Health Navigator lunch and learn – 15 January 2016
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Proactive Health Coaching Lunch and Learn 15 th of January 2016
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Transcript of Health Navigator lunch and learn – 15 January 2016
Proactive Health CoachingLunch and Learn15th of January 2016
In the UK, 35% of non-elective admissions areconcentrated in just 1% of the population
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Example from a UK CCG; non-elective hospital admissions, 2013/2014
Note: Hospital spells between 1 April 2013–31 March 2014. Only non-elective admissions (all emergency admission methods; A&E of provider, A&E of otherprovider, bed bureau, GP, outpatient, other, visit by consult, transfer from other provider)
Source: Hospital statistics UK CCG
6.2% of population (21,500 people),100% of the non-elective admissions (31,070)
1% of the population (3,472 people),35% of the non-elective admissions (10,950)53% of the non-elective bed days (100,000)
CONFIDENTIAL
0 300,000250,000
30,000
35,000
350,000100,00050,000 200,000150,000
25,000
20,000
15,000
10,000
5,000
0
Non-elective admissions
Capita
This 1% is highly transient and needs proactive support
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Example from a UK CCG
19%
29%
52%
2014/15
100%
Some inpatient care butno longer in top 1% group
Still part of top 1% group
No inpatient care(or deceased)
2013/14
Patient groupwith highest
use ofnon-elective
care(top 1%)
CONFIDENTIAL
Source: Hospital statistics UK CCG
A typical patient in the 1% group “regresses towards themean” after a period of high healthcare utilisation
3
Increasing frequencyof A&E attendances
Healthcare costper patient
Time
Period of non-electiveactivity starts; ofteninvolves repeatedadmissions
Integrated care package forpatient in place; healthcareutilisation stabilises
Patient flagged as high-risk
Secondary preventioninitiatives initiated
CONFIDENTIAL
4
Interventioncohort
Nointerventioncohort
Proactive HealthCoachingintervention
Proactive Health Coaching circumvent the period ofhigh healthcare utilisation
CONFIDENTIAL
Healthcare costper patient
Time
The intervention is a time limited non-clinical supportinitiated at the earliest signs of disease progression
5CONFIDENTIAL
Healthcare costper patient
1% group WITHintervention
(Intervention group)
1% groupWITHOUT
intervention(Control group)Identification
and start ofintervention
Time
1. Patient identificationIdentification through a predictivemodel to ensure the right intervention,to the right patients, at the right time
2. InterventionNon-clinical telephone-basedintervention to empower the patient andimprove ordinary care - so that avoidablecare can be proactively prevented
3. Evaluation and continuous follow-upContinuous monitoring to ensureresource-efficient effort per patient
4. DischargeWhen the patient no longer is in needof the support a decision is commonlytaken of the patient and the nurse toend the contact
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2
4
3
4
1
2
3
Patients are satisfied and increase their quality of life withthe intervention
6
”I now get a betteraccess to my GP and
other clinicians”
”The health coach hasbeen a constant
throughout my ordeal– the other health carecontacts has changed
consistently”
”Someone who cares, who follows up, who has the timeto listen, who calls when promised and who you can
contact when you need to”
”Other healthcare servicescan’t compete with the
frequency of calls from thehealth coach”
”The biggest difference ishaving contact with the
same person all of the time– very valuable”
40%
2%45%
14%
Negative
Positive
Neutral
Significantly positive
Are you satisfied with the support?
40%
27%4%
30%
Yes
No
Neutral Very
How has your quality of life changed?
CONFIDENTIAL
We’ve got positive reactions and support from local GP’s,community services as well as from York hospital
7CONFIDENTIAL
”Proactive Health Coaching ismaking my job much easier”
– Community specialist nurse
”I am pleased finally someoneis looking out for her”
- GP in York
”I hope the service will scale up soon. Weneeded you for our mother recently”
- Patient in Health Watch reference group
”This has been needed fora long time”
- Clinician at York Hospital
”PHC is a great fit with ourstrategy to move out carefrom the acute hospital toother proactive services”
- Vale of York CCG
CCG
The intervention leads to fewer non-elective admissions,reduced LOS, better health and higher quality of life
8CONFIDENTIAL
Source: Kings Funds report; HN research articles
Non-electiveadmissionsOther costeffects
Other effects
Patient reportedoutcomes
Reduced non-electiveadmission
Fewer ER and follow-up out-patient visits
Reduced other costs,e.g. ambulance
Shorter LOS for un-avoided admissions
Reduced excess costdue to longer LOS
Category
Better healthoutcomes etc
Impact
Higher quality of life
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2
3
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Tracked in PHCNot tracked in PHC
“Some of the outcomes demonstratedas a result of interventions includeimproved quality of life; improvementsin clinical indicators (eg, in cholesterollevels and blood pressure); betteradherence to treatment; improvedlifestyle; reduced symptoms; askingmore questions during meetings withhealth professionals; reduced re-admissions to hospital; fewer visits toA&E; and fewer nights spent inhospital”
Summary from Kings Fund report: “An overview of patient activation”and results from Proactive Health Coaching
Patie
nt a
ctiv
atio
n
A telephone-based case-management intervention reduces healthcare utilizationfor frequent emergency department visitorsEuropean Journal of Emergency Medicine, 2013 Oct;20(5):327-34.• 268 patients followed for up to one year (2010–11) in a single-centre nurse-led
intervention trial to reduce care utilisation for frequent emergency departmentvisitors
• The intervention indicated that a nurse-led telephone-based interventionsignificantly decreased the incidence of hospitalisation, number of bed days andhealthcare costs
Latest results from 12,000 patients published in theEuropean Journal of Emergency Medicine
A case management intervention targeted to reduce healthcare consumption forfrequent emergency department visitors: results from an adaptive randomized trialEuropean Journal of Emergency Medicine, 2015• 12,181 patients identified as frequent emergency department visitors in three
Swedish counties were randomised to intervention or control group and followedfor a minimum of one month and a maximum of two years
• This study indicates a significant overall 12% decrease in hospitalisation incidencefor intervention patients compared to controls. The results improved over time asthe intervention was continuously evaluated and improved.
9CONFIDENTIAL
PHC is already implemented in Vale of York and will nowbe implemented in three new CCGs during the spring
Three new CGGs will be implemented March 2016• Vale of York implemented spring 2015• Wolverhampton CCG, Cannock Chase CCG and South East Staff
CCG will be implemented spring 2016• One more slot for spring/summer 2016
10CONFIDENTIAL
Evaluation• Nuffield Trust evaluates the Randomised Control Trial• The intervention is adopted on the NIHR CRN portfolio which
means that participating trusts will benefit from conducting theresearch
• Martin Bardsley, Director of research at Nuffield Trust is ChiefInvestigator
Other aspects• Visit from NHS England in York during the autumn 2015• Case study of PHC in York is distributed to Vanguard CCGs from
NHS England
