www.hqip.org.uk

National Clinical Audit & Patient Outcome Programme: An update

Jenny Mooney Director of Operations

Healthcare Quality Improvement Partnership

Our structure and funding

The National Clinical Audit & Patient Outcome Programme (NCAPOP)

National Clinical Audit Programme 34 national audits covering: • Acute • Cancer • Children and

Women's Health • Heart • Long-term Conditions • Mental Health • Older People

Clinical Outcome Review Programmes 4 national programmes: • Maternal, Newborn

and Infant • Medical & Surgical • Mental Health • Child Health Programme

Other National Programmes National Learning Disability Mortality Review Programme National Case Record Review Programme National Perinatal Mortality Review Programme Child Death Database Project National Joint Registry Collects joint replacement information, monitoring implant, hospital and surgeon performance:

Adult Cardiac Intervention Adult Cardiac Surgery Cardiac Ambulance & MINAP Cardiac Rhythm Management Heart Failure Congenital Heart Disease Sentinel Stroke Vascular Registry Bowel Cancer Head and Neck Cancer Lung Cancer Cancer OGC Prostate Cancer Breast Cancer Care Asthma End of Life Care

Dementia Anxiety & Depression Psychosis Mental Health CORP Diabetes (Adult) Inflammatory Bowel Disease Chronic Obstructive Pulmonary Disease Chronic Kidney Disease in Primary Care Rheumatoid and Early Inflammatory Arthritis National Ophthalmology Database National STI Management with Healthcare for Adults with HIV

Diabetes (Paediatric) Neonatal Paediatric Intensive Care Epilepsy 12 Maternity & Perinatal Audit Maternal & Newborn CORP Child Health CORP CDOPS Database Specialist Rehabilitation for Patients with Complex Needs Falls & Fragility Fracture Audit Programme Emergency Laparotomy Medical & Surgical CORP

Domain 3

Domain 2 Domain 1

KEY Women and Children Mental Health Cancer Long term conditions Acute Cardiovascular

Role of NCAPOP Team

Schedule and manage all commissioning and performance management activity relating to the

national programme

Specification development

Procurement Contract

Management

Managing requests for new topics

Performance Management

Project Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

RCCR Lot 2 (re-tender)

DH Maternal & Perinatal Mortality Review Programme

Psychosis

Anxiety & Depression

Diabetes: Adult & Paed

NICOR

Chronic Kidney Disease

Dementia

Bowel Cancer

Child Health CORP

Falls & Fragility Fracture Audit

Sentinel Stroke

HIV

End of Life

Emergency Laparotomy (NELA)

Rheumatoid Arthritis

National Vascular Registry

COPD

Prostate Cancer

Lung Cancer

Medical & Surgical CORP

Mental Health CORP

Opthamology

Specialist rehab

OGC

Learning Disability CORP

Asthma Maternal and Child Health Framework

Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Framework Communication

Framework launched

Procurement underway

Contract award

MNI- CORP mini competition

NNAP mini competition

PICANET mini competition

Epilepsy 12 mini competition

Child Death Database MC

Colour code

Spec development

Tender launched

Procurement underway

Contract award

Extension

The Team

Improving care for patients

Using Audit to understanding the care that is being delivered Care Processes, Type 1 Diabetes

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Key Finding For people with Type 1 diabetes there is a large variation in care process completion performance between CCGs or LHBs.

Figure 5: The range of CCG/LHB care process completion for people with Type 1 diabetes in England and Wales, 2014-15

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

All eight care processes

Smoking

BMI

Foot surveillance

Urine albumin

Serum creatinine

Cholesterol

Blood pressure

HbA1c

Percentage of patients

Care process

3. Please see full list of footnotes in the definitions and footnote section (page 36)

Understanding variation

BMI measurement fell in 2013-14 and urine albumin checks dropped in 2014-15. These changes may reflect retirement of the respective QOF indicators and a consequent change in focus for GP practices.

Care process completion rates still vary appreciably between localities, between practices within localities, between Type 1 and Type 2 diabetes and by age.

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Recommendations: • CCGs and LHBs should network and learn about which systems best

support high levels of care process delivery • Within localities practices should be encouraged to share successful care

process delivery systems • Commissioners should consider the impact on core diabetes care of

changing pay for performance mechanisms such as QOF

What needs to improve and how?

This slide has been left blank for CCG/LHB or GP Practices to insert CCG/LHB or GP level information from the GP level excel spreadsheet.

For example:

• You may choose to show two contrasting GP practices in your area from the spreadsheet

• You may want to add here the differences in the processes for the two practices and any improvements made.

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Audits working in partnership with patients & families

What will be done to relieve my pain?

What will be done to help me if I have memory problems

or become confused?

When will I meet a geriatrician to plan my care and

rehabilitation?

Will I have surgery on my first or second day in hospital?

Will a senior surgeon and anaesthetist be in charge of my

operation?

What will be done to help me if I have difficulty with eating

or drinking?

How soon after surgery will I get out of bed and start

physiotherapy?

