Heart Failure Collaborative
Wednesday 25 March 2015
Hospital Heart Failure
Update
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
Performance
Variation
Benchmarking
EQR to 2014
Performance
Consistent
improvement
over 4 years
EQR to 2014
Performance
Consistent
improvement
over 4 years
EQR to 2014
Performance
Fall off 2014
? Loss CQUIN
But not seen in
other pathways
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
EQR to 2014
Variation
Process
Measure
(ACS)
Outcome
measure
EQR to 2014
Benchmarking (XXXTrust)
EQR
XXXT
EQR to 2014
Benchmarking (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 187
National tariff proposals
National Audits
5 year plans
CQC
Acute Heart Failure CG 187
Organisation 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.
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”.
Medical Director of NHSE
Medical Director of NHSE
Parliamentary Under Secretary of State for Quality
Medical Director of NHSE
Parliamentary Under Secretary of State for Quality
Chief Inspector of Hospitals at the CQC
EQR – National HF Audit
Rationale
Care bundles
Additional 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 data
Care bundle (ACS)
EQR
•
•
•
•
Echo
ACE / ARB (On discharge)
Management plan
Smoking cessation
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
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 old
In 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.
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]
To be discussed
•
•
•
•
•
High level exception reporting
Patient experience surveys
Long term conditions data collection
Benchmarking
Commissioning
Acute Trust: D&G
Provider: Virgincare NW
Team
Covers NW Surrey CCG .
All cause HF.
Acute Trust: MFT
Provider: CSH Surrey
Covers: Surrey Downs
CCG. LVSD<40%
Acute Trust: ASPH
Acute Trust: RSCH
Provider: Kent Community
NHS Trust
Acute Trust:
SASH
Provider: Virgincare SW Team
Covers: Guildford and Waverly
CCG. All cause HF
Crawley team.
Covers
Horsham & Mid
Sussex CCG
LVSD<50%
Chichester team.
Covers Coastal
West Sussex
CCG
LVSD<50%
Acute Trust: WSHT
(St Richards)
Acute Trust: MTW
Provider: FCHC
Covers: East Surrey
CCG. LVSD<55%
Provider:
Sussex Community NHS
T
HF MAP
2015
Provider:
Kent Community NHS T
Acute Trust:
EKHFT
Provider:
East Sussex Community
Health Care : All cause
HF
West team
High Weald Lewes Havens CCG
Eastbourne, Hailsham & Seaford
CCG. All cause HF
Brighton team.
Covers: Brighton &
Hove CCG
All cause HF
Acute Trust: WSHT
(Worthing)
Provider:
Medway Community
Healthcare
Acute Trust: BSUH
Acute Trust: ESHT
East team
Hastings and Rother
CCG. All cause HF
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?
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 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.
•
•
Quality measure
Structure:
Quality measure 6
MDT
• 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 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.
• 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 benchmark
and aid commissioning
Refreshment break
The National Heart Failure Audit
2013/14
Professor T A McDonagh, King’s
College Hospital, London. UK
The National Heart Failure
Audit-8th 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) ICD10 codes
• Purpose is to use the data to improve
the standard of care
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 HFREF/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
Mortality Data from the National
Heart Failure Audit 2013-2014
• In Hospital
•
9.5% (same as last year)
•
Was 11.1% in 2011/12
• 30-day
•
15%
• 1 year (within the audit year)
•
34%
•
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
The target is the overall proportion of 0.095.
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.
ACM following discharge
• 24.7 % at end of FU (median
180 days)
ACM Post Discharge in Those
with LVSD and Disease
Modifying Drugs
ACM for Survivors by Quality of
Care
Indicators
Place of Care
HF Nurse
Cardiology Follow Up
Cox Proportional Hazards
Model for ACM
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
•
•
•
•
•
•
•
•
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.
The Future
• 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
Thank you 2013-14 !!
