Heart Failure Collaborative Wednesday 25 March 2015

Transcription

1 Heart Failure Collaborative Wednesday 25 March 2015

2 Hospital Heart Failure Update Hugh McIntyre March 2015

3 Overview Review EQR data Aligning EQR with NHFA Rationale National context Acute HF CG 187 tariff National audits (HN) Introduction to Process

4 EQR Performance Variation Benchmarking

5 EQR to 2014 Performance

6 Consistent improvement over 4 years EQR to 2014 Performance

7 Consistent improvement over 4 years EQR to 2014 Performance Fall off 2014? Loss CQUIN But not seen in other pathways

8 Consistent improvement over 4 years EQR to 2014 Performance Fall off 2014? Loss CQUIN But not seen in other pathways Failure to deliver target performance

9 EQR to 2014 Variation Process Measure (ACS) Outcome measure

10 EQR to 2014 Benchmarking (XXXTrust) EQR XXXT

11 EQR to 2014 Benchmarking (XXXTrust) EQR XXXT

12 This data is for information and for local quality improvement Process measures do not appear to correlate with outcomes As currently measured in EQR (but not formally analysed) But note specialist input, optimal meds and ward correlate with better outcome in NHFA EQR does not measure these currently

13 National context Acute Heart Failure CG 187 National tariff proposals National Audits 5 year plans CQC

14 Organisation of care Acute Heart Failure CG 187 (All hospitals) should provide a specialist HF team based on a cardiology ward, providing outreach services. (All HF) receive early and continuing input from specialist heart failure team. Diagnosis, assessment and monitoring single measurement of serum NP BNP less than 100 ng/litre NT-proBNP less than 300 ng/litre. For raised NP perform TTE Consider TTE < 48 hours of admission

15 Acute Heart Failure CG 187 Treatment after stabilisation Beta blockade Continue BB unless heart rate less than 50 bpm, AV block, or shock. Start/restart BB treatment during hospital admission (LVSD) once stabilised Ensure stable for typically 48 hours after starting or restarting beta-blockers and before discharge ie BB established pre discharge Follow-up by specialist heart failure team within 2 weeks of discharge. CHF QS St12)

16 National tariff payment system Engagement 2015/16 - Publications - GOV.UK New BPT for emergency admissions to secondary care with a primary diagnosis of heart failure National Heart Failure Audit data as the source for measuring best practice for heart failure care in secondary care. Measure data completeness and specialist input BPT price set above national prices, while a lower price would be paid if the provider did not fulfil the criteria.

17 National Audits Everyone Counts: Planning for Patients 2014/15 to 2018/19 2 An outcomes-based approach focusing less on what is done for patients, and more on the results of what is done 26 Consultant level activity and clinical outcomes data for ten surgical specialties have now been published. This gives patients and citizens, as well as their commissioners and clinicians, enhanced access to data and information. We plan to extend this so that data from all appropriate NHS funded national clinical audits is made available before 2020.

18 Medical Director of NHSE

19 Medical Director of NHSE Parliamentary Under Secretary of State for Quality

20 Chief Inspector of Hospitals at the CQC Medical Director of NHSE Parliamentary Under Secretary of State for Quality

21 EQR National HF Audit Rationale Care bundles Additional measures

22 Aligning EQR with NHFA Why Clinical imperatives Care quality and standards National imperatives Financial and performance Inspection (CQC) Empowers clinicians Simplifies local data collection Secures local data collection for National Audit Best of both monthly data and data (tariff) compliance

23 Aligning EQR with NHFA NHFA larger data base than EQR: EQR-familiar Care bundle Existing care bundle (Minus smoking cessation) PLUS Specialist (tariff, CGs, QS) 2 week review (CGs, QS) Additional quality improvements areas (exploratory) Alignment with QS and CGs Heart Failure Clinical Reference Group

