This slide set is the second of two looking at how Clinical Commissioning Groups (CCGs) can make the best use of measurement to support them to commission for improved outcomes.
This set looks specifically at how commissioners can build up sets of measures along whole pathways of care.
How to commission for improving health outcomes: an introduction to choosing ...The King's Fund
This slide set is the first of two looking at how commissioners can make the best use of measurement to support commissioning for improved outcomes.
The slides introduce general concepts about approaches to measurement in health care, the uses of structure, process and outcome indicators, and how to achieve a good mix of indicators for commissioning.
This presentation by the Bureau of Health Information to the Royal Australasian College of Physicians looks at using clinical outcome data to improve patient care.
It examines:
Why measure and report on performance?
- Accountability and quality improvement
What is performance really?
- It is not a measure of what the system is, it is a measure of how well the system does
Whose performance is it anyway?
- Attributing results to providers, units or sectors requires a careful assessment
Healthcare’s Challenging Trio: Quality, Safety, and Complexity Health Catalyst
Dr. John Haughom expands upon the challenges with patient safety and quality in today’s modern healthcare system. First brought to light in the Institute of Medicine’s (IOM) publication of “To Err is Human: Building a Safer Health System”, the situation has only grown more complex since that seminal report. With the total cost of preventable adverse events at as much as $29 billion, preventable readmissions at $17 billion, and preventable medication errors at $16.4 billion, these are all examples of terrible medical waste that must be eliminated.
Physician-Hospital Integration Strategies to Maximize the Bottom Line for Ort...Wellbe
Economic pressures on physicians and hospitals have increased attention on integration and collaboration between providers. The passage of the Patient Protection and Affordable Care Act (ACA) has propelled physician-hospital integration onto the national stage, forcing physicians and hospitals to change and accelerate their alignment structures with each other to meet the ACA’s mandates: quality excellence, population health management, efficiency, and cost savings. This presentation provides a detailed overview of strategies for the orthopedic service line that have been successfully implemented in order to achieve the Triple Aim while enhancing alignment with the service line’s physicians.
About the Speaker:
DanielleDanielle L. Sreenivasan, MHA is a senior manager with The Camden Group with more than ten years of healthcare experience. She specializes in strategic and service line business planning, facility planning, financial feasibility analyses, and medical staff planning and alignment on behalf of community hospitals, healthcare systems, academic medical centers, and physician medical groups. Ms. Sreenivasan has worked with clients analyzing current and potential markets and developing population-based healthcare strategies.
Prior to joining The Camden Group, Ms. Sreenivasan directed the Virginia Cardiac Network, LLC for Inova Fairfax Hospital located in Falls Church, Virginia. Her responsibilities included the development of strategic business plans and scorecards for clinical quality and budgeting processes, as well as oversight for the implementation of operational performance improvement plans. Ms. Sreenivasan’s experience also includes departmental and operational audits, and reimbursement analysis.
Ms. Sreenivasan received her master’s degree in health administration from Medical University of South Carolina with Honors, and her bachelor’s degree in accounting, business administration, and finance from the College of Charleston. She is a member of the American College of Healthcare Executives.
How to commission for improving health outcomes: an introduction to choosing ...The King's Fund
This slide set is the first of two looking at how commissioners can make the best use of measurement to support commissioning for improved outcomes.
The slides introduce general concepts about approaches to measurement in health care, the uses of structure, process and outcome indicators, and how to achieve a good mix of indicators for commissioning.
This presentation by the Bureau of Health Information to the Royal Australasian College of Physicians looks at using clinical outcome data to improve patient care.
It examines:
Why measure and report on performance?
- Accountability and quality improvement
What is performance really?
- It is not a measure of what the system is, it is a measure of how well the system does
Whose performance is it anyway?
- Attributing results to providers, units or sectors requires a careful assessment
Healthcare’s Challenging Trio: Quality, Safety, and Complexity Health Catalyst
Dr. John Haughom expands upon the challenges with patient safety and quality in today’s modern healthcare system. First brought to light in the Institute of Medicine’s (IOM) publication of “To Err is Human: Building a Safer Health System”, the situation has only grown more complex since that seminal report. With the total cost of preventable adverse events at as much as $29 billion, preventable readmissions at $17 billion, and preventable medication errors at $16.4 billion, these are all examples of terrible medical waste that must be eliminated.
