Bateman eq5dforkingsfundmeeting march2015

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Here is my presentation for an exciting event at King's Fund 26 MARCH 2015 This is the published programme for the day Session one: Opening plenary 9.45am: Welcome and introduction Dr Johnny Marshall, ‎Director of Policy, NHS Confederation 9.55am: Transforming community health care services in London Caroline Alexander, Chief Nurse, NHS England, London Region 10.15am: Panel session: The challenges and opportunities for improving and developing community services Caroline Alexander, Chief Nurse, NHS England, London Region Matthew Winn, Chief Executive, Cambridge Community Services NHS Trust and Chair, NHS Confederation Community Health Services Forum Dr Crystal Oldman, Chief Executive, Queen's Nursing Institute further panelists to be confirmed 10.55am: Questions and discussion 11.10am: Refreshment break and networking Session two: What does good look like? 11.40am: Welcome and introduction Catherine Foot, Assistant Director of Policy, The King’s Fund 11.45am: Regulating community health services Ellen Armistead, Deputy Chief Inspector, Care Quality Commission 12.05pm: How and what should we measure to ensure quality? Christina Walters, Programme Director, Community Indicators Programme Andrew Barber, Technical Consultant, Community Indicators, Outcome Measures and Payment System Development Programme 12.25pm: Questions and discussion 12.40pm: Buffet lunch, networking and exhibition Session three: Good practice breakout sessions Sessions will run from 1.40-2.55pm and delegates will have the choice of: A: Quality assurance: how are you using data locally to measure for quality? 1.40pm: Welcome and introduction 1.45pm: The use of PROMs (Patient Reported Outcome Measures) in a community setting Iain Cockley-Adams, Service Improvement Manager, Gloucestershire Care Services NHS Trust 2.05pm: Over2You Quality Volunteers Ruby Smith, Head of Personalisation, South Yorkshire Housing Association 2.25pm: PROMS in Practice: The Collection Analysis and Reporting of quality of life indicator EQ5D in rehabilitation services in Cambridgeshire Community Services Andrew Bateman PhD, Physiotherapist and Service Manager, Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust 2.45pm: Questions and discussion B: Working with patients and communities: what are you doing to involve patients and their families and carers and to make your services more person-centred? C: Partnerships and relationships with other parts of the system: how are you building effective local partnerships across health and social care? 2.55pm: Refreshment break and networking Session four: Good practice breakout sessions Sessions will run from 3.15-4.30pm and delegates will have the choice of: D: Supporting and encouraging team working: what are you doing to support team working? E: Working with patients and communities: what are you doing to involve patie

Healthcare

Euroqol EQ5D-5L
in community rehab services
Andrew Bateman, NeuroRehab Manager
Oliver Zangwill Centre, Ely UK
Acknowledgements
to Community Rehab Teams,
Data warehouse team, especially Ian Moyes
March 2015
Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Luton, Norfolk, Peterborough and Suffolk

Our objectives
• Quality: to be recognised as a provider of
safe and effective services that people
want to use
• Quality: to collaborate with organisations
to improve the care given to people who
use our services
• Sustainability: to be recognised as a
provider of safe and innovative services
that helps commissioners achieve their
outcomes
Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Luton, Norfolk, Peterborough and Suffolk

• We will only know if we are
effective and if we are improving
the care given to people if we ask
our service users about their
health and outcomes
• (process measures don’t tell us if
what we do is working)
Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Luton, Norfolk, Peterborough and Suffolk

We built a read-coded data capture tool into our Electronic Patient Record

Using the EQ-5D-5L Value Sets
• A list of 3127 values is available.
The values are set on a scale
where
• 1 = full health through to
• 0 = death (minus values are
states “worse than death” e.g.
coma or severe intractable pain)
So a Health State 11111 = 1 (Full
health) 55555 = -0.594 (State
worse than death)
• example: 2 3 4 2 1 = 0.516 (or,
roughly, as a percentage of full
health 51.6%)
11111 1.000
11112 0.879
11113 0.848
11114 0.635
11115 0.414
11121 0.837
11122 0.768
11123 0.750
11124 0.537
11125 0.316
11131 0.796
11132 0.740
11133 0.725
11134 0.512
11135 0.291
11141 0.584
11142 0.527
11143 0.513
etc
Slide from Chartered Society Physiotherapy

Nochange
Higherindexscores–
improvedselfrating
Increasedawareness
ordeterioration

Uses of the data
• 1) At the individual level
• 2) aggregated for a community team
• 3) aggregated across our trust
• 4) health economics

OZC “commissioned” © artwork by Lucy Driver
https://www.facebook.com/pages/Lucy-Driver-Illustration/295208450629274
“Using the questionnaire opened the door for me to have a
holistic conversation with my patient” (Community OT)

