breakout 1.3 improving copd care in the west midlands - colin gelder
DESCRIPTION
Breakout 1.3 Improving COPD Care in the West Midlands - Colin Gelder Clinical Lead Respiratory Midlands Region, NHS Midlands & EastMidlands East Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013, Guoman Tower Hotel, London How to deliver quality and value in chronic care:sharing the learning from the respiratory programmeTRANSCRIPT
1
Improving COPD Care in the Improving COPD Care in the West MildandsWest Mildands
Colin GelderColin Gelder Clinical Lead Respiratory Clinical Lead Respiratory
Midlands Region, NHS Midlands & EastMidlands Region, NHS Midlands & East
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Purpose of Data
Purpose of Data
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West Midlands Non-Elective COPD Admissions
0.0
0.5
1.0
1.5
2.0
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3.5
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sio
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er
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00
po
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2009/10
>2 fold variation
West Midlands COPD Non-Elective
Admissions
PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10
National 2.1 2.3 2.2 146 155 140 - - - - - -
SHA 2.0 2.2 2.2 147 154 143 - - - - - -
Herefordshire PCT 1.5 1.5 1.4 117 109 98 1 1 1 23 16 22
Heart Of Birmingham Teaching PCT 1.6 1.6 1.5 229 237 215 4 2 2 31 23 27
Warwickshire PCT 1.6 1.6 1.6 133 126 119 5 3 3 35 30 36
Shropshire County PCT 1.7 1.8 1.7 110 118 108 6 5 4 45 44 42
Telford and Wrekin PCT 2.0 2.3 1.8 127 134 101 9 9 5 74 79 49
Worcestershire PCT 1.5 1.9 1.8 122 147 130 3 6 6 30 54 52
South Staffordshire PCT 1.5 1.7 1.8 109 121 127 2 4 7 24 36 55
North Staffordshire PCT 2.1 2.1 2.0 128 122 108 10 8 8 82 73 70
Solihull Care Trust 2.0 2.4 2.1 139 164 136 8 12 9 73 89 77
Dudley PCT 2.1 2.4 2.2 160 169 149 11 11 10 83 87 86
Wolverhampton City PCT 2.1 2.3 2.2 156 162 149 12 10 11 84 84 88
South Birmingham PCT 2.3 2.6 2.4 151 167 150 13 13 12 94 100 96
Coventry Teaching PCT 1.9 2.1 2.4 135 142 156 7 7 13 71 72 98
Sandwell PCT 2.8 3.0 2.7 170 176 157 14 14 14 119 117 115
Walsall Teaching PCT 3.0 3.0 2.7 194 181 153 17 16 15 129 119 116
Birmingham East and North PCT 2.9 3.1 3.0 212 226 210 15 17 16 122 123 124
Stoke On Trent PCT 3.0 3.0 3.3 163 162 166 16 15 17 125 118 133
National rankCOPD admissions per 1000 population Rank within SHACOPD admissions per 1000 registered pts
6
Coventry PCT COPD Admissions
West Midlands non-elective COPD
hospitalisation costs
PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10
National 4.2 4.6 5.1 297 314 329 - - - - - -
SHA 4.1 4.6 5.1 297 315 336 - - - - - -
Heart Of Birmingham Teaching PCT 3.4 3.3 3.5 495 500 491 6 2 1 43 23 25
Herefordshire PCT 3.1 3.1 3.5 241 227 238 3 1 2 27 15 26
Shropshire County PCT 3.3 3.4 3.8 212 220 239 5 3 3 36 27 31
Warwickshire PCT 3.3 3.6 4.1 272 271 297 4 6 4 35 39 41
Worcestershire PCT 2.8 3.5 4.2 219 268 301 1 5 5 13 38 45
Telford and Wrekin PCT 3.9 4.6 4.2 244 271 238 7 9 6 61 76 46
North Staffordshire PCT 4.4 4.0 4.4 263 231 239 11 7 7 87 58 55
South Staffordshire PCT 2.9 3.5 4.6 212 245 320 2 4 8 18 32 66
Solihull Care Trust 4.1 5.1 4.8 286 349 311 10 12 9 77 100 72
Dudley PCT 4.0 4.3 5.0 298 303 334 8 8 10 68 67 73
Wolverhampton City PCT 4.6 4.8 5.2 334 331 348 12 11 11 93 84 83
Coventry Teaching PCT 4.0 4.6 5.7 279 308 366 9 10 12 73 79 100
South Birmingham PCT 4.9 5.7 5.8 328 367 369 13 13 13 104 109 106
Sandwell PCT 5.5 5.7 6.2 332 332 358 15 14 14 116 111 110
Walsall Teaching PCT 6.5 6.8 6.8 426 407 381 17 16 15 133 131 119
Birmingham East and North PCT 6.2 6.9 7.0 452 501 493 16 17 16 129 132 124
Stoke On Trent PCT 5.5 6.0 7.2 304 320 362 14 15 17 115 116 127
COPD tariff per 1000 population COPD tariff per 1000 registered pts Rank within SHA National rank
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West Midlands non-elective COPD
hospitalisation length of stay
PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10
