All cardiac activities except CR were included in CCAD

BHF came to the rescue AGAIN and have funded York / CCAD to audit CR

As you’ll hear this has had a major effect already thanks to YOUR hard work and the dedicated staff at York

NACR and Campaign

NACR and Campaign

NACR

Split Presentation

Corinna Petre – Project Manager - will give you an idea of the challenges and triumphs of the last 4 years

Stephanie Prady - Survey and Annual Report Manager – will talk about the survey and its challenges

Campaign

Rauiri O’Connor – Policy and Public Affairs – where all this hard work is getting us and where the campaign goes next

The Story So Far …

• Enlisted 12 pilot sites in 2004

• First data uploaded in 2005

• 229 CR programmes now uploading data

• Further 98 have requested the software and are in various stages of loading it

Current Data

• 149,409 patient records from 222 sites

• 94,983 pre-rehab baseline assessment

• 42,630 post-rehab assessment

• 13,876 12 months after rehab

• Approximately 6,000 new patients records entered every month

Developments Since 2005

• Letters/discharge report• Contact history recording calls/visits/letters• Electronic referrals to other NACR users• Data sharing across sites in the same trust• Newsletters• Quarterly reports/annual reports• Yahoo discussion group

USER Satisfaction Survey

Phone Survey Results (%, N=69)

37.7

24.617.4

14.4 14.5 14.5 13 10.1 10.1 8.7 7.22.9 2.9 2.9 1.4 1.4

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ACCESS TO D

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PHASE 3

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ANNUAL AUDIT

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MAJOR ISSUES RAISED BY USERS

User feedback about York

• Lack of response to requests for help

• Inadequate training

• Lack of feedback on database updates

Problems

Solutions

• Lost staff last year and took time to recruit and train. Now have 5 more members

• A helpline that is staffed all office hours• Developed a networked call logging system to

ensure all queries are dealt with within 2 working days and previous contacts are recorded.

• Computer lab training in York• An extensive manual• Training CD with a talk through of how to use the

database step-by step• Changes to database are communicated via

‘splash screens’ on starting Lotus

Problems

Access to Data

• Lack of individualised data about your programme

• Inability to provide managers and commissioners with meaningful information on the performance of Cardiac Rehab

Solutions

• Data is available to users via download and importing into an Access database or, by asking statistician (Veronica) to do this directly. She has written numerous reports for users around the UK

• Quarterly summaries of activity are now sent by post to every programme and an annual summary of outcomes for those entering more than one assessment.

• The Annual report presents data by SHA/Health Board (Wales by Network), we are happy to provide managers and commissioners attendance figures for individual programmes, if the users concerned are happy for us to do this

ProblemsCCAD / Lotus• Ineffective IT (CCAD) helpdesk• Lack of response to requests for changes to the

database • Lotus Notes causing anxiety for local IT departments

and issues with local firewalls • Cost of buying individual licences

Solutions

• Help desk CCAD, staffing issues – resolved late last year

• Changes to database, prioritised list of changes, CCAD working through them (not all users demands can be met)

• Licences, IT department not happy to install Lotus – new web version – teething problems – try first – solution on the way

Systemic • Time required to input data

Solution• Clerking time for Audit written into BACR

Minimum Standards, NICE Purchasing Guide – networks and commissioners should ensure this time is made available

Problems

Problems with Data

• Poor completion of outcome data – less than half post-rehab data

• Essential fields not always completed such as Date Rehab Started, Menu Sessions Attended, Phase

Phone Survey Results (69%, N=151/220)

27.5 26.7

20.0 20.015.8 14.2 12.5 11.7 10.0 10.0 9.2 8.3

5.8 5.0 3 2.5 0.80

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Recent Phone Survey

In the Future …

• Review of fields on database to reflect changes in terminology e.g. initiating event

• More summary report views in the database

• Improved layout of discharge reports

• Annual reports for each centre showing outcomes where second assessment is completed

• NACR now part of minimum standards and 60% of programmes use it

• With your feedback we have continued to improve it and make it more useful

• We are here to help you just ask

THANK YOU

Come up and see me sometime!

Summary

Annual Survey

• Paper survey sent to all cardiac rehab programmes in UK• Aim is to raise profile of CR: BHF Annual Report• Some (but not all) data collected through NACR

• Data collected– Who provides CR – Count patients (NACR)– Staffing– Other data – changes annually

• In order to calculate– Uptake of CR – Cost per patient– Staffing per patient– Other annual focus

Counting patients 2007-8

Non-NACR39%

NACR 61%

NACR 41%

Paper survey

59%

Paper survey

59%

NACR 28%

? NACR13%

Calculating uptake

• Demonimator- patients discharged alive after MI, CABG, PCI for each SHA (HB, network)

• Uptake = Number rehabbed per SHA / Number in HES

• Missing data– Estimate where we can– Record as missing where we can’t– We need to know it’s missing!

Calculating uptake UK 2006-07

Full data75%

No data9%

Estimated data16%

Calculating cost per pt UK 2006-7

NR5%

No data13%

Some data15%Full data

67%Full data95%

NR5%

Changes to 2007-8 survey

• Removed– Budget section

• Added – “Do you typically accept these patients?”– Gross numbers seen at each phase– How staff are funded– Detailed guidance notes

When

• Sending out early October

• Due November

• Contact us ifProgramme has changed in structure/mergedPre-printed NACR data looks wrong

Any other queries

Suggestions for future surveys

Summary

• All programmes are on the register (?)

• More survey data = less estimates and assumptions

= more reliable report

Thank you for your time and efforts