Using NICE guidance advice and standards:
Information challenges
Val Moore, Implementation Programme Director
Nick Baillie, Associate Director: Indicators
The role of information in
implementation
• Context
Understanding role of information in implementation
– Stimulate change
– Evaluating change
– Sustaining change
Technological progress
Demand for accountability
• Today - Using information in implementation:
– Technologies
– Clinical guidelines and other NICE guidance
– Standards & indicators
Board reports on uptake information
Medicines and technologies focus
Date
Types of NICE guidance
Evaluation method
2000
NICE technology appraisals (TA’s) – cost utility
evaluation method, mostly of medicines
Cost utility
2010
Diagnostic evaluations
Cost utility
2010
Medical device evaluations – cost benefit
Cost benefit
2012
New medicines information and evidence
summaries
review
2013
Highly specialised medicines
Process tbc
Medicines and technologies focus
Date
Types of NICE guidance
Cost, volume,
2000
NICE technology appraisals (TA’s) – cost utility
recommended
evaluation
population,
other method, mostly of medicines
options, variation and
variation over time
Evaluation method
2010
Diagnostic evaluations
Cost utility
2010
Medical device evaluations – cost benefit
Cost benefit
2012
New medicines information and evidence
summaries
review
2013
Highly specialised medicines
Process tbc
Cost utility
Experimental statistics on variation
• Section 1 - observed and expected use
data from 13 of 25 treatment groups
suitable for analysis
•Section 2 - further groups where a valid
interpretation couldn’t be made
Innovation, Health & Wealth
NICE compliance regime
Innovation
scorecard
NICE Implementation
Collaborative
Formularies
• Scorecard to provide a high level view of an NHS organisation’s
use of technology appraisals (medicines and technologies) at
Trust and CCG level data
• Medicines featured within the annual Use of NICE appraised
medicines report are a source
• First one published in January 2013
• FAQ’s ….
Innovation, Health & Wealth
NICE compliance regime (2)
Innovation
scorecard
NICE Implementation
NIC
Collaborative
Formularies
• NICE Implementation Collaborative aims to:
– support and promote the timely and consistent
implementation NICE TAs and adoption of all other forms of
NICE guidance
– drive the uptake of innovation, understand the barriers and
help overcome them
– oversee 4 pilots (newer anticoagulants, denusomab, BNP
testing, insulin pumps)
– report on the assessment of the implementation issues, and
action at national level to improve uptake. Opportunity of
Academic Health Science Centres to inform and act.
Other types of guidance
Date
Types of NICE guidance
Evaluation method
2002
Clinical guidelines
Cost utility
2005
Public health interventions and programme
guidance
Cost utility
2013
Service guidance
Process tbc
2003
Interventional procedures
Safety and efficacy –
no cost effectiveness
assessment
Other types of guidance
Date
Types of NICE guidance
Evaluation method
2002
Clinical guidelines
Cost utility
Local JSNA,
2005
Publicpolicies
health,interventions and programme
audit,
national
guidance
measurement:
obesity, physical
2013
Service guidance
activity,
2003
Interventional procedures
Cost utility
Process tbc
Just safety and
Clinical coding, efficacy (no cost
registries, audit foreffectiveness
assessment)
consent and outcomes
Using NICE audit tools to improve patient
care
• ‘Thinking delirium’ in Herts and Beds critical
care units
• An audit based on the NICE clinical audit tool
for the Delirium guidance
• Baseline audit in June 2012:
Standard
Result
If indicators of delirium are identified, an
assessment based on CAM ICU has been carried
out in the previous 24 hours.
71%
If a positive score is recorded, action is taken.
50%
•
•
•
•
Action plans included:
– the use of NICE implementation tools
– local education
– consultant champions
– assessment score in nursing team handover sheets
– hosting a regional delirium conference.
Re-audit in January 2013:
Standard used
2012
2013
If indicators of delirium are identified, an
assessment based on CAM ICU has been carried out
in the last 24 hours.
71%
80%
If a positive score is recorded, action is taken.
50%
72%
Further improvement work and audit is planned.
For further details see www.nice.org.uk/sharedlearning
Guidance and quality standards
A comprehensive set of recommendations for a
particular condition or service area
Evidence
Guidance
Quality
Standards
‘Sentinel markers’
A prioritised set of concise, measureable statements
designed to drive quality improvements across a
pathway of care.
NICE quality standards
• NICE quality standards are a concise set of statements
designed to drive and measure priority quality
improvements within a particular area of care
• Library of 180 topics across clinical, public health and
social care
• Each statement has associated measures
• National data collections and local measures
What are NICE quality standards?
