providing actionable healthcare analytics at scale: a perspective from stroke care

Providing actionable healthcare analytics at scale: A

perspective from stroke care

Benjamin Bray, Research Director, Sentinel Stroke National

Audit Programme

Flickr: Jonathan Cohen

SSNAP

Ischaemic stroke Primary ICH

≈ 80,000 per year

All acute admitting hospitals in England

and Wales (&NI)

Whole pathway care quality: from admission, up to 6 months after

stroke

≈95% case ascertainment

Organisational audits of acute and post acute care services

100%

participation from trusts and

CCGs

Data, analysis, visualisations designed for: •Clinical teams •CCGs & LHBs

•Clinical networks •Stroke survivors

•National level reports

1:43

1:24

1:35

0:46

1:03

1:09

0:49

0:33

1:15

0:28

0:56

0

.5

1

1.5

2

Hou

rs

Jul 2014 Oct 2014 Jan 2015 Apr 2015

Source: SSNAP Apr-June 2015Team-centred results at team level for Key Indicator 3.5B Team 182

Median time from clock start to thrombolysis (hh:mm)

HES & ONS linkage

≈9000 bespoke outputs per annum

1 million downloads by Dec 2016 ...

Scope of data collection Organisation of care Clinical processes

Staffing Access to stroke unit, quality of SU Community services Rehabilitation and re-enablement Acute care organisation TIA/neurovascular service Multidisciplinary working Access to early supported discharge and community rehabilitation Strategic groups Policies Research Leadership

Acute care processes Timings to scan, thrombolysis, stroke unit Medical and therapy assessments and screening Therapy intensity Discharge processes Continuing care after hospital (e.g. therapy at home) 6 month assessment Outcomes

Infection rates Complications Mortality Modified Rankin score (disability)

Hyperacute care

Stroke unit

Inpatient rehabiliation

Community/home rehabiliation

Patient level SSNAP Record

A whole-pathway approach to QI

Making audit more effective

Audit components

Data are valid

Data is based on recent performance

Data are about the individual/team’s own behaviour(s)

Audit cycles are repeated, with new data presented over time

Feedback components

Presentation is multi-modal including either text and talking or text and graphical materials

Delivery comes from a trusted source

Feedback includes comparison data with relevant others

Nature of the behaviour change

required

Targeted behaviour is likely to be amenable to feedback

Recipients are capable and responsible for improvement

Targets, goals, and action plan

The target performance is provided

Goals set for the target behaviour are aligned with personal and organizational priorities

Goals for target behaviour are specific, measurable, achievable, relevant, time-bound

A clear action plan is provided when discrepancies are evident

Ivers et al , 2014

Audit components

Data are valid




Feedback components





required








Ivers et al , 2014

Validation at data entry, accuracy and completeness is measured and incentivised Real time data patient level analytics in webtool Quarterly analytics & visualiations Team level and patient-pathway level metrics Run charts

3128

33

25

42 42 4246

29

3936

39

29

0

25

50

75

100

%

Jul 2015 Oct 2015 Jan 2016 Apr 2016 Jul 2016

Source: SSNAP Apr-Jul 2016Team-centred results at team level for Key Indicator 1.1B Team 116

Scan within 1 hour

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0

10

20

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mb

er

of

tea

ms

0 10 20 30 40 50 60 70 80 90 100Team-centred Domain 3 score

Source: SSNAP Apr-Jul 2016Team-centred results for Domain 3 Team 101

Thrombolysis

Audit components

Data are valid




Feedback components





required








Multimodal outputs, including tabular data, clinical interpretation, data visualisation RCP “Brand”, Clinical leadership, multiprofessional ethos National and regional benchmarking Absolute benchmarking against standards

Audit components

Data are valid




Feedback components





required








Absolute performance vs guideline standard Metrics align with national clinical guidelines and set by multiprofessional group including stroke survivors We don’t provide action planning!

CC

B

C

E

D

D

D

D

D

C

D

CC

B

C

D

D

D

D

D

D

C

D

D

A:90%+

A:90%+

SSNAP score

Case ascertainment

Audit compliance

Total KI Score

D1:Scanning

D2:Stroke Unit

D3:Thrombolysis

D4:Specialist Assessments

D5:Occupational Therapy

D6:Physiotherapy

D7:Speech and Language

D8:Multidisciplinary team working

D9:Standards by Discharge

D10:Discharge Process

Team centredPatient centred

Source: SSNAP Apr-Jul 2016Team level results Team 116

Adding value through innovation

Building health economics into SSNAP

> Ischaemic stroke > Primary intracerebral haemorrhage ≈ 80,000 per year

All hospitals in England & Wales

Quality of care from admission, up to 6

months after stroke

Organisational audits of acute and post acute

care services

Health & social care costs up to five years

after stroke

1:43

1:24

1:35

0:46

1:03

1:09

0:49

0:33

1:15

0:28

0:56

0

.5

1

1.5

2

Hou

rs

Jul 2014 Oct 2014 Jan 2015 Apr 2015

Source: SSNAP Apr-June 2015Team-centred results at team level for Key Indicator 3.5B Team 182

Median time from clock start to thrombolysis (hh:mm)

£ $

Data, analysis, visualisations designed

for: •Clinical teams •CCG, LHBs, STP

footprints •Clinical networks •Stroke survivors

•National level reports

Discrete event simulation model generates individual cost estimates for all patients in SSNAP, up to 5 years after stroke

Age

Sex

Stroke type: ischaemic, ICH

Severity: NIHSS at admission

80 different combinations

Each dot is one patient in SSNAP

The blue

dots are

patients

with AF

Unlocking the power of big data

Increasing efficiency

Cost efficiencies through reducing data duplication and achieving economies of scale

Single source of data for multiple end users:

– Local :QI, evaluation, commissioning, research

– Regional: CCG, LHB, STP

– National: CQC, Best Practice Tariff, Public Health England, Wales Government, Department of Health

User centred design

Precision and high level of detail

Key messages/big picture

Bespoke analytics and visualisations for different users

High level key messages versus

highly granular data for QI

Design around user’s workflow (e.g. slidedecks for teams, dashboards for

CCGs)

Co-designing outputs for, and with, patients and families

Quarterly reports “Easy Access Version” downloads ≈ 8500/quarter

• Epidemiology, outcomes and health services research

• Evaluation of QI interventions & service changes (e.g. Interrupted time series with controls)

• Trials: Design, Phase IV, external generalisability

• Randomised registry based trials

• Advanced analytics and visualisation

Integration with research

• Reducing funding

• Information governance barriers to data linkage

• National policies don’t always support a philosophy of continuous improvement

• Better data on outcomes

Challenges

SSNAP is funded by the Healthcare Quality Improvement Partnership

SSNAP Health Economics was funded by NHS England

[email protected]

www.strokeaudit.org

Thank you