National 8.3 8.0 7.7 - - - - - -
SHA 8.4 8.2 7.9 - - - - - -
Solihull Care Trust 8.2 8.5 6.7 7 11 1 62 98 23
North Staffordshire PCT 8.7 7.2 6.8 10 4 2 101 34 27
Heart Of Birmingham Teaching PCT 8.7 7.8 7.2 11 9 3 102 62 46
Stoke On Trent PCT 7.4 7.1 7.3 5 3 4 30 29 51
Herefordshire PCT 8.4 7.7 7.4 8 7 5 73 58 55
Birmingham East and North PCT 9.5 9.1 7.6 14 13 6 130 130 65
Telford and Wrekin PCT 6.9 7.5 7.7 1 6 7 17 49 74
Dudley PCT 7.3 6.9 7.8 4 2 8 28 26 77
Sandwell PCT 7.2 6.6 7.9 3 1 9 23 21 91
Walsall Teaching PCT 8.6 9.7 8.1 9 17 10 87 142 97
Wolverhampton City PCT 9.3 8.3 8.1 13 10 11 123 93 100
Shropshire County PCT 9.7 9.4 8.2 17 16 12 139 138 102
South Staffordshire PCT 7.5 7.3 8.2 6 5 13 37 38 104
Worcestershire PCT 7.1 7.7 8.2 2 7 14 22 58 105
Coventry Teaching PCT 9.6 9.1 8.3 16 12 15 136 129 109
Warwickshire PCT 9.1 9.2 8.9 12 14 16 117 134 132
South Birmingham PCT 9.6 9.4 9.4 15 15 17 133 136 144
National rankCOPD Length of stay Rank within SHA
West Midlands non-elective COPD
hospitalisation 28-day readmission rate
PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10
National 0.20 0.21 0.22 - - - - - -
SHA 0.19 0.21 0.22 - - - - - -
Herefordshire PCT 0.18 0.16 0.14 5 1 1 38 4 2
Solihull Care Trust 0.20 0.26 0.18 14 17 2 92 145 17
South Staffordshire PCT 0.18 0.18 0.19 6 5 3 39 18 21
North Staffordshire PCT 0.21 0.19 0.19 17 7 4 107 34 22
Heart Of Birmingham Teaching PCT 0.20 0.21 0.19 10 9 5 80 72 27
Telford and Wrekin PCT 0.20 0.22 0.20 9 11 6 76 80 42
Worcestershire PCT 0.15 0.22 0.20 3 12 7 17 87 47
Wolverhampton City PCT 0.14 0.18 0.21 1 6 8 5 27 54
Walsall Teaching PCT 0.20 0.22 0.21 11 14 9 81 100 55
Dudley PCT 0.15 0.16 0.22 4 2 10 18 7 66
Stoke On Trent PCT 0.20 0.21 0.22 12 10 11 84 78 83
Warwickshire PCT 0.19 0.20 0.23 8 8 12 73 54 86
Shropshire County PCT 0.15 0.16 0.23 2 3 13 12 8 88
Coventry Teaching PCT 0.20 0.17 0.24 13 4 14 91 14 104
Sandwell PCT 0.19 0.22 0.24 7 13 15 62 93 106
Birmingham East and North PCT 0.21 0.23 0.25 16 15 16 106 111 110
South Birmingham PCT 0.21 0.23 0.25 15 16 17 97 112 118
COPD readmissions per spell Rank within SHA National rank
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West Midlands SHA report Page | 19
Figure 8.1: COPD non-elective hospitalisations per 1000 population by GP practice
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Coventry: COPD Admissions Practice Level Data
Making the Case for Change
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Savings if Non-Elective COPD Admissions Reduced to National Average
£-
£200,000
£400,000
£600,000
£800,000
£1,000,000
Savings if Non-Elective COPD Admissions Reduced by 20% (QIPP Target)
£-
£100,000
£200,000
£300,000
£400,000
£500,000
£600,000
£700,000
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PCT Cost Saving Potentials for COPD
PCT PopulationCOPD
Register
COPD
admissions
COPD admissions
per 1000 population
Cost per
spell (£)
Admissions reduced
if average
Savings if average
admissions (£)
Savings if
admissions -10% (£)
Savings if
admissions -20% (£)
National 54,003,337 829,767 116,130 2.2 2,350 0 0 27,286,400 54,572,800
SHA 5,707,214 86,020 12,299 2.2 2,350 26 61,292 2,890,700 5,781,400
Herefordshire PCT 180,142 2,649 259 1.4 2,436 0 0 63,100 126,200
Heart Of Birmingham Teaching PCT 313,934 2,218 476 1.5 2,288 0 0 108,900 217,800
Warwickshire PCT 546,003 7,527 899 1.6 2,488 0 0 223,700 447,400
Shropshire County PCT 295,342 4,688 504 1.7 2,222 0 0 112,000 224,000
Telford and Wrekin PCT 169,429 2,996 304 1.8 2,342 0 0 71,200 142,400
Worcestershire PCT 572,989 7,993 1,038 1.8 2,318 0 0 240,600 481,200
South Staffordshire PCT 605,435 8,726 1,112 1.8 2,511 0 0 279,200 558,400
North Staffordshire PCT 208,582 3,846 414 2.0 2,222 0 0 92,000 184,000
Solihull Care Trust 220,953 3,400 463 2.1 2,281 0 0 105,600 211,200
Dudley PCT 312,366 4,631 692 2.2 2,238 20 45,398 154,900 309,800
Wolverhampton City PCT 256,543 3,848 575 2.2 2,329 23 54,315 133,900 267,800
South Birmingham PCT 386,532 6,122 918 2.4 2,461 87 213,578 225,900 451,800
