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A Primary Care Trust Perspective NHS North Lancashire. Dr Jim Gardner Medical Director & PEC Chair. NHS North Lancashire. [email protected]. PCT Perspective. Corporate Objectives Commission health care Improve health outcomes Reduce health inequalities - PowerPoint PPT Presentation
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A Primary Care Trust Perspective
NHS North Lancashire
PCT PerspectivePCT Perspective
• Corporate Objectives• Commission health care• Improve health outcomes• Reduce health inequalities• Achieve financial balance
• ‘Patient Safety First’• Whole-systems thinking• Not experts in VTE
VTE Improvement Cycle
Raise awareness
Measure
Understand
Set standards
Sources of data
• Primary Care– PRIMIS– QoF
• Secondary Care– Regional Data Warehouse (SUS)– CHKS– Hospitals’ own –
pathology/haematology
0
500
1000
1500
2000
2500
3000
1
Primary Care Prevalencefrom PRIMIS searches
Total number of patients diagnosed with either DVT or PE as a % of a total GP population of 298,371 (5 practices data was not included due to discrepancies in the data collection)
Primary Care Patients on Warfarinfrom PRIMIS search
2811
505
383
No of Pts without eitherDVT or PE prescribedWarfarin between01.11.08 - 31.01.09
No of Pts with DVT andWarfarin
No of Pts with PE andWarfarin
Total number of patients prescribed Warfarin (in last 3/12) from the total GP population of 298,371 (5 practices data was not included due to discrepancies in the data collection)
0
200
400
600
800
1000
1200
2005-2006
2006-2007
2007-2008
UHMB
BVH
LCT
Other
Total
Annual Hospital Incidence from SUS data.
Data from Cumbria & Lancashire Commissioning Intelligence Support (CaLCIS)North Lancashire Residents (population 340,000).
Benchmarked Benchmarked Analysis of Venous Analysis of Venous Thromboembolism Thromboembolism
2006-2008 data2006-2008 data
Venous Thromboembolism – primary or secondary position
Venous Thromboembolism – Length of
Stay by type 2008 only
NHS North Lancashire - Population 340,000.
Venous Thromboembolism – mortality rates
2008 only
NHS North Lancashire – Population 340,000
VTE Improvement Cycle
Raise awareness
Measure
Understand
Set standards
Commissioning for Quality
• What is quality?– Safety, efficacy, personalisation, outcome
• ‘Advancing Quality’ – carrots v sticks• Risk Assessment for all hospital
admissions embedded in contracts• Financial support to providers• PCT Project Manger for VTE to monitor
and support– Audits / Root Cause Analyses/ Trajectories
Refining DVT diagnosis in primary care
• >140,000 referrals for ?DVT/year in UK• 80 – 90% do NOT have DVT• Need to refine tests in primary care• Clinical Decision Process including near-
patient-testing• ‘Safely Ruling out Deep Venous Thrombosis in
Primary Care’. Buller et al. Ann intern Med. 2009; 150:229-235
• One PBC consortium implementing.
VTE Mind Map from PCT Perspective
Project Plan
• Understand the data and the issues• Raise awareness• Set standards in contracts• Support improvement initiatives• Measure outcomes• Link VTE to other initiatives• Manage the project through a Lead• Share learning
Questions
• In our PCT area, our two acute hospital trusts have different heparin regimes at discharge. This causes confusion for our community staff.
• In the interests of safety, should we (as a PCT) seek to standardise heparin protocols across our health economy?
• Should we, as an exemplar community, look to standardise heparin protocols across England?
