Paul Myers presentation WSPCR 2011

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Paul Myers presentation WSPCR 2011

  1. 1. Evidence Based Decision Making in Primary Care & Public HealthWorking with GP data for health improvement inWales - realities and reactionsOctober 2011Presenter: Dr of presentation on Master Insert name Paul Myres Primary Care Quality &Information Service (PCQIS) Slide
  2. 2. What information do we have -Predicting/ Identifying Areas of Risk& Good Practice: Practice Profiling • QOF • Referrals • Audit • Hospital data • Questionnaires • No of staff WTEs • Complaints and • List size per incidents notional WTE • Immunisations • Deprivation • Risk assessment • Income/Cost per patient
  3. 3. Audit+ – What it is• A centrally funded and supported software tool for General Practices to: – improve data quality – standardise reporting – support clinical governance – Measures and contributes to health improvement• A standardised cross-GP system tool – Non-mandatory • Only 3 opt outs out of 484 Welsh practices – Complies with NHS standards - Read code driven – Enables comparison between General Practices irrespective of GP system supplier• General Practice focused – Supports LHBs and the rest of NHS Wales as a by-product
  4. 4. Audit+ Highlights – Primary Care Quality Information Service (PCQIS) quality improvement toolkits • e.g. INR (Warfarin) Monitoring Directed Enhanced Service – also supporting 1000 lives initiative – PCQIS Quality & Outcomes „Prevalence‟ • Age/sex standardised analysis – PHW Communicable Disease Surveillance Centre • Seasonal Flu Vaccination Reporting – 96.3% practices automatically reported in 2009/10 • Weekly Communicable Disease reporting – Switched to daily for pandemic H1N1 flu surveillance – On a daily basis 85% practices across Wales reported • H1N1 Flu Vaccination Reporting – Rapidly deployed and updated module in line with evolving JCVI priority groups for vaccination
  5. 5. Findings Headline crude rates for diagnosed conditions 2.0% Stroke TIA 4.1% coronary heart disease 14.9% hypertension 4.8% diabetes 6.6% asthma 2.0%COPDPresenter: Dr Paul Myres Primary Care Quality& Information Service (PCQIS)
  6. 6. Prevalence – variation –Stroke TIA health board, local authority, GPpractice QOF prevalence of stroke/transient ischaemic attack (TIA) by local authority area, 2009/10 QOF prevalence of stroke/transient ischaemic attack Produced by Public Health Wales Observatory 95% confidence interval using data from Audit+ web (TIA) by health board, 2009/10 Produced by Public Health Wales Observatory 95% confidence using data from Audit+ web interval Range of GP practice prevalence age standardised* % crude % Wales* % Stroke & TIA Wales March 2010 3.0 age standardised* % crude % Wales* %25 2.5 2.520 2.0 2.0 Percentage Percentage Wales = 1.3%15 Wales = 1.3% 1.5 1.510 1.0 1.0 0.5 5 0.5 0.0 0.0 0 Denbighshire Ceredigion Swansea Newport Carm arthenshire Monm outhshire Isle of Anglesey Torfaen Flintshire Cardiff Blaenau Gwent Cwm Taf The Vale of Glam organ Powys Betsi Cadwaladr Abertawe Bro Neath Port Talbot Pem brokeshire Conwy Gwynedd Bridgend Merthyr Tydfil Powys Caerphilly Hywel Dda Aneurin Bevan Rhondda Cynon Taff Wrexham Cardiff and Vale European age standardised rates (EASR) per 1000 registered population Morgannwg * age standardised to European standard population * age standardised to European standard population The range is 1.0% to 1.6% of The range from 1.2% to 1.4%Range from 0.4% to 2.3% of of the registered population,the population. registered patients. Crude rates again show more Crude prevalence figures show variation ranging from 1.6% more variation ranging from to 2.6% of registered patients. 1.7% to 2.2% Presenter: Dr Paul Myres Primary Care Quality & Information Service (PCQIS)