24 Aligning the data Care bundle (ACS) EQR Echo ACE / ARB (On discharge) Management plan Smoking cessation

25 Aligning the data Care bundle (ACS) EQR NHFA Echo ACE / ARB (On discharge) Management plan Smoking cessation Specialist Input Echo ACE / ARB (On discharge) Management plan (NHFA) Referral to HFNS or CHFNS follow up. (LVSD only*) BB on discharge in bundle? *Agreed by CRG

26 Additional quality measures (not part of a care bundle but reported on monthly for information). Main place of care Was a review appointment with specialist Multidisciplinary HF team made and Date. * * Recommended within 2 weeks of discharge. Referral to HFNS or CHFNS follow up. (All cause heart failure) BB on discharge in bundle Should this be part of the ACS bundle?

27 Summary Pros Next step for EQR is NHFA alignment Optimises data collection, completion and compliance Allows more relevant redefinition of care bundle Allows exploratory Quality Indicators Cons Change Loss of EQR value (keep monthly reporting) Learning (but will reduce total data collection burden) Culture New data will need to be re-evaluated against current scores

28 Plan for the morning New EQ measures Community Trusts Richard Blakey Break National Heart Failure Audit Professor Theresa McDonagh, NHFA Lead NICOR Translating data into intelligence Sally Crick, Programme Manager (Heart / Stroke), Public Health England, National Cardiovascular Health Intelligence Network (NCVIN) Overview of the breakout session Peter Carpenter, Director of Improvement, KSS AHSN

29 Community Richard Blakey

30 Purpose of this session Where are now now To introduce new community measures The patient journey from acute to community Linking to Quality Standards Benchmarking and aiding commissioning

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32 Time for a Spring clean

33 Where we are now Diminishing numbers of trusts reporting Reducing CQUINs?Diverging directions for EQ and CCGs

34 Period: Sep 2011 Jan 2015

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36 Out with the old In with the new New measures will Amalgamate some previous measures Make collection of data simpler Add important elements relating to QS

37 Management All patients with Left Ventricular Systolic Dysfunction (LVSD) should be on an ACE (or ARB) and a Beta-Blocker (licensed for Heart Failure) within the target dose range for heart failure. An average 50% dose against target doses accepted in this measure*, measuring the average dose v % reaching maximum dose is to maximise improvement outcomes. Population is: All patients with confirmed LVSD (by echo) on Community HF Nurse Caseload. *To align with NHFA findings

38 ACE (record the dose prescribed monthly) ARB (record the dose prescribed monthly) Beta-blocker (record the dose prescribed monthly) Exception reporting remains similar to previously

39 Management Aldosterone Antagonists (MRA): To be kept The current NICE Chronic heart failure (update) CG108 evidence reviewed suggests that spironolactone should be used in severe chronic heart failure (NYHA Class III-IV), and eplerenone should be used in the patients with heart failure following myocardial infarction. The latter is in keeping with the guidance of NICE on the management of myocardial infarction complicated by heart failure. Exceptions remain the same. (Ivabradine now removed as a measure)

40 Clinical assessment within 2 weeks of referral All patients referred to the Community Heart Failure Service should receive a clinical assessment from a member of the multidisciplinary heart failure team within 2 weeks of referral. Population is: All patients who have been referred and accepted to the community heart failure service caseload. Clinical assessment Record on spreadsheet: 1. Date referral received. 2. Date referral accepted by CHFNS. 3. Date of 1 st clinical assessment.

41 Clinical assessment: All patients with chronic heart failure require monitoring. This monitoring should include: A clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status. A review of medication, including need for changes and possible side effects serum urea, electrolytes, creatinine and egfr. [NICE 2003, amended 2010]

42 To be discussed High level exception reporting Patient experience surveys Long term conditions data collection Benchmarking Commissioning

