Enhanced Primary Care Services for Residents of Nursing Homes … · 2015-10-30 · Enhanced...
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Enhanced Primary Care Services for Residents of Nursing Homes in North Staffordshire The development, implementation and evaluation of a new service for Nursing Home Residents served by North Staffordshire CCG Dr Dawn Moody (GPSI Geriatric Medicine, CCG Clinical Associate), Jo Williams (Senior Commissioner), Nicola Bucknall (Commissioner) Contact Details: [email protected] Acknowledgements: We would like to take this opportunity to thank the many people who have contributed at every stage of this project and to the production of this poster. Service Design & Pilot Project Implementation at Scale Key Milestones National Context This project was initiated in response to two British Geriatrics Society reports: Quest for Quality (2011) • ‘Unmet need, unacceptable variation and often poor quality care’ Failing the Frail (2012) • ‘Chaotic approach to commissioning for care home residents’ Service Model Pilot Project Objective To design, deliver and evaluate an Enhanced Primary Care Medical Service for residents in one large nursing home. Population and Method • Single large nursing home (n=171), registered for general and EMI nursing care • Pilot service delivered by two GPs from April to November 2012 • Improved co-ordination of existing services, including care home pharmacist and community psychiatric nurse, and to establish MDT approach to care. Evaluation of Outcomes Comparison of Emergency Department (ED) attendance and acute unscheduled admission rates during pilot study period in 2012 with same period in 2011: • ED attendance rate significantly reduced (-25%, p<0.05) • Unscheduled admission rate significantly reduced (-29%, p<0.05) • Rates unchanged or increased in 4 comparator homes (n=361) • Improved patient, carer and professional satisfaction Conclusion Significant clinical benefits were achieved through delivery of the new service model. Next steps To develop the service for delivery at scale across North Staffordshire. Enhanced Primary Care for Nursing Home Residents: Good Practice Guide May 2014 Service Delivery • Total number of nursing home beds in North Staffordshire = 1113. • During the period April 2013 to March 2014, 664 (60%) beds were covered by the scheme (‘LES NHs’, n=664) and 449 (40%) beds were not (‘non-LES NHs, n=449). Evaluation of Outcomes Unscheduled admission data for 2013/14 compared to that for 2012/13. No significant difference in unscheduled admission rates between the two groups before LES implementation (p=0.41); significantly fewer admissions in LES NHs than in non-LES NHs after implementation of the LES (p<0.0001). Conclusions and Next Steps • The benefits of the pilot project have been replicated at scale. • Service implementation has been associated with a significant reduction in unscheduled admissions by residents of the nursing homes involved. • Enhanced Primary Care Services, supported by suitable training and investment, can help minimise unscheduled transitions into secondary care. • This service model is both clinically effective and cost effective • April 2014, 208 more beds covered by the enhanced service. Coverage now = 78% of eligible population Cumulative rate of unscheduled admissions/bed by month for year to date (y axis), for LES and non-LES nursing homes, ‘before’ (2012/13) and ‘after’ (2013/14) implementation: Evidence- based service design Multi- disciplinary approach Continuity of Care Proactive and Responsive Care Key Features of Service • Comprehensive geriatric assessment on admission • Patient-centred management plan • Minimum 6-monthly medication review • Review on discharge from hospital • Advanced care planning • Regular and timely GP visits • Clinically led MDT approach • Enhanced urgent and sub-acute care response • Coordinated end of life care Programme initiated and Pilot Project approved Published evidence base reviewed, local case note audit carried out and analysis of local unscheduled admission data commenced. Local Health Economy and Social Care Engagement Event To raise awareness of project and establish shared objectives. To examine systems of care and to identify GP training needs. Event supported by 75 attendees from 10 organisations. Evaluation of Pilot Project Demonstrated clinical and financial benefits, therefore business case and options appraisal developed to expand service. Governance Framework Proposal and accreditation process approved by CCG Cluster. Completion of Service Specifications, Performance Framework, Good Practice Guide, standardised documentation and online resources. Engagement and training events Series of events involving all partners, including: nursing homes, primary, community, acute and palliative care, mental health, social services and independent sector. Digital technology Implementation of digital technologies, including falls prevention and a virtual link from nursing home to Consultant Geriatrician. Launch of Locally Enhanced Service (LES) Service launched in a phased approach across North Staffordshire CCG. 8 General Practices delivering the service in 11 different nursing homes (both general and EMI registered) and providing care to 664 residents. Evaluation and reflection Project has made significant clinical impact Improvements in the quality and cost effectiveness of care September 2012 November 2012 Nov-Dec 2012 March 2013 Feb-May 2013 April 2012 April 2013 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 LES NHs - Cumulative Admissions per bed 2012/13 ('before') LES NHs - Cumulative Admissions per bed 2013/14 ('after') Non-LES NHs - Cumulative Admissions per bed 2012/13 ('before') Non-LES NHs - Cumulative Admissions per bed 2013/14 ('after') Care always proactive; and promptly reactive as needed Minimising unplanned transitions of care Recognising scope and complexity of needs Published evidence, clinical audit, data analysis North Staffordshire Clinical Commissioning Group NHS Outcomes Residents receiving the Enhanced Service (n=664) Residents NOT receiving the Enhanced Service (n=449) Number of unscheduled admissions 20% decrease (-88 episodes) 9% increase (+30 episodes) Rate of unscheduled admissions Decreased from 0.73 to 0.52 per bed per year Increased from 0.78 to 0.85 per bed per year Estimated change in net costs Decreased by >£55 per resident per year Increased by >£167 per resident per year
Transcript of Enhanced Primary Care Services for Residents of Nursing Homes … · 2015-10-30 · Enhanced...
