Evaluation of Leicestershire’s Better Care Fund programmeElizabeth Orton, Consultant in Public HealthJanine Dellar, Head of Public Health Intelligence
• Monday 22nd June 2015
Aim of the Better Care fund
Evidence-based improvements to integration of health and care
Increase community capacity
Transfer activity from acute to community
Pooled budget to sustain integration
Better Care Fund
Unified prevention
e.g. Local Area Co-ordination
Integrated proactive response for people with long term care
e.g. case management for >75s
Integrated urgent response (admission avoidance)
e.g. Falls pathway redesign, older persons unit, 7 day GP service, ICRS
Hospital discharge and re-ablement
e.g. integrated reablement
• Reduce the number of permanent admissions
• Increase the number of service users still at home 91 days after discharge
• Reduce the number of delayed transfers of care
• Reduce the number of avoidable admissions
• Reduce the number of emergency admissions due to falls
• Improve Patient experience
Expected outcomes4 Themed areas
Evaluation framework
Outcome evaluation
What are the outcomes for communities and
individuals – LACParticipatory Action
Research, asset mapping
Has an admission or residential care been
avoided?Clinical audit/case note
review
Was it the intervention that made the
difference?Data linkage cohort
analysis
Structure/Process
evaluation
Does the process work as well as it could?
Lean systems analysis and patient satisfaction
Routine Data analysisExample: Integrated crises response service
GP sees patient and refers to
integrated crises response service
Professional contacts LPTs single point of
access
Allocated to specialist nursing
service
If 09:00 to 17:00 this is an existing
service. BCF enhancement is extending this to
night nursing
Is this an improvement for
the patients?
Tracking this through the data
Inputs – LPT SPA Data
Linkage to ambulance data Epidemiology of patients using ICRS
Linkage to A&E data Understanding of full set of activity data for ICRS cohort
Linkage to Inpatient data Patient pathways pre and post ICRS
Inputs – LPT community nursing data
Linkages to outpatients data
Costs of the full patient pathway
Linkages to adult social care data
Future – matched cohort analysis
PSEU
DO
NYM
ISAT
ION
Data FlowsUHL and LPT SUS PbR
Data
Community nursing data
EMAS Ambulance Data
Adult social care data from 3 local authorities
GEM DSCRO
GEM CSU Safe Haven
Rele
ase
to P
I
Information Governance
• Overarching framework for IG– signed by all participating organisations
• Responsibility sits with Senior Information Responsible Officer (SIRO)
• NHS data is flowing under s251 exemptions linked to original NHS act allowing the transmission of pseudonymised data for secondary use
• Councils release data to ASH for pseudonymisation• Only risk is at point of transfer to the ASH• All data that is released to PI is pseudonymised using a
single encryption key
Limitations• How good will our data linkage be (65-80% anticipated on ASC data) • Ambulance data – low for NHS Number• At this time – only data from main acute provider, so cross border flows will
be an issue• No costing of social care data• No primary care data• Diagnoses flagging will be 1st five diagnoses codes in hospital inpatient data• Only three years data• Social care data only has NHS number for patients who are currently active• Care home patients – only identifying clients that are social care funded• No mortality data included at this time
• We need to start somewhere!
Next steps….
• Going out to procurement for LAC evaluation
• Ongoing Lean research with Loughborough University
• Clinical audit proposals being agreed
• Cohort analysis before and after for admission avoidance schemes