PRIMIS in Partnership: Cambridgeshire Hertfordshire

PRIMIS Partnerships For Progress March 2004

PRIMIS in Partnership: Cambridgeshire

Hertfordshire

Dawn Friend and Trish McHugh Gloria Wilkie


Working collaboratively in Peterborough!

Dawn Friend, Primary Care Information Manager

Trish McHugh, Primary Care Collaborative Manager

Greater Peterborough Primary Care Partnership


Greater Peterborough Primary Care Partnership (GP PCP)

• South Peterborough PCT– 14 practices

• North Peterborough PCT– 18 practices

• Now GP PCP, a ‘merged management team’ (Jan 2003) along with Adult Social Care


PRIMIS in Peterborough• Started 2000 (Cambridgeshire project)• All 32 practices participating• Early focus on CHD, diabetes, asthma• Recommended Read codes• Agreed templates & audits• nww.cambsprimis.nhs.uk


What is the National Primary Care Collaborative (NPCC) ?

• 1st National Primary Care Development Team (NPDT) programme

• Delivering improvements to primary care access (using the Advanced Access model) and the management of people with established CHD

• Launched June 2000, with 80 PCTs initially selected• Now over 5000 practices engaged covering >31 million

patients• Largest health quality improvement programme in the

world


NPCC in Peterborough

South Peterborough• Phase I site• Joined Mar 2001,

with 5 core practices• 4 ‘spread’ practices

signed up Jan 2002• Trish joined as

Project Manager Oct 2002

North Peterborough• Phase II site• Joined in 2002 with 4

core practices• 4 ‘spread’ practices

now signing up• Trish recently taken

over the management of this phase


Measurement in NPCC

IS

• Practical

• Pragmatic

• Focussed

IS NOT

• Time-consuming

• Academic

• Elaborate

Measurement for learning, not measurement for judgement

PDSA cycles


CHD measures (Phase I)

• Aspirin: % CHD patients on aspirin including OTC (unless contraindicated)

• Statins: % CHD patients under 75 that have a cholesterol > 5mmol on statins (unless contraindicated)

• Beta-blockers: % CHD patients has an MI in past 12 months on beta-blockers (unless contraindicated)

• BP: % CHD patients with a BP < 140/85


Lessons learnt from Phase I pilot

• 5 pilot practices’ CHD measures– very variable results - different practices,

different searches– guidance tricky to interpret, searches tricky

to build

• Not comparable with PRIMIS CHD data– eg MI & beta blockers

• Too late to help standardise for pilot– NPCC emphasis on improvement


Phase I ‘spread’ & Phase II CHD measures

• Got in early

• Sat down together

• Reviewed NPDT guidance – Not so straightforward!


Phase I vs. Phase II

• Different reporting systems and deadlines

• Changes in data measures– BP Phase I <140/85

Phase II <150/90– Statin Phase I <75s only

Phase II all ages


Phase I ‘spread’ & Phase II CHD measures

• Dawn produced ‘crib sheet’– Suggested search criteria– Read codes– Exception codes

(contraindicated/declined etc)


CHD

‘crib sheet’


Out in the practices

• Help to set up system searches– to produce CHD measures– to target patients!

• Review Read coding– Update CHD templates

• Helpful tools - calculator



Working together on CHD

• Joint CHD meetings in all practices– PRIMIS CHD feedback– Collaborative measures– Specialist nursing team

• Identify & discuss recording, coding, organisational, staffing issues and support needs in one meeting


Ongoing support for Phases I & II

• Evolving searches for CHD measures– new Read codes

• Practices wanting to expand their recording – not indicated, not tolerated

• Rolling along nicely… and then…


… Phase III !


Torbay PCT

South West Kent PCTBANES PCTBristol North PCT

Southampton PCT

Bournemouth PCT

South Stoke PCTEast Lincolsnhire PCT

Coventry PCT

South Warwickshire PCT

South Peterborough PCT

Langbaurgh PCT

North Bradford PCTEastern Wakefield PCT

Bury PCT

Birkenhead & Wallasey PCT

Eden Valley PCT

Richmond & Twickenham PCT

Harrow PCTWatford & 3 Rivers PCT

Pilot involves 20 PCTs and over 100 practices

Phase III site

allocation


Phase III

• Focus on Diabetes and Chronic Obstructive Pulmonary Disease (COPD)

• Baseline data September 2003

• 4 Diabetes measures and 3 COPD

• Rolling out to every PCT in 2004…


Phase III measuresDiabetes• % of people with diabetes with a last recorded HbA1c of <7.5 within the previous 12

months• % of people with diabetes with a last recorded cholesterol reading of <5 mmol

within the previous 12 months• % of people with diabetes with a last recorded BP reading of <140/80 within the

previous 12 months• % of people with diabetes with a retinopathy screening recorded within the previous

15 months

COPD

• % of COPD patients who have received spirometry to confirm diagnosis

• % of COPD patients with smoking status recorded within previous 12 months

• No. of acute admissions for respiratory illness in COPD patients in the previous 12

months


Partnership working for Phase III

• Early and ongoing communication

• Interpreting NPDT guidance


NPDT guidance for COPD (example)

• How do I measure the % of COPD patients who have received spirometry to confirm diagnosis?

Using the COPD register, count the number of patients identified as having received spirometry and then calculate this as a percentage of the total number of patients on the COPD register.

We suggest the use of the following READ codes to populate the COPD register: H36., H37., H38., together with H3z. for those for whom it may be difficult to carry out a spirometry on such as the elderly, housebound, those with poor technique and those with a severe disability.


