Longer Lives and beyond…
Longer Lives
Don Sinclair, Julian Flowers &
Helen Shaw
Public Health England
Today’s session The story of the Longer Lives tool
Next steps for Longer Lives
Another related high priority project
Advice from the floor on user engagement
2 Longer Lives
Background
UK health performance: findings of the Global Burden of Disease Study 2010*
For both mortality and disability, overall health has improved substantially in absolute terms in the UK from 1990 to 2010… However, the UK performed significantly worse than the EU15+ [Australia, Canada, Norway & USA] for age-standardised death rates, age-standardised Years of Life Lost rates, and life expectancy in 1990, and its relative position had worsened by 2010… * Murray C et al, Lancet 2013; 381: 997–1020
3 Longer Lives
Longer Lives
A web tool designed:
• To show premature mortality from “big killers” in a simple and transparent way
• At upper tier local authority level (England)
• Benchmarked to the national average and similarly deprived areas
Also linked to causes, evidence and feedback
http://longerlives.phe.org.uk
4 Longer Lives
Landing Page Introduction to the website
Maps premature mortality across England
Local authorities can be selected by name, postcode or by clicking
Links to more details about the project, feedback page, and the current “hot topic” e.g. liver disease
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Ranked list of all
local authorities
Ranked list of premature
mortality for all local
authorities
Colour shows statistical
comparison with England
average
Toggle between premature
deaths per 100,000 people
and total premature deaths
for an area
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Similarly deprived
local authorities
Ability to compare a local
authority with other authorities
in the same socioeconomic
deprivation bracket
Ranks can be for overall
premature mortality or for
each individual cause
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Local Authority
Pages
Ranks are displayed and colour-coded
Links to information about the common causes and interventions for each disease type
Links to relevant PHE campaign pages for individuals interested in reducing their risk
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Example of a local authority
with high rates of premature
mortality
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Local Authority
Page
Causes of Premature
Mortality
Brief description of causes
Links to information about risk factors
Example case study demonstrating a successful population intervention
Links to further information about risk factors, NICE guidance and campaign resources for local authorities
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Preventing harm at population level
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Preventing harm at individual level
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Next steps
Data was updated in February with summary of how local authorities’ data had changed
• Make all data available at district level
• Disaggregate cardiovascular mortality
• Disaggregate cancer mortality
• Add suicides (& undetermined injuries)
• Add accidents
• Include comparators available in PHOF
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Further next steps
• Add trends where possible
• Add wider determinants and risk factors
• Improve links to information on causes
• Review comparators to find those most useful to local authorities
• Add more case studies with evidence of delivering health improvement
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Co-ordination – PHE & partners Process across the whole of PHE – linking with partners
(e.g. ADPH, LGA, HSCIC, NHS England)
• Synergy in PHE processes
• Increased efficiency
• Standardised quality assurance
• Best practice in visualising data
• Shared learning across all projects
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New Priority
In 2014, Secretary of State has a new priority to illustrate chronic diseases in primary care
• Based on Longer Lives website design
• Show data on home page at LA and CCG levels
• Map selection links to simplified profile for selected area, or to practice profiles
• Include summary measures or ratings of practices or other areas
16 Longer Lives development for Primary Care
Aims
• Show variation in prevalence, activities and outcomes
• Highlight areas of better and less good practice
• Ease of use / transparency
• Ongoing development in response to feedback
• Start with diabetes as an important long term condition
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Purpose of rating CCGs & practices
• Increase accountability
• Aid choice
• Improve performance (of providers)
• Identify and prevent failures in the quality of care
• Public reassurance as to the quality of care
http://www.nuffieldtrust.org.uk/blog/should-there-be-ofsted-style-ratings-health-and-social-care-providers; accessed 23rd Feb 2014
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Ratings could improve accountability if… • Simple
• Valid
• Publicly reported
• Improve performance (of providers)
• Identify and prevent failures in the quality of care
• Public reassurance as to the quality of care
http://www.nuffieldtrust.org.uk/blog/should-there-be-ofsted-style-ratings-health-and-
social-care-providers; accessed 23rd Feb 2014
19 Longer Lives development for Primary Care
Summarizing - ratings • Outlier approach (assurance tool)
• Z-score approach (CQC)
• Target exceedence
• Profiling
20 Longer Lives development for Primary Care
Contextual information • Number of people with diabetes
• Obesity
• Deprivation
• Ethnicity (? South Asian)
• Age profile (%>50)
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Example QOF indicators –
Practice & CCG Outcomes
% of patients with diabetes in whom the last IFCC-HbA1c is 59 mmol/mol or less in the preceding 15 months
% of patients with diabetes in whom the last blood pressure is 140/80 or less.
% of patients with diabetes whose last measured total cholesterol within the preceding 15 months is 5mmol/l or less
Process
% of patients with diabetes whose notes record BMI in the preceding 15 months
% of patients with diabetes with a record of neuropathy testing in the preceding 15 months
% of patients with diabetes who have a record of retinal screening in the preceding 15 months
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Showing variation…?
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Diabetes control
Feet checked for nerve
damage
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Practice search
Selected practice on map – map shows
All in CCG RAG rated – shows initial indicator
Selected practice on map – shows
profile of indicators.
Clicking indicators on profile displays
on map
Area selection gives
CCG profile using call out box
Longer lives map
CCG profile based
On LLs
CCG map
Showing practice variation
Practice profile showing
all indicators
Wicked issues
• Roles and responsibilities/ ownership and coproduction
• Linking with other products
• Benchmarking (compared to who?)
• Colour schemes for presentation (RAG or BOB)
• Qualitative statements
• Getting user input/ feedback
• Simplicity vs. over-simplification
• Creating a summary metric/ rating
• Timescale….
27 Longer Lives development for Primary Care
How can you help…. • Join the reference/ working group
• Feedback on design
• Feedback on indicators/ methodology
• Test prototypes
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Engagement • User input critical to success
• Accessible and transparent
• Iterative improvements
• Representation in governance
• Direct feedback
• PLEASE VOLUNTEER!
29 Longer Lives development for Primary Care
Image via http://www.pgdba.org/wp-content/uploads/2013/06/we-need-you.jpg
Advice from the floor Who might use such a tool?
Which decisions would be made?
Which information would be required?
How should this information be presented for users?
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Please volunteer
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Image via http://www.pgdba.org/wp-content/uploads/2013/06/we-need-you.jpg
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