together we’re better populations or pathways? liane langdon anthony lawton nhs leeds north ccg
TRANSCRIPT
Together
we’re better
Populations or Pathways?
Liane LangdonAnthony Lawton
NHS Leeds North CCG
Local Strategic Context –Leeds Joint Health and Well Being Strategy
Together
we’re better
Together
we’re better
What did we do with Commissioning for Value?
Together
we’re better
Use CFV but also locally what fits – the life expectancy gap by cause of death
8
So Summary: Overarching messages for LeedsSum
mary on a page
Public health focus on prevention; specifically smoking prevalence (Leeds South & East and Leeds West) smoking cessation (All) and Obesity (Leeds South & East)
Significant benefit to patients if improvement to Primary Care management indicators were made (All)
High emergency admissions for CVD (Leeds South & East), costs (Leeds North and Leeds South & East) and lengths of stay (All)
High costs for CHD emergency admissions (Leeds North and Leeds South & East) and high costs for CHD elective admissions (Leeds South & East)
High emergency admissions for Heart Failure and Stroke (Leeds South & East and Leeds West)
High costs for Angiography procedures (All), CABG procedures (All) and Angioplasty procedures (Leeds West)
High lengths of stay for Angiography procedures (Leeds West)
Actions …………..
• Public Health – challenge to jointly re look at commissioning of healthy living services key priority for the Council.
• Primary care – variation target work with key practices and embed into engagement schemes in each CCG
• Whole pathway – flow and variation – LIQH.• CCG commissioning – using packs as part of
prioritisation framework• Transformation work streams -Acute – elective care
value approach; Integrated Care – Pathways work.Together
we’re better
The LIQH approach
Together
we’re better
LIQH – focussed areas
CVD• improving the management of chest pain;• optimise outcomes and quality of care for people requiring
interventions/ treatment for suspected/confirmed arrhythmia and to prevent inappropriate use of secondary services.
COPD • support people with COPD to manage their own condition
and to reduce the likelihood and impact of exacerbations;• reduction in variation of approach to COPD patients in crisis; • Improving the early and accurate diagnosis of COPD whilst
improving patient experience.
Together
we’re better
Pathways
• So, for pathways – The data gives us some clear indication of
pathways to consider– We have established clear programmes of work
• But, is this enough?
Together
we’re better
Populations• Great for quality improvement• But – is this enough for transformation?• What about complex populations?
– CfV tells us where the challenges are– But we know that with populations, pathway
approaches are not always enough– What can CfV do to inform work with the frail
elderly?
Together
we’re better
Liberating CfV for Populations• What we did next:
– Used the CfV intelligence– Used part of the £5 per head for primary care (£2.36)– Identified our target population – frail elderly 2%– Applied Outcomes Based Accountability to liberate
practices to use CfV knowledge creatively to tackle an issue requiring transformation, not quality improvement
– Look for contribution not attribution – asked practices to work in localities to give something a go
Together
we’re better
Overview of OBA
• Outcome Based Accountability™ was first developed in the early 1990s by Mark Friedman
• Principles:SIMPLE
COMMON SENSE
PLAIN LANGUAGE Together
we’re better
Definitions
OUTCOMEA condition of well-being for adults, children, families, communitiesi.e. Being Healthy, Staying Safe, Safe Communities, Clean Environment
INDICATORA measure which helps to quantify the achievement of the outcome.i.e. Rate of diagnosis of Dementia in Primary Care, Rate of teenage pregnancies
PERFORMANCE MEASUREA measure of how well a program, service is workingBased on the 3 following questions:
• How did we do?• How well did we do it?• Is anyone better off?
Popu
latio
nPe
rfor
man
ce
ENDS
MEANS
Together
we’re better
Leaking Roof
Experience:
Measure:
Story behind the baseline (causes):
Partners:
What Works:
Action Plan:
Not OK
? Fixed
Turning the curve
Together
we’re better
What now?• Supported practices in locality groupings to
identify meaningful local measures relating to how they are contributing to the issues identified within CfV
• Practices are all enhancing community nursing – but in different ways
• Measure and look for learning and impact – and share
• Worry about contribution, not attribution• Do more of whatever works!
Together
we’re better
Questions