Polly Mitchell
Damian Marlee
Julie Sanders
Project Board
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
www.ncvin.org.uk
NCVIN Overview:
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;
93
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
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
Behavioural risk factors
Fact sheet 1
Smoking
ethnicity, deprivation
Fact sheet 2
Obesity
Fact sheet 3
Physical activity
Fact sheet 4
Nutrition
Fact sheet 5
Alcohol consumption
Bodily risk factors
Fact sheet 7
Hypertension
disease
Fact sheet 8
Diabetes
failure
Fact sheet 9
Kidney disease
Fact sheet 10
Familial
hypercholesterolemia
dementia
98sheet 16
Peripheral arterial disease
Non Behaviour risk factors
Fact sheet 6
Age, sex,
CVD diseases
Fact sheet 11
Cardiovascular
Fact sheet 12
CHD and heart
Fact sheet 13
Fact sheet 14
Fact sheet 15
Atrial fibrillation
Stroke and TIA
Vascular
Fact
Cardiovascular Profiles:
Overview of CVD
Risk factors
Heart disease
Diabetes
Kidney
Stroke
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
Summary:
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
Overarching messages
6
Where does the CCG
compare poorly against its
cluster group?
Analysis by pathway
stage
(page
1 of 2)
Indicators
in the
worst quintile
versus benchmark group - difference
Table1
between the CCG and the benchmark, (p) – PCT based indicator
No indicators in the worst quintile
Opportunity - if the CCG were
to equal the benchmark
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
Analysis
Number of Indicators
where CCG has room for
improvement*
17/20 primary care
indicators
*below the average of the best 5 CCGs in the cluster group
11
Where does the CCG
compare poorly against its
cluster group?
Analysis by pathway
stage
(page
2 of 2)
versus benchmark group - difference
worst quintile
in the
Indicators
Table2
51/62 secondary care
indicators
1/1 social care indicators
between the CCG and the benchmark, (p) – PCT based indicator
CHD: average cost per female emergency admission (34.1 % higher)
Stroke male emergency admissions (DSR) (34.1 % higher)
Heart failure: average cost per female emergency admission (13.3 % higher)
CVD: average male elective LOS (41.8 % higher)
CVD: average female elective LOS (134.9 % higher)
Stroke: average male emergency LOS (240.3 % higher)
Angiography procedures: female average cost (78.2 % higher)
Angiography procedures: male LOS (119.1 % higher)
Angiography procedures: female LOS (87.4 % higher)
Angioplasty procedures: female average cost (12.9 % higher)
CABG procedures: male (DSR) (74.6 % higher)
CABG procedures: male (LOS) (104 % higher)
CABG procedures: female (LOS) (111.3 % higher)
New implantable cardioverter-defibrillator procedures (p) (86 % higher)
Opportunity - if the CCG were
to equal the benchmark
£157K
47 admissions
£65K
334 bed days
643 bed days
632 bed days
£71K
1,331 bed days
512 bed days
£19K
34 procedures
929 bed days
259 bed days
159 procedures
No indicators in the worst quintile
No indicators in the worst quintile
*below the average of the best 5 CCGs in the cluster group
Analysis
Number of Indicators
where CCG has room for
improvement*
12
Bring it all together:
what works, what could work,
who should we speak to
Prevention of cardiovascular disease
Hypertension
Atrial fibrillation
Stroke
Chronic heart failure
Lipid modification
Contact the NICE field
team for support and
advice on implementing
NICEquality
guidance
The
and productivity
collection provides quality
assured examples of
improvements across NHS
and social care and include
cardiovascular and stroke.
Analysis
NICE Guidance, Quality Standards etc.
Myocardial infarction with ST segment
elevation
Look at NICE shared
learning examples from
organisations that have put
Lower limb peripheral arterial disease
guidance into practice.
Smoking prevention and cessation
Examples include peripheral
Obesity
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.
