Integration to avoid
hospital admission:
ITHAcA
Sarah Purdy on behalf of the
HIT
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What is a HIT?
Health Integration Team
 modus operandi of Bristol Health Partners
 Should:
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improve outcomes across the patient pathway
create an integrated whole health system approach
promote research
disseminate innovation and evidence
align with education/training
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ITHAcA
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Aims to reduce avoidable hospital admissions
across BNSSG
 increase enablement of patients and carers
 reduce complexity in urgent care system
 develop capacity to use data and evaluate changes
 optimise productivity and efficiency of existing and new
interventions
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Includes all BHP partners plus BCC and
collaborators
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Address priorities for BHP
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NHS outcomes framework – reducing emergency
admissions adults and children
Highest bed days for LTCs in South West
Admissions for COPD 25% above average
Rising population over 65 years of age - pressure on
social and health care
Acute services redesign and integration priority for NHS
partners
“Admissions should be
appropriate, focused and effective”
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Challenges in urgent care: diagnosis
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simplify systems in and
OOH
match demand and
capacity
expert early assessment
reduce LOS in bedded
settings
address needs of high
risk populations
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Key
Benefits measurement – balanced scorecard approach
Operating Principles
1st June priority - top
Urgent care potential work streams
End of Life
Care
planning
Prevent
1st June priority - next
Existing work streams
Public
comms –
GP 24/7
Simplify
Other Healthy Futures
project/programme
Early senior
review at first
point of
contact
Front
Load
Match
demand
and
capacity 7
days a
week
Create
Reliability
Preventative
Escalation
Urgent
care
centres –
location
and spec
Connecting
Care –
integrate
information
NHS111 &
Directory of
services – avoid
multiple SPAs
Mental
Health
Liaison
Directory of Emergency
Ambulatory Care/Hot
Clinics (Professional
SPA link)
See
and Sort
Protocol for
ambulance
management
of HCP calls
with referrers
Minimise time in bedded
Invest in
settings
Cultural
enablers
Address financial
disincentives through tariff
changes and/or budget
integration
discharge
enablers
Advice &
Guidance
Flow
Enablers Focus on
Alternatives
Enablers
Urgent
category
transport
(same day,
1 hour)
reducing LOS –
pull from front
door, pull from
back
Evidence-base – Health Improvement Teams/Partnership integration
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Evidence based strategy targeting four
areas
1.
Using data to inform commissioning
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Model patient flows – system dynamics
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Risk profile severity at presentation
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Increase understanding of triggers for admission using
qualitative methods and case studies
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Evaluate new interventions – start with NHS 111
2.
Childhood asthma
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Model patient flows
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Inform development of interventions
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Evidence based strategy targeting four
areas
3.
4.
Dementia and intercurrent illness
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Ensure appropriateness of admission and discharge
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Increase understanding of burden on carers with aim of
increased support at home and reduced long term care
placement
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Develop living environments to sustain people with
dementia who wish to live in the community
COPD
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Optimise productivity and efficiency of existing
interventions
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Introduce and evaluate new evidence based approaches
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Improving and integrating COPD care
Improve utilisation
of smoking
cessation
Map
services
Severity at
presentation
Increase
pulmonary
rehab uptake
Model
flow
Evaluate
BTS care
bundles at
NBT
Short term 1-3 years
Acute
admission
prevention
strategy
Exemplar
for other
conditions
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Other components of a COPD acute
admission prevention strategy
Medium term (3-6 years)
Longer term (5-10 years)
Intensive education
in self management
with follow up
Increase expertise
amongst community
staff
Earlier
diagnosis
New models of
specialist/GP
working
Specialist led
care for all
admissions
Develop and pilot
new interventions
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ITHAcA strengths
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Strong existing links between senior individuals in all
partner organisations around the problems to be
addressed + underpins existing mechanisms
Expertise in research, clinical, social care and
organisational development
Links to:
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existing PPI groups
other proposed HITs
Pilot work to develop initial project funded and potential
programme manager in post
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ITHAcA challenges and opportunities
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Potentially huge agenda but a priority
NHS reconfigurations and reforms
Need for whole system changes and buy in
Robust evaluation has resource implications
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NIHR HS&D Research Programme calls: New models of
care for LTCs EOI Jan 2013
Sustaining impetus – HIT longevity an
opportunity
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