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Quality Standards to Quality Assured Indicators: The End-to-End Process
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Quality Standards to Quality Assured Indicators: The End-to-End Process

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"Quality Standards to Quality Assured Indicators: The End-to-End Process", presentation delivered by John Varlow (Director of Information Services - HSCIC) and Nick Baillie (Associate Director, …

"Quality Standards to Quality Assured Indicators: The End-to-End Process", presentation delivered by John Varlow (Director of Information Services - HSCIC) and Nick Baillie (Associate Director, Indicators, Health and Social Care Quality Team, NICE), at the Healthcare Efficiency Through Technology Expo 2013.

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  • Speaker: Nick
  • Speaker: Nick
  • Speaker: John

    Came into being on 1st April 2013
    Brings together the NHS IC and Connecting for Health
    The role is detailed in the Health and Social Care Act 2012 …


    Make our data available in formats that encourage its wider use
    Publish a database of quality indicators
    Maintain the critical national infrastructure and services that support care delivery
    Approve and accredit local and national IT systems
    Ensure the proper management of our information assets, protecting personal confidential data as required
    Help people understand the robustness of the information they are using
  • Speaker: Nick
    Evidence is reviewed to develop a clinical guideline which is then used to develop a quality standard.

    Key points to make on the statements
    Aspirational but achievable
    Key points on care pathway or journey
    Measurable
    Based on a set of core principles
    Produced collaboratively with the NHS and social care, along with their partners, service users and carers
    Online product
    Available via:
    NICE website
    NICE Evidence
    NICE pathways
    endorsing organisations

  • Speaker: Nick
    What makes up a NICE quality standard?
    Each NICE quality standard contains a concise set of quality statements (usually 6-8 statements, up to a maximum of 15 statements in exceptional circumstances) and associated measures.
    The quality statements describe key markers of high-quality, cost-effective care for a particular area of care. These statements may address prevention, as well as elements of health and social care, and will promote an integrated approach to improving quality.
    Quality measures accompany the quality statement and aim to improve the structure, process and outcomes of health and social care. They are not a new set of targets or mandatory indicators for performance management.
    All quality measures are specified in the form of a numerator and a denominator which define a proportion (numerator/denominator). It is assumed that the numerator is a subset of the denominator population.
    For instance, using Chronic Kidney Disease (CKD) as an example, if the quality measure is:
    Numerator - the number of people in the denominator receiving testing for CKD.
    Denominator - the number of people with risk factors for CKD.
    The proportion is the number of people with risk factors for CKD who receive testing for CKD. The numerator does not include those receiving testing for CKD who do not have risk factors for CKD.
  • Speaker: Nick
    For this slide we need to discuss the integrated nature of the QSs and how some will be area specific while others will consider all aspects of care.

    Healthcare referrals, covering:
    Cardiovascular, Mental Health, Neonates and children, Service delivery , Other cross cutting
    2 public health focused topics: Smoking Cessation and Physical Activity
    Social care referrals
    Pilot programme was run, which resulted in the publication of two QSs in April 2013
    Supporting people to live well with dementia
    Health & wellbeing of looked after children and young people
    Full programme went live April 2013, currently in development:
    Mental wellbeing of older people in care homes
    Autism
    Comprehensive library has been consulted upon
  • Speaker: Nick
  • Speaker: John
  • 10
  • Speaker: Nick
  • Speaker: John
  • Speaker: John
  • Speaker: Nick
  • Speaker: John

    HSCIC hosts this on behalf of the wider system rather than it being an HSCIC process.
     
    Similarly that MRG / IGB is made up of statistical / domain experts from a wide range of organisations

    The indicator library (a “national library of quality assured indicators”) is mandated under H&SC Act statutory regulations

    IGB ‘approves’ the indicators as fit for the library.  (HSCIC doesn’t approve the indicators)



  • Speaker: John

    HSCIC hosts this on behalf of the wider system rather than it being an HSCIC process.
     
    Similarly that MRG / IGB is made up of statistical / domain experts from a wide range of organisations

    The indicator library (a “national library of quality assured indicators”) is mandated under H&SC Act statutory regulations

    IGB ‘approves’ the indicators as fit for the library.  (HSCIC doesn’t approve the indicators)



  • Speaker: John
  • Speaker: John
  • Speaker: John
  • Speaker: John
  • Transcript