Will I be able to go home and if so how soon?

How will I be kept informed of my progress, so that my

family and carers can make arrangements for me when I

leave hospital?

What will be done to try and reduce my risk of falling in the

future?

What will be done to see if I need bone strengthening

treatment?

Will you check up on me after I leave hospital?

Audits working with Best Practice Tariff to help drive improved outcomes for patients

Quarter by quarter BPT criteria compliance and BPT achievement: 2010–2013

Driving improvement through Confidential Enquiry Methodology

Maternal, Newborn & Infant Clinical Outcome Review Programme 1in 200 births end in a stillbirths . I in 3 stillbirths occurs at term Every day in the UK three families are devastated by the death of their baby before labour.

Supporting Audit Reports

1. Audiences People who deliver care People who receive care People who commission care People who assure/regulate care

2. Scheduling 3. Language and tone 4. Report structure 5. Communications planning 6. Dissemination

National Emergency Laparotomy Audit

• Full Report: – Standards

– Findings

– Audit Questions

– Specific Recommendations

– Best Practice

– Patient Story

National Neonatal Audit

NNAP audit measure: Do all babies <1501g or a gestational age of <32 weeks at birth undergo the first Retinopathy of Prematurity (ROP) screening in accordance with the current guideline recommendations?

Maximising the use of audit data to support quality improvement measures at Trust level and support the CQC regulatory process

Challenges

Finance

New topics?

Step down?

www.hqip.org.uk

NCAPOP Commissioning for Improvement

Dr Yvonne Silove Associate Director, NCAPOP, HQIP

Commissioning for Improvement

a) Topic selection

b) Specification development

c) Contractual expectations

d) Facilitation, guidance and support

e) What matters most and where to next?

a) Topic Selection

• Twice yearly topic prioritisation using NCAPOP Eligibility Criteria:

• Includes specific review of evidence of:

• Poor or variable care / outcomes

• Disease burden

• Availability of national standards and appropriateness of methodology

• Professional and patient topic support

b) Specification Development

Experts in the clinical area

NAGCAE

National Quality Improvement and Clinical Audit Network (NQICAN)

Patient representatives

Self-nominated experts

Experts in the relevant methodology

Proposal lead Clinical lead

Policy leads

SDM

Service commissioners

Specification development meeting: what is discussed?

Risks

Data linkage

and sharing

Excluded

patient groups

Quality

improvement

Stakeholder needs

Data collection

burden

Current landscape

SDM

Methodology

Audit elements

Included patient

groups

Relevant policies

and quality drivers

Cost / benefit

Specification development meeting: what is discussed?

Risks

Data linkage

and sharing

Excluded

patient groups

Quality

improvement

Stakeholder needs

Data collection

burden

Current landscape

SDM

Methodology

Audit elements

Included patient

groups

Relevant policies

and quality drivers

Cost / benefit

Commissioners meeting

Benefits, risks,

local burden

Review of

discussions at

SDM

Agreement of

commissioning

brief

NAGCAE

Additional information required?

c) Contractual expectations

• Clinical leadership and patient engagement

• Improvement – led design

• Data entry burden and duplication of effort

• Robust, focussed analysis

• Timely reporting for all audiences

d) Facilitation, guidance and support

• NCAPOP seminars

• Several times each year

• Talks and workshops linking NCAPOP methodology to impactful reporting

• March 2016 ‘Maximising the impact of audit reports’

• Ad Hoc: sharing best practice, linking projects with similar reporting challenges etc.

d) Facilitation, guidance and support

AUDIENCE

FINDINGS

RECOMMENDATIONS

‘Reporting for Impact’ and Pre-publication report review

e) What matters most and where to next?

• Timely

• Clear (in derivation and reporting)

• Show results over time and against standards

• Easily accessible and digestible

• Actionable

• And increasingly…

– Interactive / customisable reporting

– Infographics and patient narratives

– Accompanied by toolkits, templates and other resources

Engaging Clinicians in Quality Improvement through National Clinical Audit – Dominique Allwood, ISL, Oct 2014

e) What matters most and where to next?

• How big is best? Clarity of message, vs. sensitivity and detail

to guide improvement

• Time- limited vs continual? Is there still a role for intermittent

data collection for national audits?

• When to report? More timely or wait for definitive outcomes?

• The best report format? Role for a more uniform output – do

we know yet what that should be?

e) What matters most and where to next?

• Limited research evidence to date

• AFFINITIE: ‘The development and evaluation of enhanced

audit and feedback interventions to increase the uptake of

evidence-based transfusion practice’ (2013-18, U of Leeds,

NIHR funded)

• Current research calls:

– NIHR: ‘Improving the outputs of National Clinical Audits to

support organisations to improve the quality of care and

clinical outcomes’

– MRC Highlight Notice: ‘Using multiple audits to look at a

provider’s overall performance.’

Thank you

• Jenny.Mooney@Hqip.org.uk

• Yvonne.Silove@Hqip.org.uk