using data to evidence eip service quality 2 mar 2017 - nhs … health/eip/eip... · 2017. 3....
TRANSCRIPT
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Using Data to Evidence EIP Service Quality
Nick Gitsham and Michael Watson
Intensive Support Team – Mental Health
2nd March 2017
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Overview
1. Measuring the EIP standards:
– Data sources
– NICE-concordant care
– SNOMED-CT
– Waiting times
– Local data
2. Changes to EIP reporting
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Measuring the EIP Standards
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EIP Standards
• By 1 April 2016, more than 50% of people experiencing a first episode of
psychosis will be treated with a NICE-approved care package within two
weeks of referral
1. Treatment delivered in accordance with NICE guidelines for psychosis
and schizophrenia – either in children and young people or in adults
2. A maximum wait of two weeks from referral to treatment
• Most initial episodes of psychosis occur between early adolescence and age
25 but the standard applies to people of all ages
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Data sources
• Mental Health Services Dataset (MHSDS) is the repository:
http://content.digital.nhs.uk/mhsds
• All data is submitted by providers
• Mental Health Five Year Forward View Dashboard:
https://www.england.nhs.uk/mentalhealth/taskforce/imp/mh-dashboard/
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NICE-Concordant Care
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NICE-Concordant Care
• NICE clinical guideline 155 (2013)
Psychosis and schizophrenia in
children and young people
• NICE quality standard Bipolar
Disorder, Psychosis and
Schizophrenia in Children and Young
People
• NICE clinical guideline 178 (2014)
Psychosis and schizophrenia in
adults: treatment and management
• NICE quality standard Psychosis and
schizophrenia in adults
• It is planned to use Systematized
Nomenclature of Medicine Clinical
Terms (SNOMED-CT) to assess this
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NICE-Recommended Treatments
Early intervention in psychosis services should aim to provide a full range of
pharmacological, psychological, social, occupational and educational interventions for
people with psychosis, consistent with this guideline.
For people with first episode psychosis offer:
• oral antipsychotic medication in conjunction with
• psychological interventions (family intervention and individual CBT)
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SNOMED CT
• The most comprehensive and precise clinical healthcare terminology product in the
world
• Allows healthcare observations and interventions to be recorded consistently using a
logical structure that supports data analysis
� better decision making and improvements in care
• Being implemented across all NHS care settings
• Interventions and outcome tools should be recorded (by clinicians) in the MHSDS
using SNOMED CT codes
• Assessments, reviews, tests, therapies etc. can all be submitted as a Care Activity
using the Coded Procedure item
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EIP SNOMED Overview
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NICE Intervention SNOMED-CT description SNOMED-CT ID
CBT for psychosis CBT for psychosis 984091000000108
Family intervention Family intervention for psychosis 985451000000105
Antipsychotic medication Medication monitoring 395170001
Physical health interventions and monitoring Assessment of physical health 705139001
Diabetic care 385804009
Weighing patient 39857003
Weight management programme 990121000000104
Cardiovascular therapy 309513005
Combined healthy eating and physical education
programme
967251000000101
Referral to smoking cessation service 871661000000106
Supported employment programmes and
vocational rehabilitation
Educational rehabilitation 183339004
Vocational rehabilitation 70082004
Carer-focused education and support programmes Carer-focused education and support programme 985651000000108
Care Planning Provision of information about psychosis 985681000000102
Mental health care and treatment planning 861361000000109
Substance misuse Substance misuse assessment 777041000000105
Substance use therapy 385989002
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SNOMED Status
• No reports using SNOMED codes have yet been produced nationally
• No precise definition of which codes would stop the clock, or how, has yet
been issued
But…
• Accurate treatment recording is still clinically important
• Used for clustering and, in the future, payments
• Several DQ items to monitor use:
– MHS-DQM23 shows valid SNOMED ‘procedure’ codes used
– MHS-DQM27 shows valid SNOMED ‘finding’ codes used
– MHS-DQM30 shows valid SNOMED ‘observation’ codes used
– But only shows the number of valid codes, not how many times the
codes ‘should’ have been used!
