Division of Primary Health Care

An evaluation of the effectiveness of ‘care bundles’ as a means of improving hospital care and reducing re-admission for patients with chronic obstructive pulmonary disease (COPD)

WEBEX 1 3 July2015Dr James Calvert

Division of Primary Health Care

Aims of the Webex…..

• Update on progress

• Issues from colleagues in each institution

• Any other business

Division of Primary Health Care

Site Recruitment

Division of Primary Health Care

First steps

• Identify an executive sponsor– Ask them to identify resource – money or people

• You need a team.• Develop and tabulate a project plan• Understand the current service using measures such

as process mapping• Collect baseline data and agree a data collection plan• Design & test interventions

Division of Primary Health Care

The right team

Team members should be drawn from across the

patient pathway and should:

• understand the pathway;

• be able to influence the decision making process;

• be prepared to test and implement changes across

the pathway;

• be mandated to take decisions regarding

changes/improvements in their respective areas.

• Should include an analyst/member of the audit

department

Division of Primary Health Care

First steps

• Identify an executive sponsor– Ask them to identify resource – money or people

• You need a team.• Develop and tabulate a project plan• Understand the current service using measures such

as process mapping• Collect baseline data and agree a data collection plan• Design & test interventions

Division of Primary Health Care

Different Levels of MappingEnters OPD

All Internal Processes

Leaves OPD

Sees admin

Sees nurse

Sees Consultant

Has Tests

Sees Consultant

Etc etcHigh

MediumEnters room

Takes history

Asst with undress

Take weight , BP etc

Etc Leaves room

Asst patient onto scales

Zero scales

Take reading

EtcLow Etc

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Analysing the map

Are we doing the right thing? (is it clinically effective)

Are we doing them in the right order? Is the right/best person doing it? How co-ordinated is the patients journey? What information do we give to patients at what

stage? Is the information useful? Baseline measurement: how often / how many /

how much?

Division of Primary Health Care

First steps

• Identify an executive sponsor– Ask them to identify resource – money or people

• You need a team.• Develop and tabulate a project plan• Understand the current service using measures such

as process mapping• Collect baseline data and agree a data collection plan• Design & test interventions

Division of Primary Health Care

Two sets of data

• Process data – necessary as part of bundle implementation– The Care Bundle Project will involve regular data collection

via the BTS audit system:

– https://audits/brit-thoracic.org.uk

• Outcome data for project evaluation – will be collected (and paid for) by UoB team

Division of Primary Health Care

Process Data

• Plan for on-going manual data collection (where, when and how)

• Manual data collection informs process performance and is essential to ensure changes being made to processes achieve the intended outcomes.

Division of Primary Health Care

If you don’t measure, you wont know…

• If the changes made have actually made a difference

• If it is an improvement

• How much difference the change has made

• If the improvement has stayed in place? – sustained

• How well the current testing is performing

• Whether aim has been reached

• How much variation there is in data/process

Division of Primary Health Care

…………..when starting to measure:

• Seek usefulness not perfection

• Measure the minimum.

• The goal is improvement and not a new measurement system.

• Aim to make measurement part of the daily routine.

• Don’t let measure issues delay the start of your improvement work / PDSA cycles.

Division of Primary Health Care

Data Entry

• Download the data collection forms to assist with collection of the data items

• Ensure you are registered for the BTS audit system and have access to the online Care Bundle data collection forms

• For each patient record or each set of monthly or yearly data click on the relevant link and add the data to the correct period.

Division of Primary Health Care

Division of Primary Health Care

High Level Data – Derived from HES Data

Division of Primary Health Care

Division of Primary Health Care

Data entry

Division of Primary Health Care

Division of Primary Health Care

First steps

• Identify an executive sponsor– Ask them to identify resource – money or people

• You need a team.• Develop and tabulate a project plan• Understand the current service using measures such

as process mapping• Collect baseline data and agree a data collection plan• Design & test interventions

Division of Primary Health Care

ACT

What changes can be made for the next cycle (adapt change, another test, implementation cycle?)

•

PLAN

• Objective

• Prediction

• Plan for change (who, what, when, where)

• Plan for data collection (who, what, when, where)

• Carry out the change

• Document observations

• Record data

DO

Complete analysis of data

Compare results to predictions

Summarize knowledge gained

•

•

•

STUDY

How to use the PDSA Cycle

• Segmentation

• Useful allies

• Huddles not meetings

• Quick & dirty wins

Division of Primary Health Care

Repeated Use of the PDSA Cycle

Hunches Theories

Ideas

Changes That Result in

Improvement

A PS D

APS

D

A PS D

D SP A

DATA

Very Small Scale Test

Follow-up Tests

Wide-Scale Tests of Change

Implementation of Change

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

Spread

Sequential building of knowledge under a wide

range of conditions

22

Division of Primary Health Care

≤ 20 implementation sites

(COPD care bundle)

≤ 20 comparator sites

(usual COPD care)

QU

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TALevel 1: Hospital-level aggregated data

Level 2: Individual-level patient data

Level 3: Case-study data

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≤8 implementation sites

(COPD care bundle)

≤ 8 comparator sites

(usual COPD care)

≤ 3-5 implementation sites

(COPD care bundle)

≤ 3-5 comparator sites

(usual COPD care)

Division of Primary Health Care

Further meetings

• Second face to face meeting 11th September– Review project plans and progress

• Feedback from each intervention site– Trouble shoot issues

• Opportunity for additional input if generic problems have become apparent

Division of Primary Health Care

Project Information

Project Website

http://www.bristol.ac.uk/copd

NIHR CRN Portfolio

http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=17828

Dr. Anne Daykin, Project Co-ordinator: Anne.daykin@Bristol.ac.uk

Problems with data entry: Carebundles@brit-thoracic.org.uk