  7. 7. Prevalence – variation – hypertension health board & local authority QOF prevalence of hypertension by local authority, 2009/10 QOF prevalence of hypertension by health board, Range of GP practice prevalence Produced by Public Health Wales Observatory 95% confidence 2009/10 interval Hypertension Wales March 2010 using data from Audit+ web Produced by Public Health Wales Observatory 95% confidence using data from Audit+ web interval200 age standardised* % crude % Wales* % 20 age standardised* % crude % Wales* % 18 20 18150 16 16 14 Wales = 11.1% 14 Percentage 12 Percentage Wales = 11.1%100 12 10 10 8 8 6 6 50 4 4 2 2 0 0 0 Denbighshire Ceredigion Swansea Carm arthenshire Newport Monm outhshire Isle of Anglesey Flintshire Torfaen Cardiff Blaenau Gwent The Vale of Glam organ Neath Port Talbot Pem brokeshire Conwy Powys Betsi Cadwaladr Bridgend Abertawe Bro Gwynedd Merthyr Tydfil Powys Caerphilly Cwm Taf Wrexham Rhondda Cynon Taff Aneurin Bevan Hywel Dda European age standardised rates (EASR) per 1000 registered population Morgannwg Cardiff and Vale * age standardised to European standard population * age standardised to European standard population Range from 3.2% to 20.0% percent ranges from 10.2% to 12.9% The range is 8.8% to 13.3% of the registered population of the population. of registered patients. Crude prevalence show more crude rates show more variation ranging from 12.4% to variation ranging from 11.5% 16.4% to 17.5% of registered patients. Presenter: Dr Paul Myres Primary Care Quality & Information Service (PCQIS)
  8. 8. Results – variation – Gp practices applying S.P.C. Distribution of GP practice age standardised prevalenceDistribution of GP practice age standardised prevalencefor Hypertension around the Welsh mean. for Stroke around the Welsh mean.Number of all practices v range of prevalance Number of all practices v range of prevalance No Pracs Min EASR/1000 Max EASR/1000 Ave EASR/1000 No pracs Min EASR/1000 Max EASR/1000 Ave EASR/1000 160 250 350 25 140 300 200 20 EASR per 1000 registered patients 120 EASR per 1000 registered patients 250 Number of practices Number of practices 100 150 15 200 80 331 137 150 100 10 60 118 108 100 40 50 5 50 20 38 31 18 43 25 15 0 0 0 0 >-3 >-2<-3 between +2 & -2 >+2<+3 >+3 >-3 >-2<-3 between +2 >+2<+3 >+3 Standard deviations from Wales hypertension prevalance mean & -2 Standard deviations from Wales stroke&TIA prevalance mean Hypertension 52% (226) Stroke & TIA 8% (33) practices > 3 standard practices > 3 standard deviations of Wales mean deviations of Wales mean Presenter: Dr Paul Myres Primary Care Quality & Information Service (PCQIS)
  9. 9. Geographical patterns of prevalence - health board comparison Hypertension QOF v WHS QOF prevalence of hypertension by health board, 2009/10 Produced by Public Health Wales Observatory 95% confidence Adults who reported currently being treated for high using data from Audit+ web interval blood pressure (hypertension), health boards, 2008 and 2009 age standardised* % crude % Wales* % Produced by Public Health Wales Observatory using Welsh Health Survey data 20 30 18 Age standardised+ percentage 16 25 14 Wales = 19.7%Percentage Wales = 11.1% 20 12 10 15 8 6 10 4 5 2 0 0 Aneurin Bevan Betsi Cadwaladr Powys Abertawe Bro Hywel Dda Cwm Taf Cardiff and Vale Powys Betsi Cadwaladr Abertawe Bro Cwm Taf Morgannwg Aneurin Bevan Hywel Dda Cardiff and Vale Morgannwg * age standardised to European standard population + age standardised to Wales population Presenter: Dr Paul Myres Primary Care Quality & Information Service (PCQIS)
