National COPD Programme
Building QI into Your Audit from
the Start
Prof. Mike Roberts
Royal College of Physicians
Barts Health/ UCLPartners
On behalf of the team
Programme Overview
• 3 plus 2 year programme 2013-8
• Commissioned & funded by HQIP
• Led by the Royal College of Physicians (RCP) working in close
partnership with
– British Thoracic Society (BTS)
– British Lung Foundation (BLF)
– Primary Care Respiratory Society (PCRS-UK) and
– Royal College of General Practitioners (RCGP)
Programme Workstreams
• Primary care audit – Collection of clinical audit data from General
Practice patient record systems looking back over a year. Spring
2015 then annual.
• Secondary care snapshot audit – Admissions to hospital with COPD
exacerbation process and outcomes at 30 and 90 days. Organisation
and Resources over data collection period. Spring 2014 & 2016.
• Pulmonary rehabilitation snapshot audits – Service quality and
patient outcomes over 3 months. Includes resources and
organisation. Jan 2015 start. Repeat 2017.
• PREM – One year development work exploring the
potential/feasibility for Patient Reported Experience Measures to
be incorporated into the programme in the future.
• Patient identifiable data linked across the workstreams and to
external sources such as HES and ONS
Measures - Process and Outcome
• Primary care e.g. compliance against NICE standard- diagnosis
confirmed, smoking cessation, annual review, referral to PR,
correct treatment etc.
• Secondary care e.g. Essential investigations and interventions
in first 24 hours, integrated discharge.
• Pulmonary Rehab e.g. Compliance with BTS standards,
completion, better QoL, improved exercise capacity.
• Mortality, Hospital Stay, Readmission.
UK COPD Audit Progression
• 1997 36 hospitals process and outcomes
• 2001 30 hospitals process/outcomes + organisation
and resources
• 2004 94% all UK Trusts (as per 2001)
• 2008 98% of all UK Trusts process/outcomes + resources and organisation
+ patient experience + primary care record
• 2010 Euro Audit of hospital care & resources
Audit is a quality improvement process
UK National COPD Audit
% patients with pH< 7.35
Receiving Ventilatory Support by Individual Units
40
N of units
30
20
10
5
0
0
-1
-5
00
-1
95 5
-9
90 90
85 85
80 80
75 75
70 70
65 65
60 60
55 55
50 50
45 45
40 40
35 35
30 30
25 25
20 20
15 15
10
0
UNIT: % of cases with ventilatory support if pH<7.35
8
Quality indicators for North West SHA acute units (14 - 27)
Acute unit
Org score
NIV
PR
EDS
LTOT
Site 14
81
88
86
83
89
Site 15
77
79
82
78
82
Site 16
77
71
82
72
32
Site 17
81
75
95
83
93
Site 18
80
63
86
100
79
Site 19
66
63
77
0
82
Site 20
77
67
95
100
64
Site 21
51
0
91
0
86
Site 22
63
67
82
0
100
Site 23
45
46
0
0
36
Site 24
68
67
91
83
96
Site 25
54
25
59
56
61
Site 26
72
83
100
94
93
Site 27
84
58
91
89
86
Hospital Report
Guideline standard: National clinical guideline on management of
chronic obstructive pulmonary disease in adults in primary and
secondary care
“When the patient arrives at hospital, arterial blood gases should
be measured and the inspired oxygen concentration noted in all
patients with an exacerbation of COPD. Arterial blood gas
measurements should be repreated regularly, according to the
response to treatment”
(NICE guideline 2004; grade D)
Proportion of patients in which arterial blood gases were taken
Recorded
blood gases taken
National audit
(9716)
99%
9596
87%
8340/9596
Your Unit (66)
99%
65%
65
43
2003 Audit: recorded 97%. If recorded, blood gases taken 85%.
NICE Management Guidelines for COPD
NICE COPD Quality Standards
DH Outcomes Strategy for COPD
NHS COPD Commissioning Toolkit
Over Time
• Some resources have increased
• Wider service provision
But
• Little evidence of improved processes
But
• Length of stay reduced
• Readmissions have increased
• Mortality remains high
What Have We Done Differently?
•
•
•
•
•
•
Acknowledge QI is key
Establish a QI group
Look for links with external organisations
Emphasise to participants the QI opportunities
Suggest QI options to participants
Engagement, engagement, engagement!
‘Make it as easy as possible to do the right thing for the patient’
Engaging with Professionals
•
•
•
•
•
•
Radical Message
Kept simple (but with significant range of consequences)
Balanced with the good
Something that appeals to professionals and patients alike
Strap line – ‘Who Cares Matters’
Supported by National Professional bodies
Engaging Commissioners
• CCG/LHB Level Reports- what do you want to see?
• CCG engagement (e.g. via CCG Champion Networks of partner
organisations)
• Identifying CCG priorities
• Targeted messaging
• Benchmarking against NICE standards
• Potential for peer review (e.g. accreditation of Pulmonary
Rehabilitation)
National Engagement
• All Party Parliamentary Group on Respiratory Health
• NHSE Domains
• NHS Wales – Policy leads (NCA; Respiratory; Primary Care;
Adult & Children’s Health)
• National Respiratory Director
• NHSE – Head of Patient Experience
• NHSIQ
Engaging Patients and Carers
• British Lung Foundation
– Including network of Breatheasy Groups
• Patient involvement groups – professional bodies (e.g. RCP
PIU)
• The plain English version
• Conferences and newsletters
• And in an ideal world patient access to their own data!
Summary
• Reporting of data has limited impact
• Acknowledging QI is critical element at outset
• Having a QI strategy
• Engaging key parties
• We have no resource or contract to deliver QI
• Over to youHealth Quality Improvement Partnership
To Find Out More
If you would like to register to receive updates:
Email: copd@rcplondon.ac.uk
Or visit: www.rcplondon.ac.uk/COPD
#COPDaudit #COPDwhocares?