Developing Nottingham’s LAA Jeanelle de Gruchy and Chris Nield Health Equality, Nottingham City PCT.
Chris Packham Director of Public Health Nottingham
description
Transcript of Chris Packham Director of Public Health Nottingham
Nottingham City PCT 1
Quality improvement to ensure health gain (and Health Inequalities reductions)
an example: commissioning cardiovascular risk management
Chris Packham
Director of Public Health
Nottingham
Nottingham City PCT 2
DH, Health inequalities intervention tool: view your gap
Nottingham City PCT 3
Health outcomes in context
Nottingham City PCT 4
CHD 8 - % patients whose last measured cholesterol <= 5mmol/l (measured in last 15 months)
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20%
40%
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100%
Practice code
Target Met Target Missed Exception Coded
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CHD 8 - % patients whose last measured cholesterol <= 5mmol/l (measured in last 15 months)Nottingham City Practices 2006-07
0%
20%
40%
60%
80%
100%
Most deprived IMD 2004 quintiles Least deprived
Target Met Target Missed Exception Coded
QOF performance – cholesterol outcomes
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Nottingham
DM 20 - % patients whose HbA1C <= 7.4 (measured in last 15 months)
0%
20%
40%
60%
80%
100%
Practice code
Target Met Target Missed Exception coded
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Understanding unmet need and inequalityEg: Heart disease deaths and Statin prescribing by GP practice
0.000
2.000
4.000
6.000
8.000
10.000
12.000
practice
CHD death rates (DSR)
statin use (ADQ/STAR-PU)
most deprived least deprived
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Commissioning Healthcare for Best Outcomes
Population Focus Optimal Population Outcome
13.Networks,leadership and coordination
6.KnownIntervention
Efficacy
1.KnownPopulation
Health Needs12. Balanced Service Portfolio
11.Adequate Service Volumes
Challenge to Providers
5.Supported self-management
10. Engaging the public
4. Responsive Services
9. Accessibility
2. Expressed Demand 7. Local Service Effectiveness
3. Equitable 3. Equitable ResourcingResourcing
8.Cost Effectiveness
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Design (Commissioning) challenges
• How to stop the CVD risk programme work widening inequalities?
• How to encourage people to turn up for assessment and then take part in interventions?
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Mosaic Group F: people living in social housing
with uncertain employment in deprived
areas
Eg: Social marketing methodologies
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Getting the technical data right:understanding the CVD risk 40-74 task
• Local estimation
• NICE guideline 67 tool– http://www.nice.org.uk/guidance/index.jsp?act
ion=download&o=40777
• QRISK 40-74
– 3% 40-54, 97% 55-74
• Framingham 40-74
– 7% 40-54, 93% 55-74
• But – S Asian and AC groups may
need DM case finding from age 30
– ‘CKD’
• From a population of 300,000…
• How many patients are we seeking for primary prevention?
• Existing CVD 11,000
• For a population of 300,000, around 12,500 out of 35,000 55-74’s estimated at risk (Framingham)
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our ‘Intervention’: first stage started
most deprived quintile – 14 practices: 8000 patients 45-74
• Trained HCAs• Computer generated lists of at risk patients• 30% one or more risk factor recorded• ABPI partnership project • Called in, risk assessed, interventions agreed• Referred on the GP/PN as necessary• Outcomes monitored • Targeted using successive 5-year descending
age bands
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Results
• first 2 months • attendance rate 73% (65% plus a further 8% on
one reminder)• 260 seen all>20%• 40% already on treatment • About 50% sent to GP/PN to date• 1 in 5 put onto drug treatment immediately
• 4% new Diabetics
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our ‘Intervention’: second stage50 practices - 27,000 patients 55-74
• Locally Enhanced Service for 55-74’s
• Option to use HCA model
• 40-54’s ?Alternative model
• Year one – Hypertensives all ages– BMI>35
• Year two – 55-74 one or more risk
factor– All BME 40-74
• Year three– Rest 55-74
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Challenges and solutions
• Problems – The DNAs
– Compliance
– Clinical buy-in
– Community awareness
• Must have supporting delivery– Healthier Communities
Collaborative – Primary prevention– HEAs on hospital and
tertiary end – Health trainers / PH
nutrition teams / smoking cessation services
– Look carefully at primary care data
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Commissioning Healthcare for Best OutcomesNST – HI support team Prof Chris Bentley
• Population quality– Empowering / Healthier
Communities Collaboratives
– Decent Health Equity Audits
– Designed around populations as well as practices (eg BME)
• Individual care quality – QOF– Use Accepted interventions – Guideline audits
– Patient satisfaction and
accessibility
For both make sure the supporting community services are in place and part of patient pathways and at industrial scale