43 Provider: Virgincare NW Team Covers NW Surrey CCG. All cause HF. Acute Trust: ASPH Provider: CSH Surrey Covers: Surrey Downs CCG. LVSD<40% Acute Trust: D&G Provider: Kent Community NHS Trust Acute Trust: MFT Provider: Medway Community Healthcare Acute Trust: RSCH Provider: Virgincare SW Team Covers: Guildford and Waverly CCG. All cause HF Chichester team. Covers Coastal West Sussex CCG LVSD<50% Acute Trust: WSHT (St Richards) Crawley team. Covers Horsham & Mid Sussex CCG LVSD<50% Acute Trust: SASH Provider: Sussex Community NHS T Acute Trust: WSHT (Worthing) Provider: FCHC Covers: East Surrey CCG. LVSD<55% Brighton team. Covers: Brighton & Hove CCG All cause HF Acute Trust: BSUH West team High Weald Lewes Havens CCG Eastbourne, Hailsham & Seaford CCG. All cause HF Acute Trust: ESHT Acute Trust: MTW Provider: East Sussex Community Health Care : All cause HF East team Hastings and Rother CCG. All cause HF Acute Trust: EKHFT Provider: Kent Community NHS T HF MAP 2015

44 Exception reporting for: Clinical Assessment within 2 weeks measure. 1. Patient declined assessment 2. Patient re-admitted to hospital with HF 3. Patient in hospital 4. Patient died 5. Consultant management plan request review > 2 weeks

45 What s that coming over the hill?

46 Opportunities Reassess the criteria for inclusion in your service? Time to embrace prodigal trusts back into the fold we want you back! One patient pathway Chance to align with NICE Quality Standards Invite CCGs to align with their priorities To integrate with primary care Admission avoidance care plans

47 Quality Measure 5 Education and self management Quality statement People with chronic heart failure are offered personalised information, education, support and opportunities for discussion throughout their care to help them understand their condition and be involved in its management, if they wish. Quality measure Structure: Evidence of local arrangements to ensure people with chronic heart failure are offered personalised information, education, support and opportunities for discussion throughout their care to help them understand their condition and be involved in its management, if they wish. Process: a) Proportion of people with chronic heart failure receiving personalised information, education, support and opportunities to discuss their care. Numerator the number of people in the denominator receiving personalised information, education, support and opportunities to discuss their care. Denominator the number of people with chronic heart failure. b) Evidence from experience surveys showing that people with chronic heart failure feel they have been provided with personalised information, education, support and opportunities for discussion throughout their care to help them understand their condition and be involved in its management, if they wished.

48 Quality measure 6 MDT Quality measure Structure: a) Evidence of a local multidisciplinary heart failure team led by a specialist and consisting of professionals with the appropriate competencies from primary and secondary care. b) Evidence of local arrangements to ensure people with chronic heart failure are given a single point of contact for the multidisciplinary heart failure team. Process: a) Proportion of people with chronic heart failure who are cared for by a multidisciplinary heart failure team led by a specialist and consisting of professionals with the appropriate competencies from primary and secondary care. Numerator the number of people in the denominator cared for by a multidisciplinary heart failure team led by a specialist and consisting of professionals with the appropriate competencies from primary and secondary care. Denominator the number of people with chronic heart failure. b) Proportion of people with chronic heart failure given a single point of contact for the multidisciplinary heart failure team. Numerator the number of people in the denominator given a single point of contact for the multidisciplinary heart failure team. Denominator the number of people with chronic heart failure cared for by a multidisciplinary heart failure team.

49 Quality measure 7 Quality statement People with chronic heart failure due to left ventricular systolic dysfunction are offered angiotensin-converting enzyme inhibitors (or angiotensin II receptor antagonists licensed for heart failure if there are intolerable side effects with angiotensin-converting enzyme inhibitors) and betablockers licensed for heart failure, which are gradually increased up to the optimal tolerated or target dose with monitoring after each increase. Structure: a) Evidence of local arrangements to ensure that people with chronic heart failure due to left ventricular systolic dysfunction (LVSD) are offered angiotensin-converting enzyme (ACE) inhibitors (or angiotensin II receptor antagonists [ARBs] licensed for heart failure if there are intolerable side effects with ACE inhibitors) and beta-blockers licensed for heart failure. b) Evidence of local arrangements to review people with chronic heart failure due to LVSD after each increase up to the optimal tolerated or target dose of ACE inhibitors (or ARBs) and beta-blockers. Process: a) Proportion of people with chronic heart failure due to LVSD who are prescribed ACE inhibitors (or ARBs licensed for heart failure if there are intolerable side effects with ACE inhibitors). Numerator the number of people in the denominator prescribed ACE inhibitors (or ARBs licensed for heart failure if there are intolerable side effects with ACE inhibitors). Denominator the number of people with chronic heart failure due to LVSD.