    • 1. Quality Standards to Quality Assured Indicators The End-to-End Process Healthcare Efficiency Through Technology Expo 2013
    • 2. Overview • Introducing – NICE and HSCIC • Background – To NICE quality standards – To the national library of quality assured indicators • The journey from quality standards to a national library of quality assured indicators
    • 3. Introducing NICE The National Institute for Health and Care Excellence (NICE) is a Non Departmental Public Body - funded by the Department of Health • Responsible for developing: – Evidence-based guidance & support tools on the most effective ways to diagnose, treat, prevent disease and ill health and care for people receiving social care – A library of quality standards (and menus of associated indicators) – NICE Evidence.
    • 4. Introducing HSCIC HSCIC is an Executive Non-Departmental Public Body (ENDPB) which came into being on 1st April 2013 • Responsible for: – The collection, linkage and secure storage and publication of the core data resources for health and social care, bringing together into a single place all indicators, the data and details of their methodologies – IT systems delivery; providing the expertise necessary to support the continuation of existing national systems and services as well as the delivery of new systems and critical services such as information standards “The Information Centre must establish procedures for the assessment of a quality indicator; and arrange for each quality indicator published in the library to be periodically reviewed.” The Health and Social Care Act Statutory Instruments 2013 No.259
    • 5. What are NICE quality standards? A comprehensive set of recommendations for a particular disease or condition, particular need or service Evidence Guidance Quality Standards A NICE quality standard is a concise set of statements designed to drive and measure priority quality improvements within a particular area of care. Around 6-8 statements per standard – up to 15 in exceptional circumstances.
    • 6. How can quality standards be used? • NICE may be directed to prepare statements of standards in relation to the provision of – NHS service – public health services or – social care in England • In discharging its duty, the NHSCB/Secretary of State must have regard to the quality standards prepared by NICE • Organisations improving the quality of health services must have regard to the quality standards prepared by NICE
    • 7. Quality standards – three interfaces Social care Public health NHS
    • 8. The development approach - EPiC • Evidence based • Partnership work making best use of expertise across HSCIC and NICE • informed by Collaboration with key stakeholders
    • 9. Key stages in the process NHS E refers topics to NICE for health-related areas Development of quality standard Publish quality standard Development of NICE menu of indicators HSCIC Indicator Assurance Service NHS E approval for use in CCG OIS
    • 10. NHS E refers topics to NICE for health-related areas 0 5 10 15 20 Blood disorders Hearing Public Health Eyes / vision Skin Infectious disease Respiratory Musculoskeletal Trauma Metabolic Genitourinary Service delivery Neurological Gastrointestinal Cancer Maternity Mental health Cardiovascular Other/cross-cutting Children Number of referrals Category
    • 11. Development of the quality standard Topic referred to NICE Development of the quality standard Published quality standard Development of NICE menu of indicators HSCIC IAS NHS E approval for use in CCG OIS Overview development Identification of quality areas Prioritisation of quality areas Draft development Consultation Final development
    • 12. HSCIC inputs to the quality standard development process Topic engagement Quality Standard Advisory Committee (QSAC) Meeting 1 Draft quality standard Consultation QSAC Meeting 2 Publishing HSCIC Comments on draft NICE topic overview paper for meeting of Quality Standards Advisory Committee HSCIC Comments on draft NICE quality standard pre-consultation HSCIC Comments on draft NICE quality standard pre-publication
    • 13. Measure development • Measures – Structure, process and outcome measures – based on existing NHS indicators or use sources of routinely collected data, where possible • High level quality measures – Use at local level as audit criteria – Inform subsequent national indicator development • Also highlight related national quality assured indicators – Including those developed by the Health and Social Care Information Centre Indicators for Quality Improvement Programme
    • 14. Development of NICE menu of indicators NHS E refers topics to NICE for health-related areas Development of quality standard Published quality standard Development of NICE menu of indicators HSCIC IAS NHS E approval for use in CCG OIS Identifying indicators for rating HSCIC Feasibility assessment Horizon scan Advisory Committee rating Advisory Committee for prioritisation Evaluation HSCIC testing Consultation Advisory Committee for recommendations NICE Menu of indicators
    • 15. HSCIC Indicator Assurance Service: towards a national library of quality assured indicators Peer Reviewers feeding into Methodology Review Group initial assurance Final Assurance by Indicator Governance Board Publishing to indicator library NHS E refers topics to NICE for health-related areas Development of quality standard Published quality standard Development of NICE menu of indicators HSCIC IAS NHS E approval for use in CCG OIS The Information Centre must establish, maintain and publish a database of quality indicators in relation to the provision of health services and adult social care in England… The Information Centre must establish procedures for the assessment of a quality indicator; and arrange for each quality indicator published in the library to be periodically reviewed.” (Health and Social Care Act: Statutory Instruments)
    • 16. HSCIC Indicator Assurance Service: towards a national library of quality assured indicators
    • 17. Putting the indicators into practice • Quality Strategic Framework Group – CCG OIS responsibility • Published indicators NHS E refers topics to NICE for health-related areas Development of quality standard Published quality standard Development of NICE menu of indicators available on HSCIC HSCIC IAS Portal and NHS iView NHS E approval for use in CCG OIS “Information is a source of learning. But unless it is organized, processed, and available to the right people in a format for decision making, it is a burden, not a benefit.” William Pollard
    • 18. NHS iView 4.1 Patient experience of GP out of hours services, in which a higher value shows greater satisfaction with the service
    • 19. What next? Can only demonstrate improvements if we have clear standards, transparent methodologies etc. Problems of snapshot indicators – need for comparison over time Context needed to understand some indicators eg SHMI "Not everything that counts can be counted, and not everything that can be counted counts." - Albert Einstein
    • 20. How can you get involved? • Public consultation on quality standards and indicators • Committee members recruited via NICE website • HSCIC Indicator Assurance Service • Assurance process is only as good as the people who input into it • MRG peer reviewers • Organisational representation on IGB
    • 21. To Find Out More About the HSCIC Follow us: Call us on: 0845 300 6016 Email us at enquiries@hscic.gov.uk @hscic @hscicmedia @hscicOpenData @HSCIC_LSP @EPSnhs @NHSSCR @NHSPathways @NHSereferral http://www.flickr.com/photos/hscic/ https://www.linkedin.com/company/health-and-social-care-information- centre http://www.slideshare.net/HSCIC https://www.youtube.com/user/HSCIC1