heart failure collaborative wednesday 25 march 2015
TRANSCRIPT
Heart Failure CollaborativeWednesday 25 March 2015
Hospital Heart FailureUpdate
Hugh McIntyre
March 2015
Overview
• Review EQR data
• Aligning EQR with NHFA– Rationale
• National context– Acute HF CG 187 – tariff – National audits (HN)
– Introduction to Process
EQR
PerformanceVariationBenchmarking
EQR to 2014Performance
EQR to 2014Performance
Consistent improvementover 4 years
EQR to 2014Performance
Consistent improvementover 4 years
Fall off 2014? Loss CQUINBut not seen in other pathways
EQR to 2014Performance
Failure to deliver target performance
Consistent improvementover 4 years
Fall off 2014? Loss CQUINBut not seen in other pathways
EQR to 2014Variation
Process Measure
(ACS)
Outcome measure
EQR to 2014Benchmarking (XXXTrust)
EQR
XXXT
EQR to 2014Benchmarking (XXXTrust)
EQR
XXXT
• 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
National context
Acute Heart Failure CG 187National tariff proposalsNational Audits
5 year plansCQC
Acute Heart Failure CG 187Organisation of care
• (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
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)
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.
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 andclinical 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”.
National AuditsEveryone Counts:
Planning for Patients 2014/15 to 2018/19
Medical Director of NHSE
Medical Director of NHSE
Parliamentary Under Secretary of State for Quality
Medical Director of NHSE
Chief Inspector of Hospitals at the CQC
Parliamentary Under Secretary of State for Quality
EQR – National HF Audit
RationaleCare bundlesAdditional measures
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
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
Aligning the dataCare bundle (ACS)
EQR
• Echo • ACE / ARB (On discharge) • Management plan • Smoking cessation
Aligning the dataCare bundle (ACS)
EQR
• Echo • ACE / ARB (On discharge) • Management plan • Smoking cessation
NHFA
• 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
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’?
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
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
Community
Richard Blakey
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
Time for a Spring clean
Where we are now
• Diminishing numbers of trusts reporting• Reducing CQUINs• ?Diverging directions for EQ and CCGs
Period: Sep 2011 – Jan 2015
Out with the oldIn with the new
• New measures will–Amalgamate some previous
measures–Make collection of data simpler–Add important elements relating to
QS
• 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
• 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
• 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)
• 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 1st 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]
Clinical assessment:
To be discussed
• High level exception reporting• Patient experience surveys• Long term conditions data collection• Benchmarking• Commissioning
West team High Weald Lewes Havens CCGEastbourne, Hailsham & Seaford
CCG. All cause HF
Crawley team. Covers
Horsham & Mid Sussex CCGLVSD<50%
Provider: FCHCCovers: East Surrey CCG. LVSD<55%
Provider: Kent Community NHS T
Acute Trust: ASPH
Acute Trust: RSCH
Provider: Virgincare NW Team
Covers NW Surrey CCG . All cause HF.
Provider: CSH SurreyCovers: Surrey Downs
CCG. LVSD<40%
East team Hastings and Rother CCG. All cause HF
Provider: Kent Community NHS Trust
Acute Trust: MTW
HF MAP 2015
Provider: Virgincare SW TeamCovers: Guildford and Waverly
CCG. All cause HF
Acute Trust: SASH
Brighton team. Covers: Brighton &
Hove CCGAll cause HF
Chichester team. Covers Coastal West Sussex
CCG LVSD<50%
Acute Trust: WSHT (Worthing)
Acute Trust: WSHT (St Richards)
Provider: Sussex Community NHS
T
Acute Trust: BSUH
Acute Trust: ESHT
Provider:East Sussex Community Health Care : All cause
HF
Acute Trust: D&G
Acute Trust: MFT
Acute Trust: EKHFT
Provider: Medway Community
Healthcare
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
What’s that coming over the hill?
LCZ 696
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
Quality Measure 5Education 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.
Quality measure 6MDT
• 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.
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 beta-blockers 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.• b) Proportion of people with chronic heart failure due to LVSD who are prescribed beta-blockers
licensed for heart failure.
• 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.
• 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.
Using data to benchmarkand aid commissioning
We had to change!
THE END
Refreshment break
The National Heart Failure Audit 2013/14
Professor T A McDonagh, King’s College Hospital, London. UK
• 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
The National Heart Failure Audit-8th Annual Report
58
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
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
Demographics 2013-14
Mean age=77.6 , median age 80.2 years
Mean age men=75.7, women 80.1
Social Deprivation and HF Admission
Symptoms
Echo diagnoses
Aetiology and Comorbidity HF-REF/HF-PEF
Place of Care
Specialist Input
Specialist Input
Treatment
Five Year Trends in Prescribing for LVSD
Treatment and Specialist Input
72
Monitoring
Discharge Planning
Length of Stay
Median LOS by Hospital
• In Hospital• 9.5% (same as last year)• Was 11.1% in 2011/12• 30-day• 15%• 1 year (within the audit year)• 34%•
Mortality Data from the National Heart Failure Audit 2013-2014
In Patient Mortality
In Patient Death 2013/14 Cox Proportional Hazards Model
5 year Trends in In Patient and 30 Day Mortality
Adjusted In Patient Mortality by Hospital 2013-14
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.
