15th November 2013
Steve Byng- PbR Implementation Lead DWMH Trust- Facilitator of Regional Quality
and Outcome Group
Mike Jones- Project Manager, South Staffordshire and Shropshire NHS Foundation
Trust
1
Aims of Presentation
Update on current position of the Quality and Outcome Agenda
Role of the Regional Quality and Outcome Group
What are Quality and Outcome Measures?
14/15 Guidance – Next Steps
2
Regional Quality and Outcome Group
•Sub Group of Regional PbR Steering Group
•Attended by regional Trusts:•Dudley Walsall Mental Health Partnership NHS Trust
•North Staffordshire Combined Healthcare NHS Trust
•South Staffordshire and Shropshire NHS Foundation Trust
•Birmingham Solihull Mental Health NHS Foundation Trust
•Black Country Partnership NHS Foundation Trust
•Worcester Health and Care NHS Trust
•Coventry and Warwick Partnership NHS Trust
•Clinical Representation
•Links into Finance & Informatic Sub Group
•Recent links with West Midlands Strategic Clinical Network- Neurological conditions, Dementia & Mental Health.
•New Links to National Group and Work streams
3
‘Quality and Outcome measures are particularly important
for mental health, because of the longer term nature of an
individuals interaction with providers and the need to
understand whether people are getting good quality care,
are recovering, and for commissioners to be able to
compare one provider with another’- Monitor Oct 13
4
Quality and Outcomes- Background and Context
•PbR currencies - Quality and Outcome Measures fundamental part of the new currency
•Quality and Outcome Measures to be mandated for all 21 Care Clusters
•Long term vision of Quality and Outcome Measures – intrinsically linked to the construction of national care
cluster tariffs and PbR currencies.
•Payment of full cluster Tariff on delivery and demonstration of the 4 measures by Trusts
•Quality and Outcome agenda driven by National Quality and Outcome Group – Development of appropriate
measures has been and remains problematic
•Regional Quality and Outcome Group - support Trusts in developing their awareness and understanding around
this agenda
5
Quality and Outcome Measures – What are they and
what do they mean?
A set of quality
indicators, reported
via MHMDS have
been analysed with
10 recommended
for use
Patient Rated
Experience
Measures (PREM)
The Clinician Rated
Outcome measure
(CROM)
Patient Rated
Outcome Measure
(PROM)
6
PREM- Patient Reported Experience Measure
•There is no universally or agreed way to assess and report Patient Experience.
•Commissioners and Providers should agree local activity to assess patient experience. Consideration should also
be given to the appropriate use of the ‘friends and family’ question.
•The scale below should be used to answer the ‘friends and family’ question:
1.
2.
3.
4.
5.
6.
Extremely Likely
Likely
Neither likely or unlikely
unlikely
Extremely unlikely
Don’t know
•PREM’s should be collected in line with the Care Cluster Allocation Tool: At initial assessment, routine review,
significant change in presenting needs and at discharge.
•It is not expected that either Proms or Patient Experience data will be linked to payment during 14/15, but
commissioners and providers should consider how this could be used in the future.
7
PREM- Patient Reported Experience Measure
•It is recommended providers ask follow up questions at the time of the family and friends question. The
number and wording of these questions should be determined locally.
•Consideration should be given to the top 12 questions rated by service users form the CQC community survey:
1. Did you feel carefully listened to the last time you seen your NHS health care worker?
2. Did this person take your views into account?
3. Did you have trust and confidence in this person?
4. Do you understand what is in your NHS care plan?
5. Do you have a telephone number to contact your mental health service out of hours?
6. In the last 12 months have you received any sort of talking therapy from NHS mental health services?
7. In the last 12 months have you had a care review meeting to discuss your care?
8. Do you think your views were taken into account when deciding what was in you NHS care plan?
9. Do you think your views were taken into account when deciding which medication to take?
10. Overall rating of the service you have received?
11. In the last 12 months has your NHS worker checked how you are getting on with your medication?
12. Time period for last seeing someone form mental health services
8
Use of PROM- Patient Reported Outcome Measure
•National Q&O Group acknowledge it has not been possible to identify a single PROM that adequately
reflects the priorities for all of the clusters.
