The Problem Collaboration
Tony MarsonKeith Bodger
University of Liverpool
Are we the problem?
What are the problems we want to fix?
We want to fix poor patient
outcomes and inefficiency
Unplanned care(Epilepsy, COPD)
Alcohol
Step 1
• Use linked routine health data–Hospital episode statistics–GP prescribing–Investigation results
Iterative change in a ‘learning health system’
Identify problems/ questions
Engage clinical
community
Analyse data
Identify and agree
changes
Implement changes
Are clinicians interested?
Do we have data to
analyse?
Can this be done? is there
budget?
Example from Epilepsy
• Maps on to– North West Coast CLAHRC– Neurology Vanguard
• Early win for CHC
• 4,544 attendances
• Wide variability across
sites
• <50% first seizures
referred to a seizure clinic
• < 50% of ‘known epilepsy’
under active follow up
• Inadequate assessments in
emergency departments
National Audit of Seizure Management in Hospitals
Patients don’t have equitable access to services!
Hospital Episode Statistics
• Dirty data, primary purpose is for reimbursement
• Heavily dependent upon coding• Risk of ‘garbage in – garbage out’• Mainly process rather than outcomes• Need clinical/NHS experience to spot the
obvious• Need complex algorithms to identify cohorts
Neurology appointment after attending ED
These patients were older, more
deprived, had longer stay,
Cheshire and Mersey Pathway
• Implement simple pathway to NHS Trusts affiliated to the Walton Centre
Patient attends ED
Epilepsy / neurology
appt
Patients identified and put on pathway.
Nurse employed to make sure it happens at 3 sites
Appointment within 2 weeks
Individual hospital reports
Individual hospital reports
We can apply the same principles to alcohol and COPD
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