Speakers:

Dr Srikanth Bellary†, Clinical Director for Diabetes, Heart of England Foundation Trust

Farid Bidgoli, Associate Director of Market Access, MSD

Panel:

Hanno Ronte, Partner, Deloitte

Peter Pigden*, Patient Representative, Insights for Care

Declaration of Interests: None of the above participants have received an honorarium for this presentation †Honorariums and expenses have been provided previously for advisory services to MSD but not in relation to Insights for Care *Expenses have been provided to support attendance at the Insights for Care governance board meetings

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For over 150 years, we have known that data can be used to transform

care

“The proposed [data gathering] would enable the mortality in hospitals, and also the mortality from particular diseases, injuries and operations, to be ascertained with accuracy, and these facts,

together with the duration of cases, would enable the value of particular methods of treatment and of special operations to be

brought to statistical proof” - Florence Nightingale, 1860

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Nightingale identified that poor health, and not wounds, caused most military

deaths…use of her data reduced all-cause mortality from 42% to 2%

Evidence Based Policy ‘ Royal Commission on the Health of the Army’

Reduced rates of Infectious disease

All-cause mortality decrease : 42% to 2%

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The Five Year Forward View identifies that data are central to achieving better

care in a financially sustainable way

• “Flat” funding with a need for transformational, disruptive change

• Evidence-based approach to future planning • New forms of care provision

‒ Evaluative component from establishment • Data assets to support system focus on integration of care

‒ Quality improvement / audits ‒ Research ‒ Risk stratification

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Why Insights for Care?

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Diabetes is an escalating national problem1

- 3.4 million patients to 5.6 million patients with Type 2 diabetes by 2035/36 in the UK - 9.8Bn to 16.9Bn of direct costs to the NHS by 2035/36 - 10% to 17% of NHS Expenditure

2010 2015 2020 2025 2030

5m

4m

3m

2m

1m

0m

9.5% 9.0%

8.5% 8.0%

English Diabetes Prevalence2

1. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs, Diabetic Medicine, 2012 2. AHPO Diabetes Prevalence Model , November 2012

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A pseudonymised data asset to provide a holistic view

of the whole pathway

Primary care Secondary Care

Pathology (LIMS)

E-prescribing

Nephrology

Diabetes

Imaging

Retinopathy

Solihull Community

CDS Administrative data

– Inpatient, outpatient,

A&E

Pathology results

Imaging activity and

scans

Retinal screening and

results

Community services

Inpatient prescriptions

Diabetes clinic specialist

database

Dialysis and other renal

specialist information

Other providers of care*

GP data

157 indiv idual

practices

– Indiv idual

engagement and data

agreements with each

practice

Pharmacy

Celesio Retail pharmacy

data

HE

FT

Info

rmati

cs

- P

seu

do

nym

isati

on

BCHC Birmingham City Council

Digital Health

Pro

vid

er

Syst

em

Pse

ud

on

ym

isati

on GP1

GP2

GPn

*On going discussions in relation to organisational participation in Insights for Care

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Contributes:

Data access

Independence, scientific research credibility

Cross-setting relationships

Service redesign implementation

Contributes:

Project funding

Pharmaceutical expertise

Publication support

Contributes:

Technical expertise & capability

Information governance compliant trusted third party

Analysis & intellectual property

Project management

Insights for Care is a three-way Real World Evidence partnership

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Commissioner

MSD

Hospital Trust

Pressing

Issues…

How can I manage the

burden of an aging

population with LTCs?

How can I reduce A&E

attendances of the most

seriously ill patients?

…demand novel solutions

Which Patients?

Remote Monitoring / Digital Health

Which Model of Care?

Observational Research

Innovative contracting

Evidence

Insights

Partnerships

Innovation

…required to improve

outcomes

Pati

en

t O

utc

om

es

Business Model Innovation

Collect PROs

Vital signs

Analytics can provide

the insight…

In which patients can our

medicines hav e most

impact?

How do my business

models need to adapt e.g.,

‘Beyond the Pill’?

What new public sector

partnerships are possible?

Integrated Models of Care

Patient Adherence programmes

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Insights for Care can enable clinicians to do more by unlocking the

value of Real World Evidence

• My frustrations as a clinician in delivering care without adequate information and insight? ‒ What does my patient population actually look like? What is the local burden of disease and

demographic mix?

‒ How are my patients managed in primary care? How often to they visit their GP? What are their diagnoses and prescriptions?

‒ Who are my most vulnerable populations?

‒ Where can I make the biggest difference to my patients’ diabetes outcomes with new services?

‒ How can I demonstrate to my Trust and CCG that my new service intervention actually works?

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Real World Evidence has the potential to address several key

limitations of classical clinical trials

• Currently, there are several limitations with clinical trials: ‒ Inclusion / exclusion criteria create an unrepresentative patient group (e.g., age groups, co-morbidities,

etc.)