Coventry Teaching PCT 349,333 5,420 846 2.4 2,346 95 222,401 198,500 397,000
Sandwell PCT 322,378 5,612 883 2.7 2,277 190 432,151 201,100 402,200
Walsall Teaching PCT 266,448 4,773 731 2.7 2,488 158 393,223 181,900 363,800
Birmingham East and North PCT 424,787 6,059 1,270 3.0 2,350 357 837,982 298,500 597,000
Stoke On Trent PCT 276,018 5,512 915 3.3 2,183 321 701,557 199,700 399,400
Metrics Patient Feedback
Pathway Analysis
Making the Case for Change in Coventry
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Access to a central specialist service with good parking
Better information about what COPD is & what treatment to expect
Better information on managing COPD, especially exacerbations (who to call and when)
Patient & Carer Feedback
Carers wanted more information about COPD & how to help the patient
More information about services that are available to support them and how to access them
Ongoing support after completing pulmonary rehabilitation programme
Consistent care
Patient & Carer Feedback
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Pathway AnalysisPathway Analysis High admissions & rising year on year
Many admitted patients not on respiratory
ward nor S/B specialist
Only 46% followed up post discharge
QOF prevalence below expected levels
Significant variation in Primary Care
spirometry QA
Less than 20% patients on HOS had
specialist assessment
No clear pathway to suport EOLC for COPD
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14
Self Management
Risk Stratification
Integrated Care
Pulmonary Rehabilitation
Rescue packs
Quality Spirometry
Case Finding
15
Post Discharge Review
Staff Training Medicines
Management
Telehealth
Oxygen
End of Life
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Oxygen
End of Life
Post Discharge Review
Staff Training Medicines
Management
Telehealth
Pulmonary Rehabilitation
Rescue packs
Quality Spirometry Case Finding
Self Management
Risk Stratification
Integrated Care
Whole System Approach
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Long Term Conditions
Long Term Conditions
Level 3 High Complexity
Case Management
Level 2 High Risk
Disease & Care Management
Level 1 70-80% LTC Population
Self Care/ Support Management
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Long Term Conditions
Level 3 High Complexity
Case Management
Level 2 High Risk
Disease & Care Management
Level 1 70-80% LTC Population
Self Care/ Support Management
Pri
mar
y C
are
P
rim
ary
Car
e
Long Term Conditions
Level 3 High Complexity
Case Management
Level 2 High Risk
Disease & Care Management
Level 1 70-80% LTC Population
Self Care/ Support Management
Pri
mar
y C
are
P
rim
ary
Car
e
Role of COPD Team
Shared care
Specialist Opinion
Support & Education
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Long Term Conditions
COPD
Heart Failure
Diabetes
Neurological
conditions
Pri
mar
y C
are
P
rim
ary
Car
e
Long Term Conditions
COPD
Heart Failure
Diabetes
Neurological
conditions
Pri
mar
y C
are
P
rim
ary
Car
e Social Care Social Care
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From Vision to Reality
Local engagement/ownership of CCG KoL
Empowering local champions
Relationship building at practice level (GP, Nurses, practice Managers)
Flexible commissioning with risk sharing
Clear & progressive goal(s) setting incorporating regular patient feedback
Clear governance across integrated pathways
From Vision to Reality
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Progress • Community team established
• COPD high on the agenda
• Widespread sign up to the model of care
• 75% of practices use POINTS
• Reduction in admissions
• 90% outpatient activity now in community
• High levels patient satisfaction
• All patients offered post discharge follow up
Quality
Up skilling Primary Care
Adherence to NICE Guidance & Quality Standards
Alignment with COPD Outcomes Framework
Minimising unnecessary variations
Patient satisfaction
End of Life Care
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0%10%20%30%40%50%60%70%80%90%100%
Theappointment mewasconvenientforme.
