Breakout 1.3 Improving COPD Care in the West Midlands - Colin Gelder
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Breakout 1.3 Improving COPD Care in the West Midlands - Colin Gelder
Clinical Lead Respiratory Midlands Region, NHS Midlands & EastMidlands East
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

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Breakout 1.3 Improving COPD Care in the West Midlands - Colin Gelder Breakout 1.3 Improving COPD Care in the West Midlands - Colin Gelder Document Transcript

  • Improving COPD Care in the West Mildands Colin Gelder Clinical Lead Respiratory Midlands Region, NHS Midlands & East 1
  • 2
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  • Purpose of DataPurpose of Data 4
  • West Midlands Non-Elective COPD Admissions 3.5 2009/10 Admissions per 100,000 population 3.0 >2 fold variation 2.5 2.0 1.5 1.0 0.5 0.0 West Midlands COPD Non-Elective Admissions COPD admissions per 1000 population COPD admissions per 1000 registered pts Rank within SHA National rankPCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10National 2.1 2.3 2.2 146 155 140 - - - - - -SHA 2.0 2.2 2.2 147 154 143 - - - - - -Herefordshire PCT 1.5 1.5 1.4 117 109 98 1 1 1 23 16 22Heart Of Birmingham Teaching PCT 1.6 1.6 1.5 229 237 215 4 2 2 31 23 27Warwickshire PCT 1.6 1.6 1.6 133 126 119 5 3 3 35 30 36Shropshire County PCT 1.7 1.8 1.7 110 118 108 6 5 4 45 44 42Telford and Wrekin PCT 2.0 2.3 1.8 127 134 101 9 9 5 74 79 49Worcestershire PCT 1.5 1.9 1.8 122 147 130 3 6 6 30 54 52South Staffordshire PCT 1.5 1.7 1.8 109 121 127 2 4 7 24 36 55North Staffordshire PCT 2.1 2.1 2.0 128 122 108 10 8 8 82 73 70Solihull Care Trust 2.0 2.4 2.1 139 164 136 8 12 9 73 89 77Dudley PCT 2.1 2.4 2.2 160 169 149 11 11 10 83 87 86Wolverhampton City PCT 2.1 2.3 2.2 156 162 149 12 10 11 84 84 88South Birmingham PCT 2.3 2.6 2.4 151 167 150 13 13 12 94 100 96Coventry Teaching PCT 1.9 2.1 2.4 135 142 156 7 7 13 71 72 98Sandwell PCT 2.8 3.0 2.7 170 176 157 14 14 14 119 117 115Walsall Teaching PCT 3.0 3.0 2.7 194 181 153 17 16 15 129 119 116Birmingham East and North PCT 2.9 3.1 3.0 212 226 210 15 17 16 122 123 124Stoke On Trent PCT 3.0 3.0 3.3 163 162 166 16 15 17 125 118 133 5
  • Coventry PCT COPD Admissions West Midlands non-elective COPD hospitalisation costs COPD tariff per 1000 population COPD tariff per 1000 registered pts Rank within SHA National rankPCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10National 4.2 4.6 5.1 297 314 329 - - - - - -SHA 4.1 4.6 5.1 297 315 336 - - - - - -Heart Of Birmingham Teaching PCT 3.4 3.3 3.5 495 500 491 6 2 1 43 23 25Herefordshire PCT 3.1 3.1 3.5 241 227 238 3 1 2 27 15 26Shropshire County PCT 3.3 3.4 3.8 212 220 239 5 3 3 36 27 31Warwickshire PCT 3.3 3.6 4.1 272 271 297 4 6 4 35 39 41Worcestershire PCT 2.8 3.5 4.2 219 268 301 1 5 5 13 38 45Telford and Wrekin PCT 3.9 4.6 4.2 244 271 238 7 9 6 61 76 46North Staffordshire PCT 4.4 4.0 4.4 263 231 239 11 7 7 87 58 55South Staffordshire PCT 2.9 3.5 4.6 212 245 320 2 4 8 18 32 66Solihull Care Trust 4.1 5.1 4.8 286 349 311 10 12 9 77 100 72Dudley PCT 4.0 4.3 5.0 298 303 334 8 8 10 68 67 73Wolverhampton City PCT 4.6 4.8 5.2 334 331 348 12 11 11 93 84 83Coventry Teaching PCT 4.0 4.6 5.7 279 308 366 9 10 12 73 79 100South Birmingham PCT 4.9 5.7 5.8 328 367 369 13 13 13 104 109 106Sandwell PCT 5.5 5.7 6.2 332 332 358 15 14 14 116 111 110Walsall Teaching PCT 6.5 6.8 6.8 426 407 381 17 16 15 133 131 119Birmingham East and North PCT 6.2 6.9 7.0 452 501 493 16 17 16 129 132 124Stoke On Trent PCT 5.5 6.0 7.2 304 320 362 14 15 17 115 116 127 6