COUNTY WIDE TEAM PRIORITIES
Our patients (n=9148) report severe problems with
40% of our patients report severe/extreme
problems doing their usual activities
14%
20%
24%
8% - 680 people

Community Service Outcomes
Our patients (n=4300) report
improvements in all domains
% reporting NO/SLIGHT problems
We can report nearly double (32%->58%)
the number of people endorsing “no/slight
problems” doing their usual activities.
This is the aim of rehabilitation.
45 65
38 59
45 65
62 77
73 82
32 58
before after

Conclusions
• There is room for improvement
• We can look at variation across
Cambridgeshire between different services
• …and between different patient groups
• More work to do on data quality, links to
activity, and psychometric/econometric work

Thank you and questions
Keep the conversation going on twitter
@ozcboss
Resources at http://www.scoop.it/t/eq-5d
Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Luton, Norfolk, Peterborough and Suffolk

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1. Pathway works to develop and test new models of care for people experiencing homelessness and extreme social exclusion. It supports "experts by experience" and trains care navigators to coordinate services across health, housing, and social care. 2. Studies show Pathway's hospital-based care coordination model reduces A&E attendances and bed days, improves housing outcomes, and increases quality of life at a cost of £26,000 per quality-adjusted life year. 3. Pathway advocates for a trusting relationship-based approach that addresses individuals' basic physiological and safety needs first through coordinated multi-disciplinary support.

QIPP: An Overview

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This document discusses QIPP (Quality, Innovation, Productivity and Prevention), the NHS strategy to improve quality and efficiency. It describes: 1) QIPP's focus on mobilizing Allied Health Professionals and liberating the NHS. 2) Yorkshire and Humber's two phase approach - initial mobilization through meetings and briefings, followed by mainstreaming QIPP into core business through regional workstreams like telehealth. 3) Examples of potential areas for improvement like falls prevention, dementia, and diabetes telehealth programs.

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The document discusses the creation of an Integrated Care System (ICS) for Norfolk and Waveney to improve how the NHS, social care, and voluntary, community and social enterprise (VCSE) sector work together. Key points: 1) An ICS will take collective responsibility for resources, standards, and population health. It aims to improve health equity, coordinate care, and make the area the best place to work in health and care. 2) Care will be increasingly integrated at the neighborhood and local place levels involving primary care, acute care, mental health, social care, and VCSE organizations. 3) A proposed ICS Partnership Board and VCSE Assembly are discussed to strengthen partnership working

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This document discusses a project called "Your Voice Matters" which aims to combine patient experience data with health intelligence to improve integrated care. It describes collecting data through a survey of over 500 patients on their experiences of care. The data shows that many patients are not receiving truly person-centered or coordinated care. The project will analyze this data, identify areas for improvement, and use a co-design process involving patients to influence changes to care delivery and specific programs like those for older persons. The goal is for this framework to enable ongoing input from patients to measure and improve their experiences over time.

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Bristol - building a truly healthy city, pop up uni, 12.00, 3 september 2015

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Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

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Healthwatch Essex uses its "555 Model of Engagement" to capture the lived experiences of patients and give them a platform to share their stories with health and social care professionals. The model involves working with 5 key partners to conduct 5 focus groups in 5 different areas with 5 participants who tell their stories at a launch event. Recommendations from the reports aim to improve services based on patient feedback. Examples showed how projects on mental health and sensory impairments led to more joined-up services, better information access for patients, and health professionals gaining a greater understanding of patients' conditions and needs.

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Healthwatch Essex uses its "555 Model of Engagement" to capture the lived experiences of patients and give them a platform to share their stories with health and social care professionals. The model involves working with 5 key partners to conduct 5 focus groups in 5 different areas with 5 participants who tell their stories at a launch event. Recommendations from the reports aim to improve services and are adopted by statutory organizations. Examples provided showed how the model led to improved mental health services, better information for those with neurological conditions, and more accessible care for those with sensory impairments. The 555 Model is highlighted as an innovative and flexible approach to meaningful engagement.

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Health Evidence hosted a 90 minute webinar examining the effectiveness of exercise programs for people with dementia. Click here for access to the audio recording: https://youtu.be/jC8HhC2XFrE Dorothy Forbes, Professor, Faculty of Nursing, University of Alberta, Edmonton led the session and presented findings from her latest Cochrane review: Forbes, D., Forbes, S. C., Blake, C. M., Thiessen, E. J., & Forbes, S. (2015). Exercise programs for people with dementia. Cochrane Database of Systematic Reviews, 2015(4), CD006489. As the population ages, the number of people suffering with dementia will also rise. Not only will this affect quality of life of people with dementia but will also increase the burden of family caregivers, community care, and residential care services. Exercise interventions have been identified as a potential way of reducing or delaying the progression of dementia and its symptoms. This review examines two questions: do exercise programs for older people with dementia improve cognition, activities of daily living (ADLs), challenging behaviour, depression, and mortality in older people with dementia? and; do exercise programs for older people with dementia have an indirect impact on family caregivers' burden, quality of life, and mortality?

