National copd programme building qi into your audit from the start
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National COPD Programme Building QI into Your Audit from the Start. Prof. Mike Roberts Royal College of Physicians Barts Health/ UCLPartners On behalf of the team. Programme Overview. 3 plus 2 year programme 2013-8 Commissioned & funded by HQIP

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National COPD Programme Building QI into Your Audit from the Start

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National COPD Programme Building QI into Your Audit from the Start

Prof. Mike Roberts

Royal College of Physicians

Barts Health/ UCLPartners

On behalf of the team


Programme Overview

  • 3 plus 2 year programme 2013-8

  • Commissioned & funded by HQIP

  • Led by the Royal College of Physicians (RCP) working in close partnership with

    • British Thoracic Society (BTS)

    • British Lung Foundation (BLF)

    • Primary Care Respiratory Society (PCRS-UK) and

    • Royal College of General Practitioners (RCGP)


Programme Workstreams

  • Primary care audit– Collection of clinical audit data from General Practice patient record systems looking back over a year. Spring 2015 then annual.

  • Secondary care snapshot audit– Admissions to hospital with COPD exacerbation process and outcomes at 30 and 90 days. Organisation and Resources over data collection period. Spring 2014 & 2016.

  • Pulmonary rehabilitation snapshot audits – Service quality and patient outcomes over 3 months. Includes resources and organisation. Jan 2015 start. Repeat 2017.

  • PREM – One year development work exploring the potential/feasibility for Patient Reported Experience Measures to be incorporated into the programme in the future.

  • Patient identifiable data linked across the workstreams and to external sources such as HES and ONS


Measures - Process and Outcome

  • Primary care e.g. compliance against NICE standard- diagnosis confirmed, smoking cessation, annual review, referral to PR, correct treatment etc.

  • Secondary care e.g. Essential investigations and interventions in first 24 hours, integrated discharge.

  • Pulmonary Rehab e.g. Compliance with BTS standards, completion, better QoL, improved exercise capacity.

  • Mortality, Hospital Stay, Readmission.


UK COPD Audit Progression

  • 1997 36 hospitals process and outcomes

  • 2001 30 hospitals process/outcomes + organisation and resources

  • 2004 94% all UK Trusts (as per 2001)

  • 2008 98% of all UK Trusts process/outcomes + resources and organisation

    + patient experience + primary care record

  • 2010 Euro Audit of hospital care & resources


Audit is a quality improvement process


UK National COPD Audit

% patients with pH< 7.35

Receiving Ventilatory Support by Individual Units


Quality indicators for North West SHA acute units (14 - 27)


Hospital Report


NICE Management Guidelines for COPD NICE COPD Quality StandardsDH Outcomes Strategy for COPDNHS COPD Commissioning Toolkit


Over Time

  • Some resources have increased

  • Wider service provision

    But

  • Little evidence of improved processes

    But

  • Length of stay reduced

  • Readmissions have increased

  • Mortality remains high


What Have We Done Differently?

  • Acknowledge QI is key

  • Establish a QI group

  • Look for links with external organisations

  • Emphasise to participants the QI opportunities

  • Suggest QI options to participants

  • Engagement, engagement, engagement!

    ‘Make it as easy as possible to do the right thing for the patient’


Engaging with Professionals

  • Radical Message

  • Kept simple (but with significant range of consequences)

  • Balanced with the good

  • Something that appeals to professionals and patients alike

  • Strap line – ‘Who Cares Matters’

  • Supported by National Professional bodies


Engaging Commissioners

  • CCG/LHB Level Reports- what do you want to see?

  • CCG engagement (e.g. via CCG Champion Networks of partner organisations)

  • Identifying CCG priorities

  • Targeted messaging

  • Benchmarking against NICE standards

  • Potential for peer review (e.g. accreditation of Pulmonary Rehabilitation)


National Engagement

  • All Party Parliamentary Group on Respiratory Health

  • NHSE Domains

  • NHS Wales – Policy leads (NCA; Respiratory; Primary Care; Adult & Children’s Health)

  • National Respiratory Director

  • NHSE – Head of Patient Experience

  • NHSIQ


Engaging Patients and Carers

  • British Lung Foundation

    • Including network of Breatheasy Groups

  • Patient involvement groups – professional bodies (e.g. RCP PIU)

  • The plain English version

  • Conferences and newsletters

  • And in an ideal world patient access to their own data!


Summary

  • Reporting of data has limited impact

  • Acknowledging QI is critical element at outset

  • Having a QI strategy

  • Engaging key parties

  • We have no resource or contract to deliver QI

  • Over to you-

    Health Quality Improvement Partnership


To Find Out More

If you would like to register to receive updates:

Email: [email protected]

Or visit: www.rcplondon.ac.uk/COPD

#COPDaudit #COPDwhocares?


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