Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.

1. Providing actionable healthcare analytics at scale: A
perspective from stroke care
Benjamin Bray, Research Director, Sentinel Stroke National
Audit Programme

2. Flickr: Jonathan Cohen

3. SSNAP
Ischaemic stroke
Primary ICH
≈ 80,000 per year
All acute admitting
hospitals in England
and Wales (&NI)
Whole pathway
care quality: from
admission, up to
6 months after
stroke
≈95% case
ascertainment
Organisational
audits of acute
and post acute
care services
100%
participation
from trusts and
CCGs
Data, analysis, visualisations
designed for:
•Clinical teams
•CCGs & LHBs
•Clinical networks
•Stroke survivors
•National level reports
1:43
1:24
1:35
0:46
1:03
1:09
0:49
0:33
1:15
0:28
0:56
0
.5
1
1.5
2
Hours
Jul 2014 Oct 2014 Jan 2015 Apr 2015
Source: SSNAP Apr-June 2015
Team-centred results at team level for Key Indicator 3.5B Team 182
Median time from clock start to thrombolysis (hh:mm)
HES & ONS
linkage
≈9000 bespoke outputs
per annum
 1 million downloads
by Dec 2016 ...

4. Scope of data collection
Organisation of care Clinical processes
Staffing
Access to stroke unit, quality of SU
Community services
Rehabilitation and re-enablement
Acute care organisation
TIA/neurovascular service
Multidisciplinary working
Access to early supported discharge and
community rehabilitation
Strategic groups
Policies
Research
Leadership
Acute care processes
Timings to scan, thrombolysis, stroke unit
Medical and therapy assessments and
screening
Therapy intensity
Discharge processes
Continuing care after hospital (e.g.
therapy at home)
6 month assessment
Outcomes
Infection rates
Complications
Mortality
Modified Rankin score (disability)

5. Hyperacute
care
Stroke
unit
Inpatient
rehabiliation
Community/home
rehabiliation
Patient level SSNAP Record
A whole-pathway
approach to QI

6. Making audit more
effective

7. Audit components
Data are valid
Data is based on recent performance
Data are about the individual/team’s own behaviour(s)
Audit cycles are repeated, with new data presented over time
Feedback components
Presentation is multi-modal including either text and talking or
text and graphical materials
Delivery comes from a trusted source
Feedback includes comparison data with relevant others
Nature of the
behaviour change
required
Targeted behaviour is likely to be amenable to feedback
Recipients are capable and responsible for improvement
Targets, goals, and
action plan
The target performance is provided
Goals set for the target behaviour are aligned with personal and
organizational priorities
Goals for target behaviour are specific, measurable, achievable,
relevant, time-bound
A clear action plan is provided when discrepancies are evident
Ivers et al , 2014

8. Audit components
Data are valid
Data is based on recent performance
Data are about the individual/team’s own behaviour(s)
Audit cycles are repeated, with new data presented over time
Feedback components
Presentation is multi-modal including either text and talking or
text and graphical materials
Delivery comes from a trusted source
Feedback includes comparison data with relevant others
Nature of the
behaviour change
required
Targeted behaviour is likely to be amenable to feedback
Recipients are capable and responsible for improvement
Targets, goals, and
action plan
The target performance is provided
Goals set for the target behaviour are aligned with personal and
organizational priorities
Goals for target behaviour are specific, measurable, achievable,
relevant, time-bound
A clear action plan is provided when discrepancies are evident
Ivers et al , 2014
Validation at data entry, accuracy and completeness is
measured and incentivised
Real time data patient level analytics in webtool
Quarterly analytics & visualiations
Team level and patient-pathway level metrics
Run charts
31
28
33
25
42 42 42
46
29
39
36
39
29
0
25
50
75
100
%
Jul 2015 Oct 2015 Jan 2016 Apr 2016 Jul 2016
Source: SSNAP Apr-Jul 2016
Team-centred results at team level for Key Indicator 1.1B Team 116
Scan within 1 hour
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0
10
20
Numberofteams
0 10 20 30 40 50 60 70 80 90 100
Team-centred Domain 3 score
Source: SSNAP Apr-Jul 2016
Team-centred results for Domain 3 Team 101
Thrombolysis

