integrated care pathways integrated care pathways for mental health: an over view & your part in...
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Integrated Care Pathways Integrated Care Pathways
Integrated Care Pathways for Mental Health:
An over view & your part in variance reporting
(debate).
Mark FlemingMark Fleming
Linda McKechnieLinda McKechnie
David ThomsonDavid Thomson
National ICP CoordinatorsNational ICP Coordinators
NHS Quality Improvement ScotlandNHS Quality Improvement Scotland
Delivering for Mental Health
Commitment 6
“NHS QIS will develop the standards for ICPs for schizophrenia, bipolar disorder, depression, dementia, and personality disorder by the end of 2007. NHS Board will develop and implement ICPs and these will be accredited from 2008 onwards.”
Definition Definition
An ICP determines locally agreed multidisciplinary An ICP determines locally agreed multidisciplinary
practice, based on guidelines and evidence where practice, based on guidelines and evidence where
available for a specific patient/client group. It forms all or available for a specific patient/client group. It forms all or
part of the clinical record, documents the care given, and part of the clinical record, documents the care given, and
facilitates the evaluation of outcomes for continuous facilitates the evaluation of outcomes for continuous
quality improvement.quality improvement.
Source: National Pathways Association, 1998
Definition
A way to compare planned care with care actually given
NHS QIS 2007
Key FeaturesKey Features
• Multidisciplinary / multi-agencyMultidisciplinary / multi-agency
• Part of the clinical recordPart of the clinical record
• Defined beginning and endDefined beginning and end
• Evidence based and best practiceEvidence based and best practice
• Patient focusedPatient focused
• Measurable outcomesMeasurable outcomes
• Variance analysisVariance analysis
Variances
What are variances?If care is not delivered as planned the
reason (variance) is completed on the ICP
Compare planned care against care actually given
What is variance analysis?
A summary of reasons when care is unable to be delivered as planned
Examine trends, patterns of variance and identify if something needs to
change as a resulte.g training needs, provision of
services, pathway changes.
Benefits of Variance Analysis
• Highlight issues which the service can resolve• Help clinicians understand better why care might
not have been delivered as planned• Identify gaps in service provision and training
needs• Highlight areas where extra resources may be
required• Identify differing practices and reasons behind
these• Clinicians receive routine feedback on
performance /activity and practice• Identify areas of development for care pathway• Provide important information for clinical
governance reporting/audit/meeting standards
What is it really!!!
Real time clinical audit within a Governance Framework??
AssessmentCare
PlanningCare
Delivery
• Social needs• Recovery approach• Interventions• Talking therapies• Admission/transfer• Review & follow up
information
info
rmat
ion
Management of variance /
decision making
Tier 1: patient varianceleading to individual
care redesign
Tier 3: NHS board level leading to
service redesign
Tier 4: SEHD / NES / NHS QIS
national redesign
PerformanceManagement
Mechanism for tracking
variations from plan
• Measurement of outcomes
Values base/Evidence base/good practice
Local ICP
Gov
erna
nce
Tier 2: clinical team level leading to
local service improvements
Perceptions can differ!
We think things are working but is there a better way of doing it?
How do we gauge the experience? Let others know?
How can we ensure the facility and opportunity is available to collect variance in a meaningful way?
What measures could be put in place for BPD and what are the
challenges?• Consistency of care• Decisions on hospital admission• Crisis management• Medication management of symptoms• Risk assessment and management• Patient involvement in care planning
DISCUSS/ASK???