improvement analytics: innovation to improve care and efficiency
TRANSCRIPT
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Improvement analytics: innovation to improve care and efficiency
Adam Steventon, Director of Analytics, The Health FoundationMartin Caunt, Project Director, NHS England
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This workshop is split into five sections (with audience participation)1. Why there is a need to assess the impact of innovations in delivery of care and
some of the challenges of doing so2. Group discussion of your experience of the challenges of assessing the impacts
of your innovations to the delivery of care 3. Case study examples of how these challenges have been addressed in previous
analytical studies4. Introduction to the Improvement Analytics Unit project aims and ambition, and
implementation plans5. General discussion focussing on how we could help people like you meet the
challenge of assessing the impacts of innovations to the delivery of care
Introducing the Improvement Analytics Unit: a new partnership between
NHS England and The Health Foundation
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The NHS will take decisive steps to break down the barriers in how care is provided
England is too diverse for a ‘one size fits all’ care model to apply everywhere. Different local health communities will be supported by the NHS’s national leadership to choose from amongst a small number of radical new care delivery options
…we will expand NHS operational research, RCT capability and other methods to promote more rigorous ways of answering high impact questions in health services redesign
NHS England’s programmes of work have their roots in the Five Year Forward View
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What is the problem? What are the options? What is the theory underpinning the proposed model?
What is causing these changes?
What is happening on the ground? What progress is being made?
What should we be replicating and spreading?
What difference are the care models making?
How do you best implement x, y, z?
A set of questions from around the policy cycle, being posed more frequently by senior
stakeholders.
NHS England is supporting national transformation programmes to answer a
set of challenging questions
www.england.nhs.ukOur values: clinical engagement, patient involvement, local ownership, national support
What is the problem? What are the options? What is the theory underpinning the proposed model?
What is causing these changes?
What is happening on the ground? What progress is being made?
What should we be replicating and spreading?
What difference are the care models making?
How do you best implement x, y, z?
Dashboard / outcome metrics; Improvement Analytics Unit; local evaluations; Independent DH study
Evidence reviews;Logic models; Independent DH study
Enabler metricsLocal evaluations
Local evaluations Local evaluations; Independent DH study
Local evaluations; Evidence reviews
NHS England has developed a response for each core questions for the New Care Model
programme
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• Dealing with complex interventions, with no implementation blueprint, where effectiveness depends on the context and how the interventions were implemented
Need to be clear about what trying to achieve and how changes being made should lead to identifiable improvement
• Understanding of impact is not sufficient – it is only one part Need to know whether any change in outcomes is a result of the intervention or due to other factors
• Traditional or piloting and trialling approaches are not appropriate for the assessment of new care delivery options if going to inform implementation and spread
Need to for more rapid feedback on impact, ability to assess more than a few variations in care model design, at whole population level
• Data available nationally is limited in its timeliness, quality and coverage of care model activity Need to understand the limitations of national analysis and work closely with local to triangulate
evidence from qualitative sources
There are significant national challenges to assessing the impacts of innovations to the
delivery of care
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• How are you approaching the challenge of assessing the impacts of your innovations to the delivery of care?
AUDIENCE PARTICIPATION
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How do you evaluate things like…• Intermediate care following hospital discharge• Integrated health and social care teams• Integrated care teams in the community• Case management• Telephone health coaching• Telehealth• Telecare• Third-sector support following hospital discharge• A national early warning system for COPD• Nursing support at the end of life • Virtual wards• Rapid-response services • Support workers for community matrons • Short-term assessment and signposting services • Structured care for dementia• Structured care for diabetes• Named accountable GPs• Financial penalties for readmissions
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What often happens
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The problem of regression to the mean
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Step one: linking records over time
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Step two: matching to find a similar control group
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Step three: comparison against control group
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Step three: comparison against control group
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Step three: comparison against control group
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Step three: comparison against control group
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We did lots of these…• Intermediate care following hospital discharge• Integrated health and social care teams• Integrated care teams in the community• Case management• Telephone health coaching• Telehealth• Telecare• Third-sector support following hospital discharge• A national early warning system for COPD• Nursing support at the end of life • Virtual wards• Rapid-response services • Support workers for community matrons • Short-term assessment and signposting services • Structured care for dementia• Structured care for diabetes• Named accountable GPs• Financial penalties for readmissions
…so how can we scale up the evaluation method?
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• Aim: by 2019, create a unit to provide rapid feedback on the progress being made to improve care and efficiency as part of national programmes in England
• Rapid feedback (ultimately end-to-end within 2-3 months)• Focus on achieving scale (‘engineering not research’)• Embedding analytics within the ‘data bloodstream’• Partnership between NHS England and The Health Foundation• Joint team (5 people from The Health Foundation, 5 from NHS England)• Using nationally available data
The Improvement Analytics Unit will help determine if discernible change has happened
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We are working with two pilots to inform subsequent roll out to more local areas
and programmes
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Rapid Cycle Evaluation
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• How could we help people like you meet the challenge of assessing the impacts of innovations to the delivery of care?
• …and questions?
For more information please visit http://www.health.org.uk/improvement-analytics-unit-faqs
AUDIENCE PARTICIPATION
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Annex – Supporting Slides
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• Each care home having an assigned GP practice• A named Community Matron / Senior Nurse for each care home• Dedicated Allied Health Professional support for falls• Community follow-up 48 hours post hospital admission• In-reach of specialist community services/professionals including geriatrician, dietetics, heart failure
and respiratory• Regular proactive resident reviews, including medication• Reviews of new residents within five days and a Comprehensive Geriatric Assessment (CGA) within
two weeks• Standardised long-term conditions planning and increased identification of dementia• Explicit end of life care discussions with resident, family and carers• Peer support for care homes staff • Direct access to district nurse on call at weekends• Advocacy support to residents and families including ‘worry catcher’Source: Principia vanguard team
Working with Principia Partners in Health vanguard (MCP) in the pilot phase to assess
its model of enhanced support to Care Homes
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Working with Northumberland vanguard (PACS) in pilot phase to help assess the impact of creation of
their integrated primary and acute care system
Source: Northumberland vanguard team