  • West Midlands non-elective COPD hospitalisation length of stay COPD Length of stay Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 N a ti o n a l 8 .3 8 .0 7 .7 - - - - - - SHA 8.4 8.2 7.9 - - - - - - Solihull Care Trust 8.2 8.5 6.7 7 11 1 62 98 23 North Staffordshire PCT 8.7 7.2 6.8 10 4 2 101 34 27 Heart Of Birmingham Teaching PCT 8.7 7.8 7.2 11 9 3 102 62 46 Stoke On Trent PCT 7.4 7.1 7.3 5 3 4 30 29 51 Herefordshire PCT 8.4 7.7 7.4 8 7 5 73 58 55 Birmingham East and North PCT 9.5 9.1 7.6 14 13 6 130 130 65 Telford and Wrekin PCT 6.9 7.5 7.7 1 6 7 17 49 74 Dudley PCT 7.3 6.9 7.8 4 2 8 28 26 77 Sandwell PCT 7.2 6.6 7.9 3 1 9 23 21 91 Walsall Teaching PCT 8.6 9.7 8.1 9 17 10 87 142 97 Wolverhampton City PCT 9.3 8.3 8.1 13 10 11 123 93 100 Shropshire County PCT 9.7 9.4 8.2 17 16 12 139 138 102 South Staffordshire PCT 7.5 7.3 8.2 6 5 13 37 38 104 Worcestershire PCT 7.1 7.7 8.2 2 7 14 22 58 105 Coventry Teaching PCT 9.6 9.1 8.3 16 12 15 136 129 109 Warwickshire PCT 9.1 9.2 8.9 12 14 16 117 134 132 South Birmingham PCT 9.6 9.4 9.4 15 15 17 133 136 144 West Midlands non-elective COPD hospitalisation 28-day readmission rate COPD readmissions per spell Rank within SHA National rankPCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10N a ti o n a l 0 .2 0 0 .2 1 0 .2 2 - - - - - -SHA 0.19 0.21 0.22 - - - - - -Herefordshire PCT 0.18 0.16 0.14 5 1 1 38 4 2Solihull Care Trust 0.20 0.26 0.18 14 17 2 92 145 17South Staffordshire PCT 0.18 0.18 0.19 6 5 3 39 18 21North Staffordshire PCT 0.21 0.19 0.19 17 7 4 107 34 22Heart Of Birmingham Teaching PCT 0.20 0.21 0.19 10 9 5 80 72 27Telford and Wrekin PCT 0.20 0.22 0.20 9 11 6 76 80 42Worcestershire PCT 0.15 0.22 0.20 3 12 7 17 87 47Wolverhampton City PCT 0.14 0.18 0.21 1 6 8 5 27 54Walsall Teaching PCT 0.20 0.22 0.21 11 14 9 81 100 55Dudley PCT 0.15 0.16 0.22 4 2 10 18 7 66Stoke On Trent PCT 0.20 0.21 0.22 12 10 11 84 78 83Warwickshire PCT 0.19 0.20 0.23 8 8 12 73 54 86Shropshire County PCT 0.15 0.16 0.23 2 3 13 12 8 88Coventry Teaching PCT 0.20 0.17 0.24 13 4 14 91 14 104Sandwell PCT 0.19 0.22 0.24 7 13 15 62 93 106Birmingham East and North PCT 0.21 0.23 0.25 16 15 16 106 111 110South Birmingham PCT 0.21 0.23 0.25 15 16 17 97 112 118 7
  • 0.0 2.0 4.0 6.0 8.0 10.0 12.0 PCT average 14.0 West Midlands SHA report M86613 M86011 M86630 M86022 M86001 M86026 M86037 M86638 M86020 M86634 M86041 M86019 M86005 M86627 M86013 M86028 M86010 M86008 M86033 M86610 M86012 M86032 M86034 M86016 M86015 M86027 M84012 M86044 M86604 M86014 M86030 M86002 M86039 M86021 M86038 M86605 M86629 M86035 Level Data M86007 M86624 Figure 8.1: COPD non-elective hospitalisations per 1000 population by GP practice M86009 M86040 M86619 M86023 M86018 M86043 M86006 M86622 M86045 M86607 M86612 M86046 M86017 M86004 M86029 M86633 Making the Case for Change M86048 Y00140 M86003 M86603 M86617 Coventry: COPD Admissions Practice M86621 Page | 198
  • Savings if Non-Elective COPD Admissions Reduced to National Average£1,000,000 £800,000 £600,000 £400,000 £200,000 £-Savings if Non-Elective COPD Admissions Reduced by 20% (QIPP Target)£700,000£600,000£500,000£400,000£300,000£200,000£100,000 £- 9