Physician-Hospital Integration Strategies to Maximize the Bottom Line for Ort...Wellbe
Economic pressures on physicians and hospitals have increased attention on integration and collaboration between providers. The passage of the Patient Protection and Affordable Care Act (ACA) has propelled physician-hospital integration onto the national stage, forcing physicians and hospitals to change and accelerate their alignment structures with each other to meet the ACA’s mandates: quality excellence, population health management, efficiency, and cost savings. This presentation provides a detailed overview of strategies for the orthopedic service line that have been successfully implemented in order to achieve the Triple Aim while enhancing alignment with the service line’s physicians.
About the Speaker:
DanielleDanielle L. Sreenivasan, MHA is a senior manager with The Camden Group with more than ten years of healthcare experience. She specializes in strategic and service line business planning, facility planning, financial feasibility analyses, and medical staff planning and alignment on behalf of community hospitals, healthcare systems, academic medical centers, and physician medical groups. Ms. Sreenivasan has worked with clients analyzing current and potential markets and developing population-based healthcare strategies.
Prior to joining The Camden Group, Ms. Sreenivasan directed the Virginia Cardiac Network, LLC for Inova Fairfax Hospital located in Falls Church, Virginia. Her responsibilities included the development of strategic business plans and scorecards for clinical quality and budgeting processes, as well as oversight for the implementation of operational performance improvement plans. Ms. Sreenivasan’s experience also includes departmental and operational audits, and reimbursement analysis.
Ms. Sreenivasan received her master’s degree in health administration from Medical University of South Carolina with Honors, and her bachelor’s degree in accounting, business administration, and finance from the College of Charleston. She is a member of the American College of Healthcare Executives.
Edifecs: Demonstrating who you are in CJREdifecs Inc
A hands-on approaches for hospitals to strategically align orthopedic surgeons and post-acute providers under CJR. This Presentation focuses on tools that providers can use to help manage their performance to be successful under the new value-based environment.
Better care at less cost - a 'how to' for commissioners and providers, pop up...NHS England
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
Realizing the Promise of Patient-Reported Outcomes MeasuresHealth Catalyst
Dr. Rachel Clark Sisodia, a champion of the system-wide adoption of Patient Reported Outcomes Measures at Partners HealthcCare, will share her experience and perspective on the relevance and necessity of Patient-Reported Outcomes Measures (PROMs). In this webinar, Dr. Sisodia will highlight how the PROMs ideas have been put into practice at Partners HealthCare.
Join us and learn:
Strategies and tactics for overcoming potential barriers to collecting and effectively using PROMs.
Through specific examples, how to demonstrate that PROMs can help deliver faster, more personalized care for individual patients.
How to collect and use advanced analytics to leverage aggregate PROMs data to inform clinical patient and provider decisions.
How to use outcomes metrics for quality improvement and comparative effectiveness.
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
The Top Five Recommendations for Improving the Patient ExperienceHealth Catalyst
Improving patient satisfaction scores and the overall patient experience of care is a top priority for health systems. It’s a key quality domain in the CMS Hospital Value-Based Purchasing (VBP) Program (25 percent) and it’s an integral part of the IHI Triple Aim. But, despite the fact that health systems realize the importance of improving the patient experience of care, they often use patient satisfaction as a driver for outcomes. This article challenges this notion, instead recommending that they use patient satisfaction as a balance measure; one of five key recommendations for improving the patient experience:
Use patient satisfaction as a balance measure—not a driver for outcomes.
Evaluate entire care teams—not individual providers.
Use healthcare analytics to understand and act on data.
Leverage innovative technology.
Improve employee engagement.
This article also explains why patient experience is so closely tied to quality of care, and why it’s a prime indicator of a healthcare organization’s overall health.