They do not restate essential standards or regulatory
requirements. Where there is overlap, statements should
be mutually supportive and complementary.
NICE quality standards
Registration
requirements
Proportion of
services
Standard of
services
Unsafe Substandard Adequate
Good
Excellent
Quality standards referrals
• Library of 180 quality standards (QS)
– including 3 public health focused topics
• Smoking Cessation (Nov 12)
• Physical Activity (Oct 13)
• Alcohol (Dec 13)
Social care
• Pilot programme – social care QS
– Supporting people to live well with dementia
– Health & wellbeing of LACYP
– Full programme went live in April 2013
• Mental wellbeing of older people in care
homes (Feb 13)
• Autism (Mar 13)
NHS
Public
health
How can quality standards be used?
NICE quality standards help demonstrate delivery of high quality care through
measureable statements and indicators, to be used in a variety of ways in
England including:
National
• NHS Outcomes Framework domains
• Quality & Outcomes Framework (QOF) and Clinical Commissioning
Outcome Indicator Set (CCG OIS)
• National audit and data collection
• Commissioning for Quality Improvement Initiatives (CQUIN)
Local
• Local audits and local contracts
NICE Quality Statement 1: People with diabetes and/or their carers
receive a structured educational programme that fulfils the
nationally agreed criteria from the time of diagnosis, with annual
review and access to ongoing education
• 74% of PCTs have contracts with services to provide NICE compliant education for
people with newly diagnosed Type 1 diabetes and 85% have contracts to provide NICE
compliant education for people with newly diagnosed Type 2 diabetes, but only 66%
review whether all people newly diagnosed are offered structured education.
• For patients under their care, two-thirds (66%) of specialist providers offer NICE
compliant structured education to all people newly diagnosed with Type 1 diabetes and
84% offer ongoing education. In addition, 70% provide structured education for people
using insulin pump therapy.
• 72% of paediatric specialist teams offer structured education to all newly diagnosed
children and young people and 75% adjust the education to the development stage of
the child/young person. However, only 52% have a written schedule of education from
diagnosis onwards, with 59% monitoring uptake of education.
Source – DiabetesE www.innove.co.uk
Information challenges
• How can we ensure quality measures are
adopted within national collections?
• How can we minimise the burden of data
collection where no national measures?
• Additional challenges within the quality
standard development process
Indicators
• NICE develops evidence based indicators
from quality standards, NICE guidance
and accredited guidance
• Rigorous development methods including
testing, public consultation and
consideration by committee
Quality and Outcomes Framework
(QOF)
• Introduced in 2004, the QOF is an incentive scheme
for GP practices in the UK, rewarding them for how
well they care for patients
• The QOF contains groups of indicators, against
which practices score points according to their level
of achievement
• The QOF gives an indication of the overall
achievement of a practice through a points system
• NICE publish a menu and final indicators negotiated
by BMA and DH (NHS England in future)
Clinical Commissioning Group
Outcomes Indicator Set (CCG OIS)
• Supports CCGs and health and wellbeing partners
in improving health outcomes by:
– providing comparative information on the quality of health
services commissioned by CCGs and the associated
health outcomes
– supporting transparency and accountability by making this
information available to patients and the public
• Includes some proxy indicators of outcomes that are
good predictors of improvement:
– ‘intermediate’ outcome indicators
– processes that are shown to have a strong link to
outcomes
• range of areas, for which they score points.
Clinical Commissioning Group
Outcomes Indicator Set (CCG OIS)
• August 2012: NICE menu of indicators
published
• August 2012– September 2012: NHS
Commissioning Board (NHS England)
engagement events
• December 2012: NHS Commissioning Board
(NHS England) published first CCG OIS
Information challenges
• QOF is an example of how improvements
in informatics can be driven by quality
agenda
• CCG OIS: how can we ensuring data is
available to ensure indicators can be
constructed by commissioning group?
Future uptake sources
Outcomes frameworks
• QOF
• CCG OIS
• NASCIS
• HQIP Social Care national
audit
Innovation, Health and
Wealth
• NICE Implementation
Collaborative
• Innovation scorecard
New data sets
• Cancer Outcomes and
Services Dataset
• General Practice Extraction
Service
Other
• Commissioning for quality and
innovation (CQUIN) payment
framework
• Quality, Innovation, Productivity
and Prevention (QIPP)
comparators
Summary
• NICE guidance at the heart of many
improvement activities
• Information is vital to stimulate, evaluate
and sustain change
• Challenges in data collection, attribution
and reporting
• Examples exist of the use of indicators
and routine data for quality improvement