  • PCT Cost Saving Potentials for COPD COPD COPD COPD admissions Cost per Admissions reduced Savings if average Savings if Savings ifPCT Population Register admissions per 1000 population spell (£) if average admissions (£) admissions -10% (£) admissions -20% (£)National 54,003,337 829,767 116,130 2.2 2,350 0 0 27,286,400 54,572,800SHA 5,707,214 86,020 12,299 2.2 2,350 26 61,292 2,890,700 5,781,400Herefordshire PCT 180,142 2,649 259 1.4 2,436 0 0 63,100 126,200Heart Of Birmingham Teaching PCT 313,934 2,218 476 1.5 2,288 0 0 108,900 217,800Warwickshire PCT 546,003 7,527 899 1.6 2,488 0 0 223,700 447,400Shropshire County PCT 295,342 4,688 504 1.7 2,222 0 0 112,000 224,000Telford and Wrekin PCT 169,429 2,996 304 1.8 2,342 0 0 71,200 142,400Worcestershire PCT 572,989 7,993 1,038 1.8 2,318 0 0 240,600 481,200South Staffordshire PCT 605,435 8,726 1,112 1.8 2,511 0 0 279,200 558,400North Staffordshire PCT 208,582 3,846 414 2.0 2,222 0 0 92,000 184,000Solihull Care Trust 220,953 3,400 463 2.1 2,281 0 0 105,600 211,200Dudley PCT 312,366 4,631 692 2.2 2,238 20 45,398 154,900 309,800Wolverhampton City PCT 256,543 3,848 575 2.2 2,329 23 54,315 133,900 267,800South Birmingham PCT 386,532 6,122 918 2.4 2,461 87 213,578 225,900 451,800Coventry Teaching PCT 349,333 5,420 846 2.4 2,346 95 222,401 198,500 397,000Sandwell PCT 322,378 5,612 883 2.7 2,277 190 432,151 201,100 402,200Walsall Teaching PCT 266,448 4,773 731 2.7 2,488 158 393,223 181,900 363,800Birmingham East and North PCT 424,787 6,059 1,270 3.0 2,350 357 837,982 298,500 597,000Stoke On Trent PCT 276,018 5,512 915 3.3 2,183 321 701,557 199,700 399,400 Making the Case for Change in Coventry Metrics Patient Feedback Pathway Analysis 10
  • Patient & Carer FeedbackAccess to a central specialist service with good parkingBetter information about what COPD is & what treatment to expectBetter information on managing COPD, especially exacerbations (who to call and when) Patient & Carer FeedbackCarers wanted more information about COPD & how to help the patientMore information about services that are available to support them and how to access themOngoing support after completing pulmonary rehabilitation programmeConsistent care 11
  • Pathway Analysis High admissions & rising year on year Many admitted patients not on respiratory ward nor S/B specialist Only 46% followed up post discharge QOF prevalence below expected levels Significant variation in Primary Care spirometry QA Less than 20% patients on HOS had specialist assessment No clear pathway to suport EOLC for COPD 12
  • 13
  • Risk Stratification Self ManagementIntegrated Care Pulmonary Rescue packs Rehabilitation Quality Spirometry Case Finding 14
  • Staff Training Medicines Management Post Discharge ReviewTelehealth End of Life Oxygen 15
  • Risk Stratification Self Management Pulmonary Rescue packs Rehabilitation Staff Training Medicines of Life End Management QualityCase Finding Spirometry Post Discharge Review Telehealth Integrated Care Oxygen Whole System Approach 16
  • Long Term ConditionsLong Term Conditions Level 3 High Complexity Case Management Level 2 High Risk Disease & Care Management Level 1 70-80% LTC Population Self Care/ Support Management 17
  • Long Term Conditions Level 3 High Complexity Case Management Primary Care Level 2 High Risk Disease & Care Management Level 1 70-80% LTC Population Self Care/ Support Management Long Term ConditionsRole of COPD Team Level 3 Shared care High Complexity Case Management Primary Care Specialist Level 2 High Risk Opinion Disease & Care Management Support & Level 1 Education 70-80% LTC Population Self Care/ Support Management 18
  • Long Term Conditions Primary Care COPD Diabetes Neurological Heart Failure conditions Long Term ConditionsSocial Care Primary Care COPD Diabetes Neurological Heart Failure conditions 19