The target is the overall proportion of 0.095.
• 24.7 % at end of FU (median 180 days)
ACM following discharge
ACM Post Discharge in Those with LVSD and Disease
Modifying Drugs
ACM for Survivors by Quality of Care Indicators
HF NursePlace of Care
Cardiology Follow Up
Cox Proportional Hazards Model for ACM
All-cause mortality for survivors to discharge by additive drug treatment on
discharge (2009-14)
All-cause mortality for survivors to discharge by place of care (2009-14) and Cardiology Follow Up
• 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.
•
Acute Heart Failure Outcomes in the England and Wales
• HQIP -100% case ascertainment is not attainable or necessary
• Results valid• 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 care and from primary care into secondary care
• Working on the best risk adjustment models to compare institutions
• HALO-research group has approved numerous studies….
The Future
Thank you 2013-14 !!
Polly MitchellDamian MarleeJulie Sanders
Project Board
National Cardiovascular Intelligence Network (NCVIN)Using data and information to improve the quality of care and outcomes for cardiovascular diseaseSally Crick, NCVIN Network Manager
www.ncvin.org.uk
NCVIN Overview:
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;
NCVIN National Partnership Board:
NHS England, Domain 1 and National Clinical Directors Stroke AssociationNCVIN Clinical Leads NHS Improving QualityNHS Health Checks Vascular RegistryNational Institute for Cardiovascular Outcomes (NICOR) British Kidney Patient AssociationBritish Heart Foundation National Kidney FederationBritish Cardiovascular Society Heart UKDiabetes UKUK Renal RegistryHealth and Social Care Information Centre (HSCIC)
NCVIN: Strategic Work streams
95
Work stream 1:To continue to develop relevant and timely tools/resources through a single portal
Cardiovascular Key Facts
Sourced and referenced national key facts
98
Behavioural risk factors Non Behaviour risk factorsFact sheet 1 Smoking Fact sheet 6 Age, sex, ethnicity, deprivationFact sheet 2 ObesityFact sheet 3 Physical activityFact sheet 4 NutritionFact sheet 5 Alcohol consumption
Bodily risk factors CVD diseasesFact sheet 7 Hypertension Fact sheet 11 Cardiovascular diseaseFact sheet 8 Diabetes Fact sheet 12 CHD and heart failureFact sheet 9 Kidney disease Fact sheet 13 Atrial fibrillationFact sheet 10 Familial Fact sheet 14 Stroke and TIA
hypercholesterolemia Fact sheet 15 Vascular dementia Fact sheet 16 Peripheral arterial disease
Cardiovascular Profiles:
Overview of CVDRisk factorsHeart diseaseDiabetes KidneyStroke
Available for all CCGs and SCNs in England.
Hard copy downloadable PDF
Published July 2014, refreshed March 2015
Prevalence Overview
Care processes and treatment indicators and variation at practice level
Treatment in secondary care
Mortality trends
Commissioning for Value CVD Focus Packs:Heart/Stroke
Refreshed December 2014
Sum
mary on a page
Summary: overarching messages
6
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
Analysis
Where does the CCG compare poorly against its cluster group?
Analysis by pathway stage (page 1 of 2)
11
Table1
*below the average of the best 5 CCGs in the cluster group
Number of Indicators where CCG has room for
improvement*Indicators in the worst quintile versus benchmark group - difference
between the CCG and the benchmark, (p) – PCT based indicatorOpportunity - if the CCG were
to equal the benchmark No indicators in the worst quintile No indicators in the worst quintile
Hypertension ratio (-5.5 % lower) 3,185 people
% AF patients stroke risk assessed using CHADS2 (-2.2 % lower) 75 people
3/5 prevention indicators
3/3 observed to expected prevalence ratios
17/20 primary care indicators
Analysis
Analysis by pathway stage (page 2 of 2)
12
Table2
Where does the CCG compare poorly against its cluster group?
*below the average of the best 5 CCGs in the cluster group
Number of Indicators where CCG has room for
improvement*Indicators in the worst quintile versus benchmark group - difference
between the CCG and the benchmark, (p) – PCT based indicatorOpportunity - 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 admissionsHeart failure: average cost per female emergency admission (13.3 % higher) £65K CVD: average male elective LOS (41.8 % higher) 334 bed daysCVD: average female elective LOS (134.9 % higher) 643 bed daysStroke: average male emergency LOS (240.3 % higher) 632 bed daysAngiography procedures: female average cost (78.2 % higher) £71K Angiography procedures: male LOS (119.1 % higher) 1,331 bed daysAngiography procedures: female LOS (87.4 % higher) 512 bed daysAngioplasty procedures: female average cost (12.9 % higher) £19K CABG procedures: male (DSR) (74.6 % higher) 34 proceduresCABG procedures: male (LOS) (104 % higher) 929 bed daysCABG procedures: female (LOS) (111.3 % higher) 259 bed daysNew implantable cardioverter-defibrillator procedures (p) (86 % higher) 159 procedures
1/1 social care indicators No indicators in the worst quintile No indicators in the worst quintile
51/62 secondary care indicators
Analysis
Bring it all together:what works, what could work, who should we speak to
15
NICE Guidance, Quality Standards etc.
