primis in partnership: cambridgeshire hertfordshire
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
PRIMIS Partnerships For Progress March 2004
PRIMIS in Partnership: Cambridgeshire
Hertfordshire
Dawn Friend and Trish McHugh Gloria Wilkie
PRIMIS Partnerships For Progress March 2004
Working collaboratively in Peterborough!
Dawn Friend, Primary Care Information Manager
Trish McHugh, Primary Care Collaborative Manager
Greater Peterborough Primary Care Partnership
PRIMIS Partnerships For Progress March 2004
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 Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
Measurement in NPCC
IS
• Practical
• Pragmatic
• Focussed
IS NOT
• Time-consuming
• Academic
• Elaborate
Measurement for learning, not measurement for judgement
PDSA cycles
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
Phase I ‘spread’ & Phase II CHD measures
• Got in early
• Sat down together
• Reviewed NPDT guidance – Not so straightforward!
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
Phase I ‘spread’ & Phase II CHD measures
• Dawn produced ‘crib sheet’– Suggested search criteria– Read codes– Exception codes
(contraindicated/declined etc)
PRIMIS Partnerships For Progress March 2004
CHD
‘crib sheet’
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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…
PRIMIS Partnerships For Progress March 2004
… Phase III !
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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…
PRIMIS Partnerships For Progress March 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
PRIMIS Partnerships For Progress March 2004
Partnership working for Phase III
• Early and ongoing communication
• Interpreting NPDT guidance
PRIMIS Partnerships For Progress March 2004
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.
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
Partnership working for Phase III
• Early and ongoing communication
• Interpreting NPDT guidance
• Identified potential coding issues
• Created Phase III ‘crib sheet’ & calculator
PRIMIS Partnerships For Progress March 2004
Phase III
‘crib sheet’
PRIMIS Partnerships For Progress March 2004
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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”…
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
Practice example: PDSA cycle for
data quality check
PRIMIS Partnerships For Progress March 2004
Diabetes measures
PRIMIS Partnerships For Progress March 2004
COPD measures
PRIMIS Partnerships For Progress March 2004
Thank you… Questions???
Dawn Friend & Trish McHughGreater Peterborough Primary Care Partnership
nww.cambsprimis.nhs.uk
www.npdt.org
PRIMIS Partnerships For Progress March 2004
DQ STRATEGY IN HERTSGloria Wilkie
Project Development Manager
Hertfordshire Health Informatics Service
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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%
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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
PRIMIS Partnerships For Progress March 2004
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?
PRIMIS Partnerships For Progress March 2004
DEVELOPMENT DAY
PRIMIS Partnerships For Progress March 2004
DEVELOPMENT DAY
PRIMIS Partnerships For Progress March 2004
THE FUTURE
• INCORPORATE A DQ STRATEGY AS AN ESSENTIAL COMPONENENT IN PLANS FOR ACHIEVING ……….
PRIMIS Partnerships For Progress March 2004
TARGET FOR THE FUTURE
• 2008 EPR AND INTEGRATED CARE RECORDS SERVICE
PRIMIS Partnerships For Progress March 2004
DQ IN HERTFORDSHIRE CONTACT
Tel: 01707 390855 extn 2084