  10. 10. Geographical patterns of prevalence - health board comparison Stroke QOF v WHS QOF prevalence of stroke/transient ischaemic attack (TIA) by health board, 2009/10 Produced by Public Health Wales Observatory 95% confidence Adults who reported having ever been treated for using data from Audit+ web interval stroke, Wales health boards, 2008 and 2009 Produced by Public Health Wales Observatory using Welsh Health Survey age standardised* % crude % Wales* % data 4 2.5 Age standardised+ percentage 2.0 3 Wales = 2.5%Percentage Wales = 1.3% 1.5 2 1.0 1 0.5 0.0 0 Aneurin Bevan Betsi Cadwaladr Powys Abertawe Bro Cwm Taf Hywel Dda Cardiff and Vale Cwm Taf Powys Betsi Cadwaladr Abertawe Bro Morgannwg Hywel Dda Aneurin Bevan Cardiff and Vale Morgannwg * age standardised to European standard population + age standardised to Wales population Presenter: Dr Paul Myres Primary Care Quality & Information Service (PCQIS)
  11. 11. Hypertension V Stroke prevalence Prevalence hypertension v stroke (inc TIA) 200 180 160 140 120 100 80 60 40 20 0 5 10 15 20 25 Stroke European age standardised rates per 1000 registered patients source Audit+ 2010 Primary Care Quality Information Service
  12. 12. Findings - Geographical patterns ofprevalence• The QOF prevalence of diagnosed chronic conditions shows broadly an expected geographical pattern, – higher prevalence in more deprived areas such as Cwm Taf and – lower prevalence in less deprived areas such as Powys.• Some consistency in the relative position of health board and local authority areas between QOF and the Welsh Health Survey (WHS).• Some inconsistent such as – relatively low prevalence of diagnosed stroke or transient ischaemic attack (TIA) in Blaenau Gwent, – relatively low prevalence of diagnosed asthma in Cwm Taf – relative position for asthma and COPD inconstant with WHS in Carmarthenshire Presenter: Dr Paul Myres Primary Care Quality & Information Service (PCQIS)
  13. 13. Deprivation V Prevalence Stroke/TIA Hypertension 2002520 Age standardised rate per 1000 patients 15015 10010 50 5 -10 -5 0 5 10 -10 -5 0 5 10 Deprivation (Townsend 2001) Deprivation (Townsend 2001) In this instance the co-efficient value for In this instance the co-efficient value for Wales is 0.23 Although this association is Wales is 0.35, Although this association is statistically significant, it is so weak it falls statistically significant, it shows a weak into the little or no association grade positive correlation or association Presenter: Dr Paul Myres Primary Care Quality & Information Service (PCQIS)
  14. 14. Examining the correlation between age standardised prevalence & deprivation Data from 2006 shows a Weak positive correlation over all from 206 practices from North, Mid & West Wales Spearman Rank Correlation Coefficient By LHB for COPD EASR V Practice Townsend Score Project Sample DENBIGHSHIRE Correlation shown by the former WREXHAM LHBs contributing data (Green Bars ANGLESEY are the LHBs and the Red overall) GWYNEDD POWYS SWANSEA NEATH PORT TALBOT CEREDIGION PEMBROKESHIRE-1 -0.8 -0.6 -0.4 -0.2 0 0.2 0.4 0.6 0.8 1 EASR per 1000 registered patients. Spearman COPD Strong Negative Weak Negative(Upper limit) Weak positive (upper limit) Rank correlation co-efficient used Strong Positive Weak Negative (Lower Limit) Weak Positive (low er Limit)
  15. 15. Findings Deprivation V Prevalence Many conditions demonstrate the expected association with deprivation, although this association is weak Calculation of practice deprivation scores may underestimate the correlation as practice catchment populations span areas of mixed deprivation levels It can also highlight pockets of deprivation where a single practice may serve one specific area of deprivation in, an otherwise affluent area. Student populations demonstrate deprived characteristics through the Townsend index. Presenter: Dr Paul Myres Primary Care Quality & Information Service (PCQIS)
