maternity. 8a Number of patients that smoke that have an inpatient episode. Excludes maternity. Medway has a very high percentage on smokers, which means that approximately 27% of all admissions are smokers. The Stop Smoking Service is a recognised means of supporting patients to give up smoking to reduce likelihood of suffering from long term conditions. Medway NHS Foundation Trust medical notes monthly Organisation responsible for data collection Medway NHS Foundation Trust Frequency of reporting to commissioner Monthly Baseline period / date 2008/09 Estimates indicate that 3855 referrals could have occurred if the service had been offered. Medway PCT Stop Baseline value Smoking Service can manage an additional 600 referrals form the acute Trust at current service levels. Final indicator period / date (on which payment is based) Month / by year end for Medway PCT patients, 240 by year end for Eastern Coastal Kent PCT and other PCT Final indicator value (on which payment is based) patients to be given the same opportunity (as numbers so low) Final indicator reporting date Month /12 Rules for partial achievement of indicator at year-end Rules for any agreed in-year milestones that result in payment Rules for delayed achievement against final indicator period/date and/or in-year milestones

12 Initial Impact What does CQUIN mean to hospital staff? What is CQUIN actually worth? Can a CQUIN Target alone make a difference? Quarter One Data (2009) 100 referrals 45 set a quit date 25 quit Quarter One Data (2010) (CQUIN Target now in operation) 98 referrals 35 set a quit date 19 quit

13 Increasing Referral Rates Additional work was undertaken to increase referrals: Approaching Directorate Senior Management Teams to discuss CQUIN Staff Training (formal & drop-in clinics) Open Days Quarterly Updates (Newsletter + Referral Summary) Designing and producing learning resources Appointed a BTS Smoking Cessation Champion Hospital Intranet Site Hospital Communications Team A CQUIN Target is a motivational tool. It cannot create change without additional work.

14 Results Quarterly Comparison (2010/11) Quarter One: 98 referrals 35 set a quit date 19 quits (19.4%) Quarter Four 183 referrals 58 set a quit date 39 quits (21.3%) Treatment Success Rates: 54.3 % 67.2% Yearly Comparison 2009/ referrals 174 set a quit date 98 quits (25.1%) 2010/ referrals 171 set a quit date 111 quits (22.4%) 2011/12 (Q1 & Q2 only) 485 referrals 138 set a quit date 92 quits (19%) 56.3% 64.9% 66.7%

15 Issues and Problems Making the CQUIN Target relevant to all staff Making smoking cessation relevant to all staff Making smoking cessation intervention a priority Challenging negative attitudes Turnover of hospital staff Creating a sustainable change beyond 2010/11! Quality Control!

16 Enhancing Quality Programme A clinical change programme which triangulates information to drive quality improvements in clinical interventions, patient reported outcomes and patient experience.a significant component of the locally agreed CQUIN payment scheme. Kent, Surrey & Sussex AMI, Hip & Knee, Pneumonia, Heart Failure, (Dementia) Adult Smoking Cessation Advice/Counselling is an indicator MFT has an EQ Charge Nurse Aims of programme include: Reduce complications Reduce re-admissions Avoid admissions Reduce bed days Improve health outcomes for patients

17 The NHS s role in the public s Health A report from the NHS Future Forum One of the reports submitted to Health Secretary Andrew Lansley (Jan 2012) Key Recommendations: NHS must do more to prevent poor health Making every contact count More efforts to support NHS staff wellbeing Work with MFT was used as a case study example of successful use of Incentives for providers of NHS-funded care Government will consult on a new responsibility for healthcare professionals to promote healthy living through their daily contact with patients.

18 Foundation Doctors Teaching Training repeated annually on all wards Referral Quality Smokefree Site Enhancing Quality Programme Trust Induction Days Hospital-based volunteer

19 Thank You! Angela Green