15
Annex 1:
spine charts
KEY
:
England
best
Worst quintile in
cluster
Prevention
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)
Better outcome \ Low
prevalence
Opportunit
y
3,071 people
229 people
1,912 patients
-
Annexes
England
worst
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
* (p) = PCT based indicator
58 people
1,259 people
182 people
152 people
585 people
3,185 people
95 people
232 people
178 people
744 people
For data sources used, see slide
16
Annex 1:
spine charts
KEY
:
England
best
Worst quintile in
cluster
Primary care
Worse outcome
% patients with CHD whose last BP reading is 150/90 or less
% patients with CHD whose cholesterol is 5mmol/l or less
% CHD patients record of aspirin
% CHD patients treated with a beta blocker
% 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
% of patients with HF due to LVD, treated with ACE inhibitor
% of patients with HF due to LVD, treated with ACE + beta-blocker
% of patients with stroke/TIA last BP is 150/90 or less
% of patients with stroke/TIA record of cholesterol
% of patients with stroke/TIA cholesterol is 5mmol/l or less
% of patients with stroke/TIA had influenza immunisation
% of stroke patients with a record an anti-platelet agent taken
% of new stroke/TIA patients referred further investigation
% of patients with hypertension record of BP
% of patients with hypertension BP is 150/90 or less
% AF patients stroke risk assessed using CHADS2
AF & CHADS2 score of 1, % treated anti-coagulation drug therapy
AF & CHADS2 score > 1, % treated anti-coagulation drug therapy
* (p) = PCT based indicator
Better outcome
Opportunit
y
53 people
14 people
2 people
291 people
0 people
12 people
30 people
44 people
90 people
81 people
10 people
31 people
412 people
778 people
75 people
8 people
86 people
For data sources used, see slide
Annexes
England
worst
17
Annex 1:
spine charts
KEY
:
Secondary
care
Worst quintile in
cluster
Worse outcome
CVD: average cost per male emergerncy admission
CVD: average cost per female emergerncy admission
CVD male emergerncy admissions (DSR)
CVD female emergerncy admissions (DSR)
CVD: average male emergency LOS
CVD: average female emergency LOS
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
CVD: average female elective LOS
CHD: average cost per male emergerncy admission
CHD: average cost per female emergerncy admission
CHD male emergerncy admissions (DSR)
CHD female emergerncy admissions (DSR)
CHD: average male emergency LOS
CHD: average female emergency LOS
CHD: average cost per male elective admission
CHD: average cost per female elective admission
CHD male elective admissions (DSR)
CHD female elective admissions (DSR)
CHD: average male elective LOS
CHD: average female elective LOS
* (p) = PCT based indicator
England
best
Better outcome
Opportunit
y
£207K
£158K
222 admissions
200 admissions
3,930 bed days
1,752 bed days
334 bed days
643 bed days
£160K
£157K
53 admissions
35 admissions
184 bed days
209 bed days
£52K
£3K
54 bed days
14 bed days
For data sources used, see slide
Annexes
England
worst
18
Outcome versus Expenditure Tools:
Cardiovascular and Diabetes
DOVE
tool
Presentation title - edit in Header and Footer
Presentation title - edit in Header and Footer
Outcome
versus
expenditure
tool
http://www.yhpho.org.uk/default.aspx?RID=200330
116
National Cardiovascular Intelligence Network
Presentation title - edit in Header and Footer
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 Masterclasses
One half day session in each
SCN
Programme: Introduction
Delivered in Partnership
with:
World café
NICOR
Local data
National Diabetes Audit
Local example
Sentinel Stroke National Audit
Programme
Renal Registry
Commissioning for Value
121
NHS Health Checks
Master class Programme
22 April 2015 London www.phe-events.org.uk/ncvinlondon
21st May 2015, East of England
11th June 2015, South East
9th 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
125 www.ncvin.org.uk
Thank you
sally.crick@phe.gov.uk
126
Lunch in Traders
Restaurant