  16. 16. Is QOF providing an equitable service : CHD QOF register coverage V deprivation GP practices(Wales); Coverage of the QOF CHD register 2009/10 GP practices(Wales); Coverage of the QOF CHD register 2009/10 CHD05 patients with BP recorded (previous 15 months) CHD06 patients last BP (previous 15 months) 150/90 or less 100 100 90 90 80 80 % QOF register covered 70 70 60 least deprived 5th 60 mid three 5ths most deprived 5th 50 50 least deprived 5th mid three 5ths most deprived 5th 40 40 30 30 20 20 10 10 0 0 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 11 Recording BP Cholesterol Deprivation (Townsend 2001) -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 11 Management BP Cholesterol Deprivation (Townsend 2001) GP practices(Wales); Coverage of the QOF CHD register 2009/10 GP practices(Wales); Coverage of the QOF CHD register 2009/10 CHD08 patients last total cholesterol (previous 15 months) 5mmol/l or less CHD07 patients with record of total cholesterol (previous 15 months) 100 100 90 90 80 80 % QOF register covered 70 70 60 60 50 least deprived 5th mid three 5ths most deprived 5th 50 40 40 least deprived 5th mid three 5ths most deprived 5th 30 30 20 20 10 10 0 0 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 11 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 11 Deprivation (Townsend 2001) Deprivation (Townsend 2001)
  17. 17. Primary care annual report key messagesfrom effectiveness section“The systematic, evidence based management of chronic disease inprimary care settings can make a significant contribution to the preventionof disability and deaths from these conditions.”LHBs must ensure that:-•practices have effective case finding approaches•unmet need is identified and managed•treatments are effective•inappropriate variation is minimised Presenter: Dr Paul Myres Primary Care Quality & Information Service (PCQIS)
  18. 18. Crude rate per 1000 registered patients AB, 46 CV, 35 Pow, 42 ABMU, 47 CwnTaf , 43 BCU, 39 done? 2007 HywelDda, 43 2008 increasing but look at QOF more work to be 2009 prevalence model v current Crude Diabetes prevalence 2010 Mean Health Board Crude prevalance growth 2007-11 Diabetes 9.5% Isle of Anglesey 4.78% 8.9% Gwynedd 3.99%& Information Service (PCQIS) 10.4% Conwy 2011 5.04% 55 48 56 41 50 52 53 9.6% Denbighshire 4.81% 8.5% Flintshire 4.43% 8.5% Wrexham 4.16% 9.7% Powys 4.55% 8.6% Ceredigion 4.29% 9.5% Pembrokeshire 5.14% 9.5% Carmarthenshire 5.47% 8.8% Swansea APHO Model 4.80%Presenter: Dr Paul Myres Primary Care Quality 9.8% Neath Port Talbot 5.81% 9.1% Bridgend 5.46% 8.5% QOF register The Vale of Glamorgan 4.51% 2010 Welsh Counties 7.4% Cardiff 3.74% 9.2% Case finding Rhondda, Cynon, Taff 4.97% 9.9% Merthyr Tydfil 4.70% APHO modeled data V Actual QOF registers 9.0% Caerphilly 5.33% for 2011 report 10.0% Blaenau Gwent 6.04% 9.2% Torfaen 5.61% Diabetes example 8.9% Monmouthshire 4.69% 9.0% Newport 5.07%
  19. 19. Unmet need is identified and managed QOF COPD 08 flu immunisation QOF performance Wales QoF 2009/10 COPD08 Register performance Wales QoF 2009/10 Indicator to register COPD08 100 100 Cases as a Percentage of Total Number of patients qualifying Cases as a Percentage of Total number of patients on the 90 for indicator nett of contract exclusions & Exceptions 90 80 70 80 register for the indicator 60 50 70 40 60 30 Wales GP practices Wales GP practices Average Average 20 2SD limits 50 2SD limits 3SD limits 3SD limits 10 Health Board Practices Health Board Practices 0 40 0 100 200 300 400 500 600 700 0 100 200 300 400 500 600 700 800 COPD08 Num erator Total num ber of patients on the register for the indicatorSource: QOF 2009/10 Source: QOF 2009/10 Unmet need ? Ave QOF coverage 90% + Coverage of register 78% Presenter: Dr Paul Myres Primary Care Quality & Information Service (PCQIS)

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