Quality Data is Essential for Doctors Concerned with Patient EngagementHealth Catalyst
It might be a bit of a leap to associate quality data with improving the patient experience. But the pathway is apparent when you consider that physicians need data to track patient diagnoses, treatments, progress, and outcomes. The data must be high quality (easily accessible, standardized, comprehensive) so it simplifies, rather than complicates, the physician’s job. This becomes even more important in the pursuit of population health, as care teams need to easily identify at-risk patients in need of preventive or follow-up care. Patients engaged in their own care via portals and personal peripherals contribute to the volume and quality of data and feel empowered in the process. This physician and patient engagement leads to improved care and outcomes, and, ultimately, an improved patient experience.
Three Strategies to Deliver Patient-Centered Care in the Next NormalHealth Catalyst
Juggling financial demands, uncertain healthcare legislation, and COVID-19 can distract healthcare leaders from the most important aspect of care—patients. Delivering patient-centered care in this volatile market can be challenging, especially when traditional healthcare methods (e.g., in-person visits) are on hold. These sudden disruptions to routine care have highlighted the importance of keeping patients at the center of care, whether care delivery is in-person or virtual. Health systems can manage competing priorities, adjust to pandemic-induced changes, and deliver patient-centered care by focusing on three strategies:
Improve the patient experience.
Implement the Meaningful Measures Initiative.
Transition in-person visits to virtual.
The Population Health Management Market 2015Lifelog Health
Population health management is a problem term because it can mean something different to each person who hears it. However, I believe that the words capture the overall spirit and energy of healthcare reform in a unique way. Providers are thinking big when it comes to a patient’s engagement, responsibility, and preventative care, and they’re leveraging technology to do it. I discuss an overall picture of PHM, present some useful technology, and tell a few PHM stories herein.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
Healthcare Process Improvement: Six Strategies for Organizationwide Transform...Health Catalyst
Healthcare processes drive activities and outcomes across the health system, from emergency department admissions and procedures to billing and discharge. Furthermore, in the COVID-19 era’s uncertainty, process quality is an increasingly important driver in care delivery and organizational success. Given this broad scope of impact, process improvement is intrinsically linked to better outcomes and lower costs. Six strategies for healthcare process improvement illustrate the roles of strategy, skillsets, culture, and advanced analytics in healthcare’s continuing mission of transformation.
Making Quality Your Core Business Strategy: A Foundational ElementHealth Catalyst
W. Edwards Deming, the father of quality improvement, defined “waste” as any circumstance in which a quality failure increases operating costs. The latest fully comprehensive study on waste from the National Academy of Medicine in 2010 used Deming’s approach to conclude that “a minimum of 30%, and probably over 50%, of all money spent on health care delivery is waste.” That means that quality-associated waste dominates all other financial performance strategies within health care delivery. It links directly to pay-for-value and other provider-at-risk payment. The path to financial success runs through clinical excellence.
Improving quality to remove waste and improve financial performance requires clinical change. At its best and most effective, strong clinical change leadership links directly to the values and culture of the healing professions. One critical, early step in driving quality as a core business strategy is creating a cadre of leaders, spread through all levels of an organization, who have a deep understanding of care delivery science. These leaders are the key vehicle for culture change, quality improvements in daily operations, and long-term organizational success.
View this webinar with Brent James, MD, MStat to hear him discuss proven methods to create and maintain just that sort of clinical change leadership.
BPS DCP SIGOPAC Good Practice Guidance in Demonstrating Quality and Outcomes ...Alex King
This report outlines a rigorous, multidimensional framework for evaluating quality and outcomes in psycho-oncology services, which can be flexibly adapted to local needs and priorities.
It aims to challenge psycho-oncology services to develop and standardise procedures that address the clinical and operational aspects of quality, while maintaining a firm focus on the experiential.
The proposed framework focuses on six key domains of service quality:
- Is this service safe?
- Is this service equitable, while also focused on those most in need?
- Is this service timely and responsive?
- Is this service respectful, collaborative and patient-centred?
- Is this service offering effective interventions?
- Is this service contributing to efficient multidisciplinary care?
To address these domains, psycho-oncology services need to draw on multiple, convergent sources of data, including key performance indicators, activity levels, patient self-report measures, feedback from professional colleagues, etc.