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Systems used by providers submitting SNOMED codes to MHSDS
• ACS
• Care Notes
• EPEX
• Lorenzo
• Paris
• RiO
• Silverlink
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System Suppliers
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Provider System supplier
Bradford District Care Trust RiO
Community Links (northern) Ltd Paris
Humber NHS Foundation Trust Lorenzo
Navigo Silverlink
Nottinghamshire Healthcare NHS Trust RiO
Rotherham Doncaster And South Humber NHS Foundation Trust Silverlink
Sheffield Health & Social Care NHS Foundation Trust Local solution
South West Yorkshire Partnership NHS Foundation Trust RiO
Tees, Esk And Wear Valleys NHS Foundation Trust Paris
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SNOMED Usage
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SNOMED Usage
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SNOMED Issues
So…
• Is your system compliant with SNOMED?
• Is the SNOMED assessment directly linked to the relevant appointment?
• Have staff been trained on how/which codes to use?
• Is the full list available e.g. RiO?
• Any other issues?
Reference resources and webinars available at:
https://digital.nhs.uk/snomed-ct
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Waiting times
Clock starts and stops
Your data
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Guidance documents
https://www.england.nhs.uk/mentalhealth/resources/access-waiting-time/
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Waiting Times Principles
• Choice of the time of treatment by the person is important i.e. DNAs and
cancellations do not stop the clock
• Al patients should be offered a timely appointment
• Measurements and monitoring of the standards should always keep the
experience of the person at the centre
• Local areas are accountable for the information that they report and submit
• In addition to tracking compliance against clock stop standards, waiting times
for incomplete referral pathways will be monitored both nationally and locally
– Proportion of people waiting more than two weeks following referral
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Referral to Treatment
• All patients should:
• Have been assessed by the EIP service
• And, where appropriate:
• Have been accepted onto the EIP service caseload
• Have been allocated an EIP care coordinator who has actively engaged
with the person to develop a plan of care and commence treatment in
line with NICE recommendations
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Clock Starts
• Referral received for a person with suspected first episode psychosis (FEP),
or is recognised as such upon receipt.
– The primary reason for referral should be suspected FEP
– The clock start date is defined as the date referral received
• Where pathways start with an interface service, the clock start date is the
date the interface service receives the referral – not the date the referral is
passed onto the relevant clinical team.
• Where a primary reason for referral is not recorded as suspected FEP but
this is identified during triage/SPA, the clock start date is the date of initial
referral
• If this is not suspected during triage but at a subsequent assessment then
the date the clock starts is when suspicion is first raised.
– If a person is already in the system the clock starts when suspicion of
FEP is first raised
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MHSDS
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MHSDS
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Clock Start Data
• MHS101 – Service or Team Referral
– Primary reason for referral = 01 (Suspected) First Episode Psychosis
– Referral request received date
• Only referrals where Primary reason for referral is 01 (Suspected) First
Episode Psychosis are included.
• People could have a co-existing problem and this might be recorded in Table
MHS103 as Other Reason for Referral
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FEP Referrals Received – CCG
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FEP Referrals Received – Provider
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Clock Stops
• The patient is confirmed as having FEP or suspected FEP following
assessment
or
• The patient is confirmed as requiring ‘at risk’ mental state (ARMS) specialist
assessment
And
• NICE-approved package of care starts, this is when the person:
1. has been accepted on to the caseload of an EIP service, AND
2. has had an initial assessment, AND
3. has been allocated to and engaged with an EIP care coordinator
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MHSDS
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MHSDS
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1. Accepted on to the caseload of an EIP
service
• MHS102 Service or Team Type Referred To
• Care Professional Team Local Identifier = links to MHS201 (Care Contact)
• Service or Team Type Referred to =
A14 Early Intervention Team for Psychosis
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MHSDS
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MHSDS
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2. Initial assessment
• MHS201 Care Contact
• Care Professional Team Local Identifier = link to MHS102
• Consultation Medium Used =
– 01:Face to face communication
– 02:Telephone
– 03:Telemedicine web camera
– 04:Talk type for a person unable to speak
• Attended or did not attend code =
– 5 Attended on time or, if late, before the relevant professional was ready
to see the patient
– 6 Arrived late, after the relevant professional was ready to see the
patient, but was seen
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FEP First Contacts – CCG
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FEP First Contacts – Provider
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Use of SNOMED for assessment
To indicate allocation of a care coordinator and commencement of ARMS
assessment – table MHS202
• Care Professional Team Local Identifier = link to MHS102
• Procedure Scheme in Use = 06 – SNOMED
• Coded Procedure =
802551000000107 – Mental health risk indicator assessment
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MHSDS
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MHSDS
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3. Allocated to and engaged with an EIP care coordinator
• “The care coordinator actively attempts to form a therapeutic professional
relationship with the person and offers treatment to them”
• MHS006 Mental Health Care Coordinator
• Care Professional Service or Team Type Association (Mental Health) =
A14 Early Intervention Team for Psychosis
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Care Coordinator Allocation – CCG
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Care Coordinator Allocation – Provider
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Summary
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FEP Patients Treated – CCG
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FEP Patients Treated – Provider
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Key Points
• Only patients treated in the period are counted, not patients stopped for non-
treatment
• Only patients referred on or after 01/01/2016 are included in waiting times.