•It is suggested that where no PROM is currently being used within an organisation, WEMWEBS should be the
PROM of choice.
•Additional or different PROMs may also be used
•Commissioners and Providers should ensure a PROM is being used for all of the clusters
•Use of PROM should be tied in with Cluster reviews.
•A quarterly review of the data relating to this should be undertaken.
9
10
Quality Indicators
Recommended Indicators
1.
The proportion of users with a Crisis Plan in place, limited
to those on CPA
2.
The accommodation status of all users (as measured by an
indicator of settled status and an indicator of
accommodation problems)
3.
The completeness of ethnicity recording
4.
The proportion of users on CPA who have had a review in
the last 12 mths
5.
The proportion of users who have a valid ICD 10 diagnosis
code recorded
6.
The intensity of care (Bed days as a proportion of care days)
7.
The intensity of care (OBD)
8.
Proportion of in scope patients assigned to a cluster
9.
Proportion of initial cluster allocations adhering to red rules
10.
Proportion of patients within cluster review periods
Additional Indicators
1.
Distribution of Actual Cluster Review Periods
2.
Distribution of Actual Cluster Episode Period Duration
3.
Distribution of Actual MH Cluster Review Period Duration
4.
Re-referral Rate (to any in scope services
5.
Proportion of Reviews (CPA) with a corresponding
Clustering review
6.
Indicator of accommodation problems
7.
Cluster Profile
8.
Step Up/ Step Down/ Little change/ Discharge
The Recommended Indicators will be reported nationally from MHMDS submissions during14/15.
Additional indicators can be used locally to inform service improvement.
Providers and commissioners may wish to assess how they could be used as part of a local payment.
11
Use of CROM- Clinical Reported Outcome Measure
The HONOS four Factor Model is the mandated generic clinician rated outcome measure which will be one of the
methods used to demonstrate outcome for PbR
The model allows reliable change to be reported across total and factor scores showing clinical significance. The
four factors are derived from the HoNOS ratings extracted from the cluster tool.
The 4 factors are:
1.
2.
3.
4.
Personal Well Being
Emotional Well Being
Social Well Being
Severe Disturbance
Further information is expected regarding the methodology used to analyse and report on outcome data using
the four factor model including total score and clinical significance.
HONOS scores to be completed at:
•Initial assessment
•routine review
•significant change in presenting needs
•Discharge.
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4 Factor Model (Speak et al 2013)
- Based on the Health of the Nation Outcome Scales (HoNOS 12 Questions)
FACTOR 1
Personal
Well Being
FACTOR 2
Emotional
Well Being
FACTOR 3
Social
Well Being
FACTOR 4
Severe
Disturbance
Item 4:
Cognitive Problems
Item 2:
Non-accidental Injury
Item 3:
Problem-drinking or drug
taking
Item 1:
Overactive, aggressive,
disruptive or agitated
behaviour
Item 5:
Physical Illness or disability
or disability problems
Item 7:
Problems with depressed
mood
Item 9:
Problems with relationships
Item 6:
Problems associated with
hallucinations & delusions
Item 10:
Problems with activities of
daily living
Item 8:
Other mental and
behavioural problems
Item 11:
Problems with living
conditions
Item 12:
Problems with occupation
and activities
Item 12:
Problems with occupation
and activities
0
1
2
3
4
No problem
Minor problem
require no action
Mild problem but
Definitely present
Moderately
severe
problem
Severe to very
severe problem
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LEGEND
4 Factor Model (Speak et al 2013)