Edifecs: Demonstrating who you are in CJREdifecs Inc
A hands-on approaches for hospitals to strategically align orthopedic surgeons and post-acute providers under CJR. This Presentation focuses on tools that providers can use to help manage their performance to be successful under the new value-based environment.
Better care at less cost - a 'how to' for commissioners and providers, pop up...NHS England
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
Realizing the Promise of Patient-Reported Outcomes MeasuresHealth Catalyst
Dr. Rachel Clark Sisodia, a champion of the system-wide adoption of Patient Reported Outcomes Measures at Partners HealthcCare, will share her experience and perspective on the relevance and necessity of Patient-Reported Outcomes Measures (PROMs). In this webinar, Dr. Sisodia will highlight how the PROMs ideas have been put into practice at Partners HealthCare.
Join us and learn:
Strategies and tactics for overcoming potential barriers to collecting and effectively using PROMs.
Through specific examples, how to demonstrate that PROMs can help deliver faster, more personalized care for individual patients.
How to collect and use advanced analytics to leverage aggregate PROMs data to inform clinical patient and provider decisions.
How to use outcomes metrics for quality improvement and comparative effectiveness.
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
The Top Five Recommendations for Improving the Patient ExperienceHealth Catalyst
Improving patient satisfaction scores and the overall patient experience of care is a top priority for health systems. It’s a key quality domain in the CMS Hospital Value-Based Purchasing (VBP) Program (25 percent) and it’s an integral part of the IHI Triple Aim. But, despite the fact that health systems realize the importance of improving the patient experience of care, they often use patient satisfaction as a driver for outcomes. This article challenges this notion, instead recommending that they use patient satisfaction as a balance measure; one of five key recommendations for improving the patient experience:
Use patient satisfaction as a balance measure—not a driver for outcomes.
Evaluate entire care teams—not individual providers.
Use healthcare analytics to understand and act on data.
Leverage innovative technology.
Improve employee engagement.
This article also explains why patient experience is so closely tied to quality of care, and why it’s a prime indicator of a healthcare organization’s overall health.
Quality Data is Essential for Doctors Concerned with Patient EngagementHealth Catalyst
It might be a bit of a leap to associate quality data with improving the patient experience. But the pathway is apparent when you consider that physicians need data to track patient diagnoses, treatments, progress, and outcomes. The data must be high quality (easily accessible, standardized, comprehensive) so it simplifies, rather than complicates, the physician’s job. This becomes even more important in the pursuit of population health, as care teams need to easily identify at-risk patients in need of preventive or follow-up care. Patients engaged in their own care via portals and personal peripherals contribute to the volume and quality of data and feel empowered in the process. This physician and patient engagement leads to improved care and outcomes, and, ultimately, an improved patient experience.
Three Strategies to Deliver Patient-Centered Care in the Next NormalHealth Catalyst
Juggling financial demands, uncertain healthcare legislation, and COVID-19 can distract healthcare leaders from the most important aspect of care—patients. Delivering patient-centered care in this volatile market can be challenging, especially when traditional healthcare methods (e.g., in-person visits) are on hold. These sudden disruptions to routine care have highlighted the importance of keeping patients at the center of care, whether care delivery is in-person or virtual. Health systems can manage competing priorities, adjust to pandemic-induced changes, and deliver patient-centered care by focusing on three strategies:
Improve the patient experience.
Implement the Meaningful Measures Initiative.
Transition in-person visits to virtual.
The Population Health Management Market 2015Lifelog Health
Population health management is a problem term because it can mean something different to each person who hears it. However, I believe that the words capture the overall spirit and energy of healthcare reform in a unique way. Providers are thinking big when it comes to a patient’s engagement, responsibility, and preventative care, and they’re leveraging technology to do it. I discuss an overall picture of PHM, present some useful technology, and tell a few PHM stories herein.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
Healthcare Process Improvement: Six Strategies for Organizationwide Transform...Health Catalyst
Healthcare processes drive activities and outcomes across the health system, from emergency department admissions and procedures to billing and discharge. Furthermore, in the COVID-19 era’s uncertainty, process quality is an increasingly important driver in care delivery and organizational success. Given this broad scope of impact, process improvement is intrinsically linked to better outcomes and lower costs. Six strategies for healthcare process improvement illustrate the roles of strategy, skillsets, culture, and advanced analytics in healthcare’s continuing mission of transformation.