50 Quality Measure 8 People with stable chronic heart failure and no precluding condition or device are offered a supervised group exercise-based cardiac rehabilitation programme that includes education and psychological support. Quality Measure 9 People with stable chronic heart failure receive a clinical assessment at least every 6 months, including a review of medication and measurement of renal function.

51 Quality Measure 10 People admitted to hospital because of heart failure have a personalised management plan that is shared with them, their carer(s) and their GP. Quality Measure 12 People admitted to hospital because of heart failure are discharged only when stable and receive a clinical assessment from a member of the multidisciplinary heart failure team within 2 weeks of discharge. Quality Measure 13 People with moderate to severe chronic heart failure, and their carer(s), have access to a specialist in heart failure and a palliative care service.

52 Using data to benchmark and aid commissioning

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55 Refreshment break

56 The National Heart Failure Audit 2013/14 Professor T A McDonagh, King s College Hospital, London. UK

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58 The National Heart Failure Audit-8 th Annual Report Established in 2007 Report the clinical practice and patient outcomes for acute patients discharged from hospital with a primary diagnosis of heart failure (also record I/P death) ICD- 10 codes Purpose is to use the data to improve the standard of care 58

59 Cont d Participation in the audit is mandated by the Department of Health s NHS Standard Contracts for 2012/13,11 and by the NHS Wales National Clinical Audit and Outcome Review Plan 2012/13. Supported by BSH, managed by NICOR, commissioned by HQIP ICD-10 codes: I11.0 Hypertensive heart disease with (congestive) heart failure, I25.5 Ischaemic cardiomyopathy,i42.0 Dilated cardiomyopathy, I42.9 Cardiomyopathy, unspecified, I50.0 Congestive heart failure, I50.1 Left ventricular failure, I50.9 Heart failure, unspecified

60 April 2013-March 2014 Participation and Case Ascertainment 96.7% NHS Trusts in England and 100% Welsh Health Boards submitting data Reporting on 55,040 admissions 54,654. -post data cleaning 25% increase since last year! HES admission increased by 16% in the previous year 66% submitted >20 /month or 70% of HES coding Should represent the target of represent 70% of all HF Aggregate data presented 240,710 patient episodes since the beginning

61 Demographics Mean age=77.6, median age 80.2 years Mean age men=75.7, women 80.1

62 Social Deprivation and HF Admission

63 Symptoms

64 Echo diagnoses

65 Aetiology and Comorbidity HF- REF/HF-PEF

66 Place of Care

67 Specialist Input

68 Specialist Input

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70 Treatment

71 Five Year Trends in Prescribing for LVSD

72 Treatment and Specialist Input 72

73 Monitoring

74 Discharge Planning

75 Length of Stay Median LOS by Hospital

76 Mortality Data from the National Heart Failure Audit In Hospital 9.5% (same as last year) Was 11.1% in 2011/12 30-day 15% 1 year (within the audit year) 34%

77 In Patient Mortality

78 In Patient Death 2013/14 Cox Proportional Hazards Model

79 5 year Trends in In Patient and 30 Day Mortality

80 Adjusted In Patient Mortality by Hospital The target is the overall proportion of The adjusted in-hospital mortality funnel plot was obtained from a logistic regression model adjusting for age, gender, treatment ward and length of stay with random effects for hospital of admission to account for clustering. All hospitals were within the upper 95% and 99.8% control limit with most hospitals clustering around the overall average value.