  • From Vision to Reality From Vision to RealityLocal engagement/ownership of CCG KoLEmpowering local championsRelationship building at practice level (GP, Nurses, practice Managers)Flexible commissioning with risk sharingClear & progressive goal(s) setting incorporating regular patient feedbackClear governance across integrated pathways 20
  • Progress• Community team established• COPD high on the agenda• Widespread sign up to the model of care• 75% of practices use POINTS• Reduction in admissions• 90% outpatient activity now in community• High levels patient satisfaction• All patients offered post discharge follow up QualityUp skilling Primary CareAdherence to NICE Guidance & Quality StandardsAlignment with COPD Outcomes FrameworkMinimising unnecessary variationsPatient satisfactionEnd of Life Care 21
  • Patient Feedback 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100% The appointment me was convenient for me. I had confidence in the nurse/therapist who visited me. I was involved in the decisions about my care Strongly Disagree and treatment. I understood what the nurse/therapist said to Disagree me. Agree I feel knowledgeable and in control of my symptoms. Strongly Agree I was instructed on the use of my medica ons N/A in a way I could understand. No Answer I was given advice about other services and support that is available to me. I was treated with respect and dignity. Overall I was sa sfied with the standard of treatment I received. Overall I was sa sfied with the venue. InnovationWorking SmarterNetworkIntegrationCare closer to homeEmpowering patientsEducation/ SPACE manualUsing dataTele health 22
  • ProductivityAdmissions avoidanceMoving out patient care to communityEfficient use of resourcesMedicines managementHome oxygen COPD Admissions12001000800 2006-07 2007-08600 2008-09400 2009-10 2010-11200 2011-12 0 Coventry Teaching Warwickshire PCT PCT 23
  • COPD Admissions by CCG 500 400 COPD Admissions 300 2010/11 200 2011/12 100 0 Godiva Inspires PreventionPrimary: Smoking cessation, educationSecondary: Early detection, smoking cessation, self management, pulmonary rehabilitation, rescue packs, oxygen alert cards 24
  • Savings & Investment £600,000 £400,000 £200,000 £- £(200,000)£ £(400,000) £(600,000) £(800,000) £(1,000,000) £(1,200,000) 2011/12 2102/13 2013/14 Savings (including growth) £(308,597) £(635,565) £(989,747) Additional Investment £353,000 £353,000 £353,000 Net Costs/savings £44,403 £(282,565) £(636,747) 25
  • Karen Jackson Paul Davies Practice Tracy King physiologist Practice Manager nurse Finance COPD Rhea Fielding Manager UHCW Chris Mullins nurse Jerry Head UHL Dan Horne of MundayMark Galloway Breathe Easy pulmonary rehabilitation Tim Berry Head of medicines management Coventry Professor PCT GP & LTC lead Sally Consultant palliative care Godiva CCG Singh IM&T Fiona Shally Andrew Michelle Hardy Park John Thompson Directorate Manager Dymphna Medlock Lead Nurse UHCW Community CEO UHCW Contract Manager COPD nurse COPD Team PCT Jo Peter Shakespeare O’Brien Jeremy Bacon Stephen Mark Jones Jones Estates Manager GP & LTC lead CEO Arden Head of Respiratory BLF Inspires CCG Cluster Physiology UHCW PCT Roy Sarah Phipps Lee Sharrard Thompson Head of information Angela Wall Associate general Finance Community UHCW Claudia Roginski manager UHCW Manager PCT matron CWPT Business rcp.nhslocal.nhs www.inhale.nhs.uk 26
  • 0 5 10 15 20 25 1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 151 161 171 181 191 201 211 221 231 241 251 261 271 281 291 301 311 321 331 341 351 361 371 381 391 401 411 421 431 441 451 461 471 Hospital Coventry 2010/11 481 491 501 COPD Admissions to University 511 521 531 541 551 561 571 581 591 60127