Making Quality Your Core Business Strategy: A Foundational ElementHealth Catalyst
W. Edwards Deming, the father of quality improvement, defined “waste” as any circumstance in which a quality failure increases operating costs. The latest fully comprehensive study on waste from the National Academy of Medicine in 2010 used Deming’s approach to conclude that “a minimum of 30%, and probably over 50%, of all money spent on health care delivery is waste.” That means that quality-associated waste dominates all other financial performance strategies within health care delivery. It links directly to pay-for-value and other provider-at-risk payment. The path to financial success runs through clinical excellence.
Improving quality to remove waste and improve financial performance requires clinical change. At its best and most effective, strong clinical change leadership links directly to the values and culture of the healing professions. One critical, early step in driving quality as a core business strategy is creating a cadre of leaders, spread through all levels of an organization, who have a deep understanding of care delivery science. These leaders are the key vehicle for culture change, quality improvements in daily operations, and long-term organizational success.
View this webinar with Brent James, MD, MStat to hear him discuss proven methods to create and maintain just that sort of clinical change leadership.
BPS DCP SIGOPAC Good Practice Guidance in Demonstrating Quality and Outcomes ...Alex King
This report outlines a rigorous, multidimensional framework for evaluating quality and outcomes in psycho-oncology services, which can be flexibly adapted to local needs and priorities.
It aims to challenge psycho-oncology services to develop and standardise procedures that address the clinical and operational aspects of quality, while maintaining a firm focus on the experiential.
The proposed framework focuses on six key domains of service quality:
- Is this service safe?
- Is this service equitable, while also focused on those most in need?
- Is this service timely and responsive?
- Is this service respectful, collaborative and patient-centred?
- Is this service offering effective interventions?
- Is this service contributing to efficient multidisciplinary care?
To address these domains, psycho-oncology services need to draw on multiple, convergent sources of data, including key performance indicators, activity levels, patient self-report measures, feedback from professional colleagues, etc.
Final Progress Report on the Implementation of the Government‟s Response to the Special Commission of Inquiry into Acute Care Services in NSW Hospitals
October 2011
I suspect the news my smartphone will soon turn into my doctor is exaggerated. While a consultation with my phone will always be easier to arrange than an appointment with my GP, I know for a fact that even the techiest among us still want to see a living, breathing, qualified person when they’re under the weather.
I say this with confidence as this is one of the key findings from the first ever mHealth report by Ruder Finn. The report, based on a survey of more than 1,000 smartphone and tablet users, shows that while there’s an appetite for healthcare applications, and consumers generally love a good app, developers of health applications have not convinced the public of this kind of app’s value to them. The survey’s results show that apps for social media, games and news are the most popular with users of smartphones and tablets; healthy living apps languish in last place in terms of popularity.
The survey, conducted on our behalf by pollster YouGov, reveals some interesting links between type of device and the likelihood of the user to use health & lifestyle apps. The research suggests apps that help take away some of the pain associated with healthcare – booking appointments and getting hold of test results for example – are more popular than those to actually manage health. Our results suggested a great deal of caution around apps to help patients manage long term health conditions – significantly even among those suffering from chronic disease/ health problems. These findings may come as a disappointment to the World Health Organization, which along with The International Telecommunication Union (ITU), is launching an mHealth initiative to help combat noncommunicable diseases, based on the fact that mHealth is cost effective, scalable and sustainable.
In our survey, there is a difference between the generations and the impact that might have on app usage. While 75% of respondents between 25-34 owned a smartphone fewer than 30% in the 55+ category did. Although everyone accesses healthcare it’s usually the oldest among us who use it most. It will be interesting to see how usage patterns change as the gamers and Tweeters of today get older.
This presentation also contains slides from Prof. Christopher James
Professor of Healthcare Technology (University of Warwick) and
Director, Institute of Digital Healthcare; Dr Tom Barber
Associate Professor