81 ACM following discharge 24.7 % at end of FU (median 180 days)

82 ACM Post Discharge in Those with LVSD and Disease Modifying Drugs

83 ACM for Survivors by Quality of Place of Care Care Indicators HF Nurse Cardiology Follow Up

84 Cox Proportional Hazards Model for ACM

85 survivors to discharge by additive drug treatment on discharge ( )

86 All-cause mortality for survivors to discharge by place of care ( ) and Cardiology Follow Up

87 Acute Heart Failure Outcomes in the England and Wales Mortality fall for in patients has been maintained prescribing rates particularly Beta-Blockers and MRAs treatment in specialist wards and referral to heart failure follow-up services trend to increasing age no difference comorbidities or disease severity of patients across the last three years. Mortality rates remain high. Good clinical management by heart failure and cardiology specialists continue to result in significantly better outcomes for patients: in hospital, the month after discharge and remains several years after their hospital admission.

88 HQIP -100% case ascertainment is not attainable or necessary Results valid The Future Case submission will remain at 70% HES Note consultation on using Audit data results for Best Practice Tariff for Heart Failure 70% HES and 60% of cases receiving specialist input Piloting project tracking patients into primary

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90 Thank you !! Polly Mitchell Damian Marlee Julie Sanders Project Board

91 National Cardiovascular Intelligence Network (NCVIN) Using data and information to improve the quality of care and outcomes for cardiovascular disease Sally Crick, NCVIN Network Manager

92 NCVIN Overview:

93 93 the NHS CB and PHE will look to establish a cardiovascular intelligence network (NCVIN) bringing together epidemiologists, analysts, clinicians and patient representatives. The CVIN, working with the HSCIC, will bring together existing CVD data and identify how to use it best;

94 NCVIN National Partnership Board: NHS England, Domain 1 and National Clinical Directors Association NCVIN Clinical Leads Quality NHS Health Checks Registry National Institute for Cardiovascular Outcomes (NICOR) Patient Association British Heart Foundation Federation British Cardiovascular Society Diabetes UK UK Renal Registry Health and Social Care Information Centre (HSCIC) Stroke NHS Improving Vascular British Kidney National Kidney Heart UK

95 95 NCVIN: Strategic Work streams

96 Work stream 1: To continue to develop relevant and timely tools/resources through a single portal

97 Cardiovascular Key Facts

98 98 Sourced and referenced national key facts Behavioural risk factors Non Behaviour risk factors Fact sheet 1 Smoking Fact sheet 6 Age, sex, ethnicity, deprivation Fact sheet 2 Obesity Fact sheet 3 Physical activity Fact sheet 4 Nutrition Fact sheet 5 Alcohol consumption Bodily risk factors CVD diseases Fact sheet 7 Hypertension Fact sheet 11 Cardiovascular disease Fact sheet 8 Diabetes Fact sheet 12 CHD and heart failure Fact sheet 9 Kidney disease Fact sheet 13 Atrial fibrillation Fact sheet 10 Familial Fact sheet 14 Stroke and TIA hypercholesterolemia Fact sheet 15 Vascular dementia Fact sheet 16 Peripheral arterial disease

99 Cardiovascular Profiles: Overview of CVD Risk factors Heart disease Diabetes Kidney Stroke

100 Available for all CCGs and SCNs in England. Hard copy downloadable PDF Published July 2014, refreshed March 2015

101 Prevalence Overview

102 Care processes and treatment indicators and variation at practice level

103 Treatment in secondary care

104 Mortality trends

105 Commissioning for Value CVD Focus Packs: Heart/Stroke Refreshed December 2014

106 Summary: overarching messages Overarching messages Public health focus on prevention Significant benefit to patients if improvement to primary care management indicators were made High costs for: CHD emergency admissions, heart failure emergency admissions, angiography procedures, angioplasty procedures High numbers of admissions for: stroke emergency admissions, CABG procedures High lengths of stay for: CVD elective admissions, stroke emergency admissions, angiography procedures, CABG procedures Summary on a page 6