Enhanced Primary Care Services for Residents of Nursing Homes in North Staffordshire The development, implementation and evaluation of a new service for Nursing Home Residents served by North Staffordshire CCG
Dr Dawn Moody (GPSI Geriatric Medicine, CCG Clinical Associate), Jo Williams (Senior Commissioner), Nicola Bucknall (Commissioner)
Contact Details: [email protected]
Acknowledgements: We would like to take this opportunity to thank the many people who have contributed at every stage of this project and to the production of this poster.
Service Design & Pilot Project Implementation at Scale Key Milestones
National Context This project was initiated in response to two British Geriatrics Society reports:
Quest for Quality (2011) • ‘Unmet need, unacceptable variation and often poor quality care’ Failing the Frail (2012) • ‘Chaotic approach to commissioning for care home residents’
Service Model
Pilot Project Objective To design, deliver and evaluate an Enhanced Primary Care Medical Service for residents in one large nursing home. Population and Method • Single large nursing home (n=171), registered for general and EMI nursing care • Pilot service delivered by two GPs from April to November 2012 • Improved co-ordination of existing services, including care home pharmacist and
community psychiatric nurse, and to establish MDT approach to care. Evaluation of Outcomes Comparison of Emergency Department (ED) attendance and acute unscheduled admission rates during pilot study period in 2012 with same period in 2011: • ED attendance rate significantly reduced (-25%, p<0.05) • Unscheduled admission rate significantly reduced (-29%, p<0.05) • Rates unchanged or increased in 4 comparator homes (n=361) • Improved patient, carer and professional satisfaction Conclusion Significant clinical benefits were achieved through delivery of the new service model. Next steps To develop the service for delivery at scale across North Staffordshire.
Enhanced Primary Care for Nursing Home Residents: Good Practice Guide
May 2014
Service Delivery • Total number of nursing home beds in North Staffordshire = 1113. • During the period April 2013 to March 2014, 664 (60%) beds were covered by the
scheme (‘LES NHs’, n=664) and 449 (40%) beds were not (‘non-LES NHs, n=449). Evaluation of Outcomes Unscheduled admission data for 2013/14 compared to that for 2012/13.
No significant difference in unscheduled admission rates between the two groups before LES implementation (p=0.41); significantly fewer admissions in LES NHs than in non-LES NHs after implementation of the LES (p<0.0001).
Conclusions and Next Steps • The benefits of the pilot project have been replicated at scale. • Service implementation has been associated with a significant reduction in
unscheduled admissions by residents of the nursing homes involved. • Enhanced Primary Care Services, supported by suitable training and investment,
can help minimise unscheduled transitions into secondary care. • This service model is both clinically effective and cost effective • April 2014, 208 more beds covered by the enhanced service. Coverage now =
78% of eligible population
Cumulative rate of unscheduled admissions/bed by month for year to date (y axis), for LES and non-LES nursing homes, ‘before’ (2012/13) and ‘after’ (2013/14) implementation:
Evidence- based service
design
Multi-disciplinary approach
Continuity of Care
Proactive and Responsive
Care
Key Features of Service • Comprehensive geriatric assessment on admission • Patient-centred management plan • Minimum 6-monthly medication review • Review on discharge from hospital • Advanced care planning • Regular and timely GP visits • Clinically led MDT approach • Enhanced urgent and sub-acute care response • Coordinated end of life care
Programme initiated and Pilot Project approved Published evidence base reviewed, local case note audit carried out and analysis of local unscheduled admission data commenced. Local Health Economy and Social Care Engagement Event To raise awareness of project and establish shared objectives. To examine systems of care and to identify GP training needs. Event supported by 75 attendees from 10 organisations. Evaluation of Pilot Project Demonstrated clinical and financial benefits, therefore business case and options appraisal developed to expand service. Governance Framework Proposal and accreditation process approved by CCG Cluster. Completion of Service Specifications, Performance Framework, Good Practice Guide, standardised documentation and online resources. Engagement and training events Series of events involving all partners, including: nursing homes, primary, community, acute and palliative care, mental health, social services and independent sector. Digital technology Implementation of digital technologies, including falls prevention and a virtual link from nursing home to Consultant Geriatrician. Launch of Locally Enhanced Service (LES) Service launched in a phased approach across North Staffordshire CCG. 8 General Practices delivering the service in 11 different nursing homes (both general and EMI registered) and providing care to 664 residents. Evaluation and reflection Project has made significant clinical impact Improvements in the quality and cost effectiveness of care
September 2012
November 2012
Nov-Dec 2012
March 2013
Feb-May 2013
April 2012
April 2013
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
LES NHs - Cumulative Admissions per bed 2012/13 ('before') LES NHs - Cumulative Admissions per bed 2013/14 ('after') Non-LES NHs - Cumulative Admissions per bed 2012/13 ('before') Non-LES NHs - Cumulative Admissions per bed 2013/14 ('after')
Care always proactive;
and promptly reactive as
needed
Minimising unplanned
transitions of care
Recognising scope and
complexity of needs
Published evidence,
clinical audit, data analysis
North Staffordshire Clinical Commissioning
Group
NHS$
Outcomes
Residents receiving the Enhanced Service (n=664)
Residents NOT receiving the Enhanced Service (n=449)
Number of unscheduled admissions
20% decrease (-88 episodes)
9% increase (+30 episodes)
Rate of unscheduled admissions
Decreased from 0.73 to 0.52 per bed per year
Increased from 0.78 to 0.85 per bed per year
Estimated change in net costs
Decreased by >£55 per resident per year
Increased by >£167 per resident per year