Ihadconfidenceinthenurse/therapistwhovisitedme.
Iwasinvolvedinthedecisionsaboutmycareandtreatment.
Iunderstoodwhatthenurse/therapistsaidtome.
Ifeelknowledgeableandincontrolofmysymptoms.
Iwasinstructedontheuseofmymedica onsinawayIcouldunderstand.
Iwasgivenadviceaboutotherservicesandsupportthatisavailabletome.
Iwastreatedwithrespectanddignity.
OverallIwassa sfiedwiththestandardoftreatmentIreceived.
OverallIwassa sfiedwiththevenue.
StronglyDisagree
Disagree
Agree
StronglyAgree
N/A
NoAnswer
Patient Feedback
Innovation
Working Smarter Network Integration Care closer to home Empowering patients Education/ SPACE manual Using data Tele health
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Productivity
Admissions avoidance
Moving out patient care to community
Efficient use of resources
Medicines management
Home oxygen
COPD Admissions
0
200
400
600
800
1000
1200
CoventryTeachingPCT
WarwickshirePCT
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
24
0
100
200
300
400
500
Godiva Inspires
COPDAdmissions
2010/11
2011/12
COPD Admissions by CCG
Prevention
Primary: Smoking cessation, education
Secondary: Early detection, smoking cessation, self management, pulmonary rehabilitation, rescue packs, oxygen alert cards
25
2011/12 2102/13 2013/14
Savings (including growth) £(308,597) £(635,565) £(989,747)
Additional Investment £353,000 £353,000 £353,000
Net Costs/savings £44,403 £(282,565) £(636,747)
£(1,200,000)
£(1,000,000)
£(800,000)
£(600,000)
£(400,000)
£(200,000)
£-
£200,000
£400,000
£600,000
£
Savings & Investment
26
Jerry
Horne
GP & LTC lead
Godiva CCG
Peter
O’Brien
GP & LTC lead
Inspires CCG
John Thompson Directorate Manager
UHCW
Fiona Shally
Lead Nurse
Community
COPD Team
Mark Jones Estates Manager
Michelle
Park
Contract Manager
PCT
Andrew
Hardy
CEO UHCW
Roy
Finance
Manager PCT
Dan
Munday
Consultant
palliative care
Sarah Phipps
Business
UHCW
Dymphna Medlock
COPD nurse
Lee Sharrard
Associate general
manager UHCW
Mark Galloway Head of medicines management
PCT
Stephen
Jones CEO
Arden
Cluster
Jo
Shakespeare
Head of Respiratory
Physiology UHCW
Professor
Sally
Singh
Head
of pulmonary rehabilitation
UHL
Paul Davies
Finance Manager UHCW
Claudia Roginski
Head of information
PCT
Jeremy Bacon
BLF
Angela Wall
Community
matron CWPT
Thompson
Karen Jackson Practice
nurse
Tracy King
nurse COPD
Breathe Easy Coventry
Chris Mullins
Practice
Manager
Tim Berry
IM&T
Rhea Fielding
physiologist
rcp.nhslocal.nhs
www.inhale.nhs.uk
rcp.nhslocal.nhs
www.inhale.nhs.uk
27
COPD Admissions to University Hospital Coventry 2010/11
0
5
10
15
20
25
1
11
21
31
41
51
61
71
81
91
101
111
121
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461
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491
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511
521
531
541
551
561
571
581
591
601