9. Audit cycles are repeated, with new data presented over time
Feedback components
Presentation is multi-modal including either text and talking or
text and graphical materials
Delivery comes from a trusted source
Feedback includes comparison data with relevant others
Nature of the
behaviour change
required
Targeted behaviour is likely to be amenable to feedback
Recipients are capable and responsible for improvement
Targets, goals, and
action plan
The target performance is provided
Goals set for the target behaviour are aligned with personal and
organizational priorities
Goals for target behaviour are specific, measurable, achievable,
relevant, time-bound
A clear action plan is provided when discrepancies are evident
Multimodal outputs, including tabular data, clinical
interpretation, data visualisation
RCP “Brand”, Clinical leadership, multiprofessional ethos
National and regional benchmarking
Absolute benchmarking against standards

10. required
Recipients are capable and responsible for improvement
Targets, goals, and
action plan
The target performance is provided
Goals set for the target behaviour are aligned with personal and
organizational priorities
Goals for target behaviour are specific, measurable, achievable,
relevant, time-bound
A clear action plan is provided when discrepancies are evident
Absolute performance vs guideline standard
Metrics align with national clinical guidelines and set by
multiprofessional group including stroke survivors
We don’t provide action planning!
CC
B
C
E
D
D
D
D
D
C
D
CC
B
C
D
D
D
D
D
D
C
D
D
A:90%+
A:90%+
SSNAP score
Case ascertainment
Audit compliance
Total KI Score
D1:Scanning
D2:Stroke Unit
D3:Thrombolysis
D4:Specialist Assessments
D5:Occupational Therapy
D6:Physiotherapy
D7:Speech and Language
D8:Multidisciplinary team working
D9:Standards by Discharge
D10:Discharge Process
Team centredPatient centred
Source: SSNAP Apr-Jul 2016
Team level results Team 116

11. Adding value
through innovation

12. Building health economics into SSNAP
> Ischaemic stroke
> Primary
intracerebral
haemorrhage
≈ 80,000 per year
All hospitals in
England & Wales
Quality of care from
admission, up to 6
months after stroke
Organisational audits
of acute and post acute
care services
Health & social care
costs up to five years
after stroke
1:43
1:24
1:35
0:46
1:03
1:09
0:49
0:33
1:15
0:28
0:56
0
.5
1
1.5
2
Hours
Jul 2014 Oct 2014 Jan 2015 Apr 2015
Source: SSNAP Apr-June 2015
Team-centred results at team level for Key Indicator 3.5B Team 182
Median time from clock start to thrombolysis (hh:mm)
£ $
Data, analysis,
visualisations designed
for:
•Clinical teams
•CCG, LHBs, STP
footprints
•Clinical networks
•Stroke survivors
•National level reports

13. Discrete event simulation model generates individual
cost estimates for all patients in SSNAP, up to 5 years
after stroke
Age
Sex
Stroke type: ischaemic, ICH
Severity: NIHSS at admission
80 different
combinations

14. Each dot is one
patient in
SSNAP

15. The blue
dots are
patients
with AF

16. Unlocking the
power of big data

18. Increasing
efficiency

20. Cost efficiencies through reducing data
duplication and achieving economies of
scale
Single source of data for multiple end users:
– Local :QI, evaluation, commissioning, research
– Regional: CCG, LHB, STP
– National: CQC, Best PracticeTariff, Public Health
England,Wales Government, Department of
Health

21. User centred
design

22. Precision and high level of detail
Key messages/big picture

23. Bespoke analytics and visualisations
for different users
High level key messages versus
highly granular data for QI
Design around user’s workflow (e.g.
slidedecks for teams, dashboards for
CCGs)

24. Co-designing outputs for, and
with, patients and families
Quarterly reports “Easy Access
Version” downloads ≈ 8500/quarter

26. • Epidemiology, outcomes and health services
research
• Evaluation of QI interventions & service changes
(e.g. Interrupted time series with controls)
• Trials: Design, Phase IV, external generalisability
• Randomised registry based trials
• Advanced analytics and visualisation
Integration with
research

27. • Reducing funding
• Information governance barriers to data
linkage
• National policies don’t always support a
philosophy of continuous improvement
• Better data on outcomes
Challenges

28. SSNAP is funded by the Healthcare Quality
Improvement Partnership
SSNAP Health Economics was funded by NHS
England
benjamin.bray@kcl.ac.uk
www.strokeaudit.org
Thank you