Prevention of cardiovascular disease
Hypertension
Atrial fibrillation
Stroke
Chronic heart failure
Lipid modification
Myocardial infarction with ST segment elevationLower limb peripheral arterial disease
Smoking prevention and cessation
Obesity
Physical activity
Contact the NICE field team for support and advice on implementing NICE guidanceThe 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
NICE is recruiting additional members to join its Commissioning reference panel and to support the NICE commissioning programme.
Annexes
Annex 1:spine charts
16
PreventionWorse outcome \ High prevalence
Better outcome \ Low prevalence
Prevalence
England worst
England best
Worst quintile in cluster
KEY:
* (p) = PCT based indicator For data sources used, see slide 23
Opportunity
Obesity (p)Binge drinking (p)
% of patients registered with a GP with a LTC who smoke4 week quitters as a proportion of estimated smokers (p)
Smoking (p) 3,071 people229 people1,912 patients--
CVD prevention registerAtrial fibrilliation
Heart failure due to LVD registerHeart Failure
Hypertension observed to expected prevalence ratioHypertension
Stroke observed to expected prevalence ratioStroke
CHD observed to expected prevalence ratioCHD 58 people
1,259 people182 people152 people585 people3,185 people95 people232 people178 people744 people
Annexes
Annex 1:spine charts
17
Primary careWorse outcome Better outcome
England worst
England best
Worst quintile in cluster
KEY:
* (p) = PCT based indicator For data sources used, see slide 23
Opportunity
AF & CHADS2 score > 1, % treated anti-coagulation drug therapyAF & CHADS2 score of 1, % treated anti-coagulation drug therapy
% AF patients stroke risk assessed using CHADS2% of patients with hypertension BP is 150/90 or less
% of patients with hypertension record of BP% of new stroke/TIA patients referred further investigation
% of stroke patients with a record an anti-platelet agent taken% of patients with stroke/TIA had influenza immunisation
% of patients with stroke/TIA cholesterol is 5mmol/l or less% of patients with stroke/TIA record of cholesterol
% of patients with stroke/TIA last BP is 150/90 or less% of patients with HF due to LVD, treated with ACE + beta-blocker
% of patients with HF due to LVD, treated with ACE inhibitor% of patients with HF confirmed by an echocardiogram
% of MI patients treated with an ACE inhibitor% of patients with CHD who have had influenza immunsation
% CHD patients treated with a beta blocker% CHD patients record of aspirin
% patients with CHD whose cholesterol is 5mmol/l or less% patients with CHD whose last BP reading is 150/90 or less 53 people
14 people2 people291 people--0 people12 people30 people44 people90 people81 people-10 people31 people412 people778 people75 people8 people86 people
Annexes
Annex 1:spine charts
18
Secondary care Worse outcome Better outcome
England worst
England best
Worst quintile in cluster
KEY:
* (p) = PCT based indicator For data sources used, see slide 23
Opportunity
CHD: average female elective LOSCHD: average male elective LOS
CHD female elective admissions (DSR)CHD male elective admissions (DSR)
CHD: average cost per female elective admissionCHD: average cost per male elective admission
CHD: average female emergency LOSCHD: average male emergency LOS
CHD female emergerncy admissions (DSR)CHD male emergerncy admissions (DSR)
CHD: average cost per female emergerncy admissionCHD: average cost per male emergerncy admission
CVD: average female elective LOSCVD: average male elective LOS
CVD female elective admissions (DSR)CVD male elective admissions (DSR)
CVD: average cost per female elective admissionCVD: average cost per male elective admission
CVD: average female emergency LOSCVD: average male emergency LOS
CVD female emergerncy admissions (DSR)CVD male emergerncy admissions (DSR)
CVD: average cost per female emergerncy admissionCVD: average cost per male emergerncy admission £207K
£158K 222 admissions200 admissions3,930 bed days1,752 bed days----334 bed days643 bed days£160K £157K 53 admissions35 admissions184 bed days209 bed days£52K £3K --
54 bed days14 bed days
Outcome versus Expenditure Tools:Cardiovascular and Diabetes
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DOVE tool
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Outcome versus expenditure tool
http://www.yhpho.org.uk/default.aspx?RID=200330
116 National Cardiovascular Intelligence Network
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Unique analysis
Co-morbidities: draft – not for circulation
Prevalence of comorbidities by age Comorbidity matrix
Work stream 2:To embed information/intelligence into local service improvement
NCVIN MasterclassesOne half day session in each SCN
Programme: Introduction
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 Checks121
Master class Programme
22 April 2015 London www.phe-events.org.uk/ncvinlondon
21st May 2015, East of England11th June 2015, South East9th July 2015, Yorkshire and Humber
www.ncvin.org.uk
Work stream 3:To take a strategic lead on the creative/innovative development of information
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
125www.ncvin.org.uk
Lunch in Traders Restaurant