Integrated Care Pathways Integrated Care Pathways

Integrated Care Pathways for Mental Health:

An over view & your part in variance reporting

(debate).

Mark FlemingMark Fleming

Linda McKechnieLinda McKechnie

David ThomsonDavid Thomson

National ICP CoordinatorsNational ICP Coordinators

NHS Quality Improvement ScotlandNHS Quality Improvement Scotland

Delivering for Mental Health

Commitment 6

“NHS QIS will develop the standards for ICPs for schizophrenia, bipolar disorder, depression, dementia, and personality disorder by the end of 2007. NHS Board will develop and implement ICPs and these will be accredited from 2008 onwards.”

Definition Definition

An ICP determines locally agreed multidisciplinary An ICP determines locally agreed multidisciplinary

practice, based on guidelines and evidence where practice, based on guidelines and evidence where

available for a specific patient/client group. It forms all or available for a specific patient/client group. It forms all or

part of the clinical record, documents the care given, and part of the clinical record, documents the care given, and

facilitates the evaluation of outcomes for continuous facilitates the evaluation of outcomes for continuous

quality improvement.quality improvement.

Source: National Pathways Association, 1998

Definition

A way to compare planned care with care actually given

NHS QIS 2007

Key FeaturesKey Features

• Multidisciplinary / multi-agencyMultidisciplinary / multi-agency

• Part of the clinical recordPart of the clinical record

• Defined beginning and endDefined beginning and end

• Evidence based and best practiceEvidence based and best practice

• Patient focusedPatient focused

• Measurable outcomesMeasurable outcomes

• Variance analysisVariance analysis

Variances

What are variances?If care is not delivered as planned the

reason (variance) is completed on the ICP

Compare planned care against care actually given

What is variance analysis?

A summary of reasons when care is unable to be delivered as planned

Examine trends, patterns of variance and identify if something needs to

change as a resulte.g training needs, provision of

services, pathway changes.

Benefits of Variance Analysis

• Highlight issues which the service can resolve• Help clinicians understand better why care might

not have been delivered as planned• Identify gaps in service provision and training

needs• Highlight areas where extra resources may be

required• Identify differing practices and reasons behind

these• Clinicians receive routine feedback on

performance /activity and practice• Identify areas of development for care pathway• Provide important information for clinical

governance reporting/audit/meeting standards

What is it really!!!

Real time clinical audit within a Governance Framework??

AssessmentCare

PlanningCare

Delivery

• Social needs• Recovery approach• Interventions• Talking therapies• Admission/transfer• Review & follow up

information

info

rmat

ion

Management of variance /

decision making

Tier 1: patient varianceleading to individual

care redesign

Tier 3: NHS board level leading to

service redesign

Tier 4: SEHD / NES / NHS QIS

national redesign

PerformanceManagement

Mechanism for tracking

variations from plan

• Measurement of outcomes

Values base/Evidence base/good practice

Local ICP

Gov

erna

nce

Tier 2: clinical team level leading to

local service improvements

Perceptions can differ!

We think things are working but is there a better way of doing it?

How do we gauge the experience? Let others know?

How can we ensure the facility and opportunity is available to collect variance in a meaningful way?

What measures could be put in place for BPD and what are the

challenges?• Consistency of care• Decisions on hospital admission• Crisis management• Medication management of symptoms• Risk assessment and management• Patient involvement in care planning

DISCUSS/ASK???