107 Number of Indicators where CCG has room for improvement* Analysis by pathway stage (page 1 of 2) Table1 3/5 prevention indicators 3/3 observed to expected prevalence ratios Where does the CCG compare poorly against its cluster group? Indicators in the worst quintile versus benchmark group - difference Opportunity - if the CCG were between the CCG and the benchmark, (p) PCT based indicator to equal the benchmark No indicators in the worst quintile No indicators in the worst quintile Hypertension ratio (-5.5 % lower) 3,185 people Analysis % AF patients stroke risk assessed using CHADS2 (-2.2 % lower) 75 people 17/20 primary care indicators *below the average of the best 5 CCGs in the cluster group 11

108 Number of Indicators where CCG has room for improvement* Analysis by pathway stage (page 2 of 2) Table2 51/62 secondary care indicators Where does the CCG compare poorly against its cluster group? Indicators in the worst quintile versus benchmark group - difference between the CCG and the benchmark, (p) PCT based indicator Opportunity - if the CCG were to equal the benchmark CHD: average cost per female emergency admission (34.1 % higher) 157K Stroke male emergency admissions (DSR) (34.1 % higher) 47 admissions Heart failure: average cost per female emergency admission (13.3 % higher) 65K CVD: average male elective LOS (41.8 % higher) 334 bed days CVD: average female elective LOS (134.9 % higher) 643 bed days Stroke: average male emergency LOS (240.3 % higher) 632 bed days Angiography procedures: female average cost (78.2 % higher) 71K Angiography procedures: male LOS (119.1 % higher) 1,331 bed days Angiography procedures: female LOS (87.4 % higher) 512 bed days Angioplasty procedures: female average cost (12.9 % higher) 19K CABG procedures: male (DSR) (74.6 % higher) 34 procedures CABG procedures: male (LOS) (104 % higher) 929 bed days CABG procedures: female (LOS) (111.3 % higher) 259 bed days New implantable cardioverter-defibrillator procedures (p) (86 % higher) 159 procedures Analysis 1/1 social care indicators No indicators in the worst quintile No indicators in the worst quintile *below the average of the best 5 CCGs in the cluster group 12

109 Bring it all together: what works, what could work, who should we speak to NICE Guidance, Quality Standards etc. Prevention of cardiovascular disease Hypertension Atrial fibrillation Stroke Chronic heart failure Lipid modification Myocardial infarction with ST segment elevation Lower limb peripheral arterial disease Smoking prevention and cessation Obesity Contact the NICE field team for support and advice on implementing NICE guidance The quality and productivity collection provides quality assured examples of improvements across NHS and social care and include cardiovascular and stroke. Look at NICE shared learning examples from organisations that have put guidance into practice. Examples include peripheral arterial disease, hypertension and obesity Physical activity NICE is recruiting additional members to join its Commissioning reference panel and to support the NICE commissioning programme. Analysis 15

110 Annex 1: spine charts KEY : Prevention England worst Worst quintile in cluster Worse outcome \ High prevalence Smoking (p) 4 week quitters as a proportion of estimated smokers (p) % of patients registered with a GP with a LTC who smoke Binge drinking (p) Obesity (p) England best Better outcome \ Low Opportunit prevalence y 3,071 people 229 people 1,912 patients - - Annexes Prevalence CHD CHD observed to expected prevalence ratio Stroke Stroke observed to expected prevalence ratio Hypertension Hypertension observed to expected prevalence ratio Heart Failure Heart failure due to LVD register Atrial fibrilliation CVD prevention register 58 people 1,259 people 182 people 152 people 585 people 3,185 people 95 people 232 people 178 people 744 people * (p) = PCT based indicator For data sources used, see slide 16