Care Clusters & Weighted Domains
S
Expected Improvement/Significant Change
M
Minimum Improvement/No change in presentation
V
Worsening of Symptoms/Deterioration in Condition
CARE CLUSTER
HoNOS Scale
Factor
1
2
3
4
5
6
7
8
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
18
1
9
2
0
2
1
S
S
S
S
S
S
M
M
S
S
M
M
S
S
M
M
S
M
M
M
S
S
S
S
S
S
M
M
S
S
M
M
S
S
M
M
S
M
M
M
S
S
S
S
S
S
M
M
S
S
S
S
S
S
M
M
S
M
M
M
Cognitive Problems
4
Physical Illness
5
Activities of daily living
10
Occupation & Activities
12
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
V
V
Non-accidental self injury
2
M
M
M
M
S
S
S
S
S
S
S
S
S
S
S
S
S
S
V
V
Depressed mood *
7
S
S
S
S
S
S
M
M
S
S
M
M
S
S
M
M
M
V
V
V
Other mental &
behavioural problems
8
S
S
S
S
S
S
M
M
S
S
M
M
S
S
M
M
M
V
V
V
Problem drinking or drug
taking
3
M
M
M
M
S
S
S
S
S
S
S
S
S
S
S
S
S
S
V
V
Relationships
9
S
S
S
S
S
S
M
M
S
S
S
S
S
S
M
M
S
M
M
M
Living conditions
11
S
S
S
S
S
S
M
M
S
S
S
S
S
S
M
M
S
M
M
M
Occupation & Activities
12
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
V
Overactive, aggressive,
disruptive or agitated
behaviour
1
M
M
M
M
S
S
S
S
S
S
S
S
S
S
S
S
S
S
V
V
Hallucinations and
Delusions
6
S
S
S
S
S
S
M
M
S
S
M
M
S
S
M
M
M
V
V
V
Personal
Well-Being
Emotional
Well-Being
Social
Well-Being
Severe
Disturbance
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HoNOS Scale
Factor
Accumulated
Score
Individual
Score
Weighted
Domains
4
Cognitive Problems
1
M
5
Physical Illness
1
M
Personal Well-Being
6 (16)
10
Activities of daily living
3
S
12
Occupation & Activities
3
S
2
Non-accidental self injury
0
S
7
Depressed mood *
2
M
8
Other mental & behavioural problems:
3
M
3
Problem drinking or drug taking
0
S
9
Relationships
2
S
Emotional Well Being
5 (12)
Sleep
Social Well-Being
4 (16)
11
Living conditions
1
S
12
Occupation & Activities
3
S
1
Overactive, aggressive, disruptive or agitated
behaviour
3
S
4
M
6
Severe Disturbance
6 (8)
Hallucinations and Delusions
Care Cluster 14 Psychotic Crisis
TOTALS
21 (48)
26
15
Acute Care Plan
-
-
Multi Disciplinary
Focus
- Severe Disturbance
- Emotional Well-being
-
Home Treatment or Inpatient Care
Plan
-
Diagnose
Treat acute symptoms
Manage and reduce risk/behaviours
Liaise with & support family/carers
Expected Outcomes with Clinical Significance
-
Reduction/management of symptoms
Medication compliance
Reduction in risk/behaviours
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THE EFFECTIVENESS OF CARE PACKAGES: FACTOR SPECIFIC
OUTCOME EVALUATION
Review 10 August 2013
Patient A - Comparison Chart
Review 06 September 2013
HoNOS Rating
4
3
2
1
0
4
5
10
12
2
7
8
3
9
11
12
1
6
HoNOS Scale
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14/15 Guidance- Next Steps
National Guidance mandates the use of one outcome measure.
Pilot sites have been selected to start collecting PROM/PREM information to understand how they are to be
used, interpreted and be linked to full tariff payment.
Updates are expected out during 2014 to inform 15/16 contracting agreements
Opportunity for local development of PREMs and PROMs
As PREMs and PROMs remain in development, HONOS, reported through MHMDS extracts would be the
natural Outcome choice for Trusts.
One of the quality indicators is to be reported per cluster and mandated within contracts ( Reported through
MHMDS)
14/15 guidance is suggesting that for next year, adherence to review periods will be a quality measure not mandated within 14/15 contracts.
For more detail on Quality and Outcome Measures, please see Draft guidance on mental health currencies
and payment- 3rd October 2013.
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Any Questions?
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