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Evaluating and monitoring Care Homes

Evaluating and monitoring Care Homes. Where it all began… . Several pieces of work converged at the same time… Care Homes MDT Pilot intervention in Amber Valley to reduce hospital admissions: how would we evaluate the impact?

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Evaluating and monitoring Care Homes

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  1. Evaluating and monitoring Care Homes

  2. Where it all began… • Several pieces of work converged at the same time… • Care Homes MDT Pilot intervention in Amber Valley to reduce hospital admissions: how would we evaluate the impact? • Care Homes Health & Safety Multi Agency project: how would they evaluate impact on falls? • Improve uptake of the Diabetic Retinopathy Screening Service: how do we identify care home residents who should access? • DH Alert for ‘Medicines Management in Care Homes’ • A poorly performing care home: how could we compare admissions and deaths against other homes? • A practice with a large care home population: was this adversely influencing their health outcomes? • Conclusion… No standard methodology or datasets in place to answer these questions! No one person with strategic responsibility for care homes in the PCT!

  3. What we did next… • Pilot Report for 2 Local Commissioning Groups, aiming to identify data sources and develop a standard reporting and analysis methodology • Including: • Literature Review: evidence of disease prevalence and effective health interventions is scarce and of variable quality levels • Care Home Populations: snapshot from Exeter verified by practices allowed basic analysis of age and gender by care home and practice • Correlation of population against outcomes at practice level – a moderate relationship with dementia register • Emergency admissions: matched by NHS Number to Exeter snapshot, one year period, rates per 1000, by diagnosis, LOS and cost • Mortality: from PHMF using Comm Est Code, rates per 1000 • Conclusion… Issues with quality of available data sources rendered comparative analysis meaningless!

  4. Issues identified: • Naming protocols: Exeter, CQC and ONS all differ in names of same care homes • CQC have unique reference number not compatible with ONS communal establishment codes • Denominator population: snapshot not suitable need more robust data • Exeter only has quarterly update for out of area registered patients, need age/sex breakdown • No source of disease prevalence • No identifier in SUS for care homes • PHMF versus PCMD • Matching up Social Care individual payments with health data – going through IG

  5. Outcomes/Next steps: • Minimum dataset as part of new East Midlands nursing homes contract to provide rolling denominator population • Create a standardised directory with care home name, nursing home code, communal establishment code and postcode for robust matching • Addition of CQC code to Exeter • Extract disease prevalence from Primary Care systems • Development of a template for Primary Care • Identify data from other relevant sources • Development of care home profiles identifying any statistically significant differences between care homes • Evaluation framework required for interventions targeted at care homes in order to evaluate effectiveness

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