111 Annex 1: spine charts KEY : Primary care England worst Worst quintile in cluster England best Worse outcome Better outcome Opportunit y % patients with CHD whose last BP reading is 150/90 or less 53 people % patients with CHD whose cholesterol is 5mmol/l or less 14 people % CHD patients record of aspirin 2 people % CHD patients treated with a beta blocker 291 people % of patients with CHD who have had influenza immunsation - % of MI patients treated with an ACE inhibitor - % of patients with HF confirmed by an echocardiogram 0 people % of patients with HF due to LVD, treated with ACE inhibitor 12 people % of patients with HF due to LVD, treated with ACE + beta-blocker 30 people % of patients with stroke/tia last BP is 150/90 or less 44 people % of patients with stroke/tia record of cholesterol 90 people % of patients with stroke/tia cholesterol is 5mmol/l or less 81 people % of patients with stroke/tia had influenza immunisation - % of stroke patients with a record an anti-platelet agent taken 10 people % of new stroke/tia patients referred further investigation 31 people % of patients with hypertension record of BP 412 people % of patients with hypertension BP is 150/90 or less 778 people % AF patients stroke risk assessed using CHADS2 75 people AF & CHADS2 score of 1, % treated anti-coagulation drug therapy 8 people AF & CHADS2 score > 1, % treated anti-coagulation drug therapy 86 people Annexes * (p) = PCT based indicator For data sources used, see slide 17

112 Annex 1: spine charts KEY : Secondary care England worst Worst quintile in cluster England best Worse outcome Better outcome Opportunit y CVD: average cost per male emergerncy admission 207K CVD: average cost per female emergerncy admission 158K CVD male emergerncy admissions (DSR) 222 admissions CVD female emergerncy admissions (DSR) 200 admissions CVD: average male emergency LOS 3,930 bed days CVD: average female emergency LOS 1,752 bed days CVD: average cost per male elective admission - CVD: average cost per female elective admission - CVD male elective admissions (DSR) - CVD female elective admissions (DSR) - CVD: average male elective LOS 334 bed days CVD: average female elective LOS 643 bed days CHD: average cost per male emergerncy admission 160K CHD: average cost per female emergerncy admission 157K CHD male emergerncy admissions (DSR) 53 admissions CHD female emergerncy admissions (DSR) 35 admissions CHD: average male emergency LOS 184 bed days CHD: average female emergency LOS 209 bed days CHD: average cost per male elective admission 52K CHD: average cost per female elective admission 3K CHD male elective admissions (DSR) - CHD female elective admissions (DSR) - CHD: average male elective LOS 54 bed days CHD: average female elective LOS 14 bed days * (p) = PCT based indicator For data sources used, see slide Annexes 18

113 Outcome versus Expenditure Tools: Cardiovascular and Diabetes

114 DOVE tool Presentation title - edit in Header and Footer

115 Presentation title - edit in Header and Footer

116 Outcome versus expenditure tool National Cardiovascular Intelligence Network

117 Presentation title - edit in Header and Footer

118 Unique analysis

119 Co-morbidities: draft not for circulation Prevalence of comorbidities by age Comorbidity matrix

120 Work stream 2: To embed information/intelligence into local service improvement

121 NCVIN Masterclasses One half day session in each SCN Programme: Introduction 121 World café Local data Local example Delivered in Partnership with: NICOR National Diabetes Audit Sentinel Stroke National Audit Programme Renal Registry Commissioning for Value NHS Health Checks

122 Master class Programme 22 April 2015 London 21 st May 2015, East of England 11 th June 2015, South East 9 th July 2015, Yorkshire and Humber

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124 Work stream 3: To take a strategic lead on the creative/innovative development of information

125 NCVIN Vision: Data Linkage Where it is efficient and effective, data will be shared securely between national agencies and audit programmes to provide a population wide view through from prevention, early diagnosis, treatment and care to end of life e.g.. proof of concept data linkage between cancer registration and the national heart audit data within NICOR to investigate how interactions between heart disease and cancer affect patients outcomes 125

126 Thank you 126

127 Lunch in Traders Restaurant