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This document summarizes an event about improving access to seven day NHS services. The event included welcome remarks, presentations on seven day services in Yorkshire and Humber, the national requirements and priorities, and the 10 clinical standards for seven day services. It also discussed involvement of patients and the public, the self-assessment tool, and sharing experiences from early adopter sites including County Durham and Darlington.

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Presentation by Alan Dubovsky, Chief Patient Experience Officer, Cedars Sinai Medical Center, about their Patient Experience Program. Begins with a review of patient satisfaction scores, clinical performance initiatives, medical outcomes, ongoing research, academic programs, and national awards. Next is a timeline of activites, from building the PX Infrastructure, PX Improvement Projects, Launching PX Skill Building Programs and introducing PX Innovation. Includes details about the Primary functions of the office of Patient Experience: The measurement, reporting, and analysis of all Patient Feedback and the coordination and implementation of all Patient Experience improvement efforts across the health system. The patient voice is captured through Solicited Feedback, Patient & Family Advisor Programs and Verbatim Feedback. Presentation finishes with a discussion about the Future Of Patient Feedback. Some of those areas: Using patient segmentation to group patients into distinct segments, Asking patients unique questions to understand their primary concerns, Asking planned admissions who helped set their expectations? Asking new patients what was their prior perception compared to reality?

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1. Euroqol EQ5D-5L in community rehab services Andrew Bateman, NeuroRehab Manager Oliver Zangwill Centre, Ely UK Acknowledgements to Community Rehab Teams, Data warehouse team, especially Ian Moyes March 2015 Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Luton, Norfolk, Peterborough and Suffolk

2. Our objectives • Quality: to be recognised as a provider of safe and effective services that people want to use • Quality: to collaborate with organisations to improve the care given to people who use our services • Sustainability: to be recognised as a provider of safe and innovative services that helps commissioners achieve their outcomes Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Luton, Norfolk, Peterborough and Suffolk

3. • We will only know if we are effective and if we are improving the care given to people if we ask our service users about their health and outcomes • (process measures don’t tell us if what we do is working) Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Luton, Norfolk, Peterborough and Suffolk

4. We built a read-coded data capture tool into our Electronic Patient Record

5. Using the EQ-5D-5L Value Sets • A list of 3127 values is available. The values are set on a scale where • 1 = full health through to • 0 = death (minus values are states “worse than death” e.g. coma or severe intractable pain) So a Health State 11111 = 1 (Full health) 55555 = -0.594 (State worse than death) • example: 2 3 4 2 1 = 0.516 (or, roughly, as a percentage of full health 51.6%) 11111 1.000 11112 0.879 11113 0.848 11114 0.635 11115 0.414 11121 0.837 11122 0.768 11123 0.750 11124 0.537 11125 0.316 11131 0.796 11132 0.740 11133 0.725 11134 0.512 11135 0.291 11141 0.584 11142 0.527 11143 0.513 etc Slide from Chartered Society Physiotherapy

6. Nochange Higherindexscores– improvedselfrating Increasedawareness ordeterioration

7. Uses of the data • 1) At the individual level • 2) aggregated for a community team • 3) aggregated across our trust • 4) health economics

8. OZC “commissioned” © artwork by Lucy Driver https://www.facebook.com/pages/Lucy-Driver-Illustration/295208450629274 “Using the questionnaire opened the door for me to have a holistic conversation with my patient” (Community OT)

9. COUNTY WIDE TEAM PRIORITIES Our patients (n=9148) report severe problems with 40% of our patients report severe/extreme problems doing their usual activities 14% 20% 24% 8% - 680 people

10. Community Service Outcomes Our patients (n=4300) report improvements in all domains % reporting NO/SLIGHT problems We can report nearly double (32%->58%) the number of people endorsing “no/slight problems” doing their usual activities. This is the aim of rehabilitation. 45 65 38 59 45 65 62 77 73 82 32 58 before after

11.

12. Conclusions • There is room for improvement • We can look at variation across Cambridgeshire between different services • …and between different patient groups • More work to do on data quality, links to activity, and psychometric/econometric work

13. Thank you and questions Keep the conversation going on twitter @ozcboss Resources at http://www.scoop.it/t/eq-5d Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Luton, Norfolk, Peterborough and Suffolk

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