Unify collection does not exclude these but this should be minimal by now
• The clock is not affected by patients who cancel and DNA
• ARMS is only identified after a contact and if a SNOMED code is recorded
• It is planned to use SNOMED to assess NICE-compliance
• Currently very little SNOMED data
• SNOMED data is not reported except through data quality reports
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Changes in EIP reporting
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Unify2 and MHSDS
• Unify2 submissions extended to June 2017 (submitted in August 2017)
• MHSDS will be primary source for performance information from April 2017,
i.e. data submitted in June 2017 (preliminary) and July 2017 (refresh)
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Publication month Unify2 data MHSDS data
April 2017February 2017 (Final) January 2017 (Final)
February 2017 (Provisional)
May 2017March 2017 (Final) February 2017 (Final)
March 2017 (Provisional)
June 2017April 2017 (Final) March 2017 (Final)
April 2017 (Provisional)
July 2017May 2017 (Final) April 2017 (Final)
May 2017 (Provisional)
August 2017June 2017 (Final) May 2017 (Final)
June 2017 (Provisional)
September 2017June 2017 (Final)
July 2017 (Provisional)
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Unify2 and MHSDS EIP data
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1 Figures rounded to nearest 5* Replaces values 0-4
Su
bm
itte
d r
eco
rds
in
MH
SD
S
Su
bm
itte
d E
IP r
eco
rds
in
MH
SD
S
Su
bm
itte
d r
eco
rds
to
Un
ify
EIP
op
en
re
ferr
als
(31
/12
/16
) -
MH
SD
S1
EIP
op
en
re
ferr
als
(31
/12
/16
) -
Un
ify
EIP
en
teri
ng
tre
atm
en
t
(01
/10
/16
-3
1/1
2/1
6)
-
MH
SD
S1
EIP
en
teri
ng
tre
atm
en
t
(01
/10
/16
-3
1/1
2/1
6)
-
Un
ify
BRADFORD DISTRICT CARE Yes Yes Yes 30 29 80 69
COMMUNITY LINKS (NORTHERN) LTD Yes Yes Yes 20 19 60 50
HUMBER NHS FOUNDATION TRUST Yes Yes Yes 5 6 30 35
NAVIGO Yes Yes Yes 5 4 10 12
NOTTINGHAMSHIRE HEALTHCARE Yes Yes Yes * 13 15 105
ROTHERHAM DONCASTER AND SOUTH HUMBER Yes Yes Yes 35 2 * 124
SHEFFIELD HEALTH & SOCIAL CARE Yes No Yes * 13 * 43
SOUTH WEST YORKSHIRE PARTNERSHIP Yes Yes Yes 25 21 75 79
TEES, ESK AND WEAR VALLEYS Yes Yes Yes 105 90 160 148
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October – December Patients Treated
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sheffield Health& Social Care
NHS FoundationTrust
Rotherham,Doncaster andSouth Humber
NHS FT
NottinghamshireHealthcare NHS
Trust
CommunityLinks (northern)
Ltd
Tees, Esk AndWear Valleys
NHS FoundationTrust
South WestYorkshire
Partnership NHSFoundation Trust
Bradford DistrictCare Trust
Humber NHSFoundation Trust
Navigo
% Patients Treated Who Waited
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Patients Waiting: 31/12/16
50
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Rotherham,Doncsater and
Humber NHS FT
Sheffield Health& Social Care
NHS FoundationTrust
NottinghamshireHealthcare NHS
Trust
Community Links(northern) Ltd
Bradford DistrictCare Trust
South WestYorkshire
Partnership NHSFoundation Trust
Tees, Esk AndWear Valleys
NHS FoundationTrust
Humber NHSFoundation Trust
Navigo
% Patients Not Yet Treated Who Have Been Waiting
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Contact
Nick Gitsham Michael Watson
Intensive Support Manager Intensive Support Manager
M: 07730 376404 M: 07879 113249
E: [email protected] E: [email protected]
Follow us on Twitter
@MH_ISTNetwork