Identified potential coding issues

• COPD register“We suggest the use of the following READ codes to

populate the COPD register: H36., H37., H38., together with H3z. “

– Different to nGMS at the time

• Spirometry recording• No Read code for COPD admission• Diabetes HbA1c results

– Batch data conversions to cope with local PMIP changes


Partnership working for Phase III

• Early and ongoing communication

• Interpreting NPDT guidance

• Identified potential coding issues

• Created Phase III ‘crib sheet’ & calculator


Phase III

‘crib sheet’



Visits to Phase III practices

• Dawn & Trish

• Help to set up searches

• Validate baseline measures

• Discuss coding issues

• Build a COPD template

• Raise Trish’s awareness


Working together works well!

• Pooling knowledge/skills

• Good registers, recording, templates in place (headstart for nGMS!)

• Linking in to PRIMIS training & support

• “I know a man who can”…


Working together – practice example

• Practice reverted to manual trawl for figures. “BP <140/80 search not right”. 31 pats, not 20.

• Dawn met with practice nurse to investigate. Checked search – seemed to be fine

• So why the different results?

BP target is less than 140/80 (20 pats)

not less than or equal to 140/80 (31 pats)

• Information management - PRIMIS


Practice example: PDSA cycle for

data quality check


Diabetes measures


COPD measures


Thank you… Questions???

Dawn Friend & Trish McHughGreater Peterborough Primary Care Partnership

[email protected]

nww.cambsprimis.nhs.uk

[email protected]

www.npdt.org


DQ STRATEGY IN HERTSGloria Wilkie

Project Development Manager

Hertfordshire Health Informatics Service


DQ STRATEGY IN HERTS• Heart of strategy to modernise the NHS ~

effective use of information management & IT • LIS - Information for Health Programme• Aims & Role of PRIMIS in Herts:

– Extend level of usage, quality and consistency – Improve patient care– Facilitate effective data for health promotion, clinical

audit, clinical governance, referral monitoring, Himp targets

– Assist in meeting NSF standards and reporting


HERTS DISEASE PREVALENCE DATA 02/03

National Prevalences 2~ 2.5% 8% 2 ~ 2.5% 7%

PCTsNo. of

PracticesDiabetes

%Hypertension

%IHD %

Asthma %

No. of Patients

% Pts.

Dacorum 13 2.30 9.25 2.99 6.07 98807 67%Hertsmere 7 2.34 9.40 3.42 5.65 45842 68%North Herts & Stevenage 10 2.41 7.74 3.45 6.35 80279 40%RB & B 4 2.01 9.79 2.53 6.85 38347 49%South East Herts 10 2.35 5.72 2.53 4.51 93186 54%St Albans & Harpenden 8 2.06 9.18 2.85 5.92 89487 68%Watford & 3R 17 2.72 7.81 2.82 5.90 132107 75%WelHat 4 2.02 7.69 2.46 5.62 62189 59%

Hertfordshire 73 2.28 8.32 2.88 5.86 640,244 60%


IHD PREVALENCE IN HERTS 02/03

IHD %

0.00

1.00

2.00

3.00

4.00

Dacorum Hertsmere North Herts& Stevenage

RB & B South EastHerts

St Albans &Harpenden

Watford &3R

WelHat Hertfordshire


AIMS OF DQ STRATEGY IN HERTS

• Continue to extend levels of usage• New ways of developing & sharing data • Improve holistic approach to patient care using

integrated information technology• Guide PCTs & Practices in effective use of data• Assist PCTs to meet national standards & GMS

2• Set up clearly defined progress reporting

structures


ACTION PLAN• Secure Funding• Develop Plan to share• Meet with PCTs• Agree 2 year DQ strategy• Set DQ targets• Develop standards

• Investigate new solutions• Incorporate DQ/EPR/ICRS• Review DQ NSF targets• Pilot PCO clinical and

managed service solution• Review Year 1


ISSUES• Identifying PCT Lead• Duplication/Triplication• Information gathering• Retaining DQ Facilitators• Streamlining collection• Information Security • Training

• Raised levels of awareness

• Initiated clinical & management discussion

• Highlighted need for PCT responsibility/resource

• NSF DQ Initiatives• PCT Strategies & Action

Plans developed

PROGRESS


OUTCOMES & BENEFITS

• Improvement in patient care through the effective use of information technology

• Practice and PCT audit and review of the quality of care provided

• Integrated planning of services• Support for the Health Improvement Programme • Monitoring trends in disease incidence and

prevalence


OUTCOMES & BENEFITS

• Locally sensitive commissioning

• Improving the effectiveness of NSF reporting and clinical audit

• Use new GP contract to engage practices

• Setting up clearly defined reporting structures


PCT DATA FLOWS• WHO IS COLLECTING?• PRIMIS• PRESCRIBING ADVISER• CHD COLLABORATIVE• DIABETIC NURSE• ACCESS FACILITATOR• AUDIT OFFICER

• WHAT IS BEING COLLECTED?

• HOW IS IT BEING COLLECTED?

• WHAT IS DATA USED FOR?

• FOR WHOM?• HOW OFTEN?


DEVELOPMENT DAY


DEVELOPMENT DAY


THE FUTURE

• INCORPORATE A DQ STRATEGY AS AN ESSENTIAL COMPONENENT IN PLANS FOR ACHIEVING ……….


TARGET FOR THE FUTURE

• 2008 EPR AND INTEGRATED CARE RECORDS SERVICE


DQ IN HERTFORDSHIRE CONTACT

[email protected]

Tel: 01707 390855 extn 2084

Documents

PRIMIS in Partnership: Cambridgeshire Hertfordshire