‒ Cannot capture factors such as health professional behaviour, adherence to guidelines, etc.

‒ Limited ability to understand impact on long term outcomes

• Real World Evidence can address many of the above limitations:

‒ Provides insights into practical aspects of clinical care

‒ Allows design of care models that are appropriate for local communities (e.g., Retinal screening frequency, benefits of new therapies, hypoglycaemia, etc.)

‒ Allows resource investment to drive better outcomes through ongoing evaluation and improvement

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It can help ensure patients living with diabetes have access to the most

appropriate treatment pathway…

• Risk stratification underpinned by analysis of patient demographic and clinical data can be used to ensure that treatment pathways are aligned with the current burden of a patient’s disease and its likely evolution

0%

5%

10%

15%

< 6.5 6.5 - 7.5

9.5 - 10.5

8.5 - 9.5

>10.5 7.5 - 8.5

Five-Year Mortality by baseline HbA1c

2008 2009 2010 2011 2012 2013 2014

0%

100%

98%

96%

Quartile 2

Quartile 1

Quartile 3

Quartile 4

Survival by IMD Quartile Hypothetical data, for Illustrative purposes only

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HBA1C Year

Surv

ival

Mo

rtal

ity

…And that vulnerable groups of patients do not ‘slip through the net’

0%

25%

50%

75%

100%

45 + 40 - 45

15%

35 - 40

20%

75%

30 - 35

40%

25 - 30

50%

20 - 25

53%

15 - 20

54%

< 15

60%

Attend Education

Programme

Structured Education Attendance versus Index of Multiple Deprivation

• Attendance at structured education programmes drops off sharply for high-deprivation patient groups, identifying areas where new interventions have the potential to significantly improve outcomes

Key Target for New Interventions

Index modelled deprivation % o

f P

ts w

ith

Dia

be

tes

acce

ssin

g

stru

ctu

red

ed

uca

tio

n

Hypothetical data, for Illustrative purposes only

Insights for Care also has the potential to quantify the benefits of new

interventions

6

7

8

9

10

11

12

13

36 30 24 18 12 0 -12 -18 -24 -30 -36

Hb

A1c (

%) Median

Treated with single OAD Treated with multiple OAD

Q3

Q1

• We can track glycaemic durability in simplified Rx pathways – potentially allowing us to quantify the benefit of more intensive monitoring

Time to Transition to Insulin (Months)

Hypothetical data, for Illustrative purposes only

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The IfC programme can also provide a range of organisational benefits

for Heart of England NHS Foundation Trust

• The Trust recognises key benefits for its community and development of services from the partnership: ‒ Deeper understanding of the community we serve

‒ Maximising the value of existing patient data to inform best care

‒ Tailoring of services to improve patient outcomes

‒ Improved future capacity planning and operational efficiency

‒ Greater research output for wide dissemination

‒ Improved Management against KPIs / targets

‒ Supporting professional development and attracting/retaining talent

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The programme is underpinned by a robust governance framework…

• Insights for Care’s Information Governance processes and policies have been approved by the HEFT Caldecott Guardian and Board, and reviewed by Birmingham CrossCity CCG

• Our research protocol has been reviewed and received a favourable opinion by HEFT’s and MSD’s internal research ethics processes and by the HRA South East Coast Surrey Research Ethics Committee

• We have also received positive feedback on project Information Governance from the HRA Confidentiality Advisory Committee (CAG)

‒ The CAG confirmed “the data disclosed to Deloitte was not considered to constitute confidential patient information as the identity would not be ascertainable by those in receipt of and processing data”

• The CAG also gave positive feedback on the level of patient engagement in IfC, and

the general governance arrangements in place

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…And a multi-channel approach to external communications

• Patient awareness posters displayed in all HEFT clinics commonly visited by diabetic patients, communal areas in HEFT and in participating GP surgeries

• Patient awareness / opt-out leaflets (with freepost envelopes) displayed all HEFT clinics commonly visited by diabetic patients and in participating GP surgeries ‒ Available in English and five most common monoglot languages in

HEFT catchment

• Patient helpline at HEFT to answer enquiries • Presence on HEFT and CCG websites* • HEFT and CCGs communicating IfC to all GPs (participating and not) to

provide awareness should their patients make enquiries Note: * In process

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Lessons Learnt

Have a shared vision! Drive each other!

Early engagement across all organisations

Underpin the collaboration with strong governance

Strong project planning and communications

• Build broad stakeholder relationships • Align benefits to addressing organisational challenges and objectives • Organically grow from one disease area of interest

• Governance by design • Identify external expertise to support Caldecott guardians and IT • Patient and public engagement and involvement

• Strong project management with weekly progress calls • Strong clinical engagement • Resourcing commitment from all parties

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Thank you!

Questions for the Panel

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