National COPD Programme Building QI into Your Audit from

the StartProf. Mike Roberts

Royal College of PhysiciansBarts Health/ UCLPartners

On behalf of the team

Programme Overview

• 3 plus 2 year programme 2013-8• Commissioned & funded by HQIP• Led by the Royal College of Physicians (RCP) working in close

partnership with– British Thoracic Society (BTS)– British Lung Foundation (BLF)– Primary Care Respiratory Society (PCRS-UK) and – Royal College of General Practitioners (RCGP)

Programme Workstreams• Primary care audit – Collection of clinical audit data from General

Practice patient record systems looking back over a year. Spring 2015 then annual.

• Secondary care snapshot audit – Admissions to hospital with COPD exacerbation process and outcomes at 30 and 90 days. Organisation and Resources over data collection period. Spring 2014 & 2016.

• Pulmonary rehabilitation snapshot audits – Service quality and patient outcomes over 3 months. Includes resources and organisation. Jan 2015 start. Repeat 2017.

• PREM – One year development work exploring the potential/feasibility for Patient Reported Experience Measures to be incorporated into the programme in the future.

• Patient identifiable data linked across the workstreams and to external sources such as HES and ONS

Measures - Process and Outcome

• Primary care e.g. compliance against NICE standard- diagnosis confirmed, smoking cessation, annual review, referral to PR, correct treatment etc.

• Secondary care e.g. Essential investigations and interventions in first 24 hours, integrated discharge.

• Pulmonary Rehab e.g. Compliance with BTS standards, completion, better QoL, improved exercise capacity.

• Mortality, Hospital Stay, Readmission.

UK COPD Audit Progression

• 1997 36 hospitals process and outcomes

• 2001 30 hospitals process/outcomes + organisation and resources

• 2004 94% all UK Trusts (as per 2001)

• 2008 98% of all UK Trusts process/outcomes + resources and organisation + patient experience + primary care record

• 2010 Euro Audit of hospital care & resources

Audit is a quality improvement process

UK National COPD Audit% patients with pH< 7.35

Receiving Ventilatory Support by Individual Units

8

Quality indicators for North West SHA acute units (14 - 27)

Acute unit Org score NIV PR EDS LTOT

Site 14 81 88 86 83 89

Site 15 77 79 82 78 82

Site 16 77 71 82 72 32

Site 17 81 75 95 83 93

Site 18 80 63 86 100 79

Site 19 66 63 77 0 82

Site 20 77 67 95 100 64

Site 21 51 0 91 0 86

Site 22 63 67 82 0 100

Site 23 45 46 0 0 36

Site 24 68 67 91 83 96

Site 25 54 25 59 56 61

Site 26 72 83 100 94 93

Site 27 84 58 91 89 86

Hospital ReportGuideline standard: National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care “When the patient arrives at hospital, arterial blood gases should be measured and the inspired oxygen concentration noted in all patients with an exacerbation of COPD. Arterial blood gas measurements should be repreated regularly, according to the response to treatment” (NICE guideline 2004; grade D) Proportion of patients in which arterial blood gases were taken National audit

(9716) Your Unit (66)

Recorded 99% 9596 99% 65 blood gases taken 87% 8340/9596 65% 43 2003 Audit: recorded 97%. I f recorded, blood gases taken 85%.

NICE Management Guidelines for COPD NICE COPD Quality Standards

DH Outcomes Strategy for COPDNHS COPD Commissioning Toolkit

Over Time

• Some resources have increased• Wider service provisionBut• Little evidence of improved processesBut• Length of stay reduced• Readmissions have increased• Mortality remains high

What Have We Done Differently?

• Acknowledge QI is key• Establish a QI group• Look for links with external organisations• Emphasise to participants the QI opportunities• Suggest QI options to participants• Engagement, engagement, engagement!

‘Make it as easy as possible to do the right thing for the patient’

Engaging with Professionals

• Radical Message• Kept simple (but with significant range of consequences)• Balanced with the good• Something that appeals to professionals and patients alike• Strap line – ‘Who Cares Matters’• Supported by National Professional bodies

Engaging Commissioners

• CCG/LHB Level Reports- what do you want to see?• CCG engagement (e.g. via CCG Champion Networks of partner

organisations)• Identifying CCG priorities• Targeted messaging• Benchmarking against NICE standards• Potential for peer review (e.g. accreditation of Pulmonary

Rehabilitation)

National Engagement

• All Party Parliamentary Group on Respiratory Health• NHSE Domains• NHS Wales – Policy leads (NCA; Respiratory; Primary Care;

Adult & Children’s Health) • National Respiratory Director• NHSE – Head of Patient Experience• NHSIQ

Engaging Patients and Carers

• British Lung Foundation – Including network of Breatheasy Groups

• Patient involvement groups – professional bodies (e.g. RCP PIU)

• The plain English version• Conferences and newsletters• And in an ideal world patient access to their own data!

Summary

• Reporting of data has limited impact• Acknowledging QI is critical element at outset• Having a QI strategy• Engaging key parties• We have no resource or contract to deliver QI• Over to you- Health Quality Improvement Partnership

To Find Out More

If you would like to register to receive updates:Email: copd@rcplondon.ac.uk

Or visit: www.rcplondon.ac.uk/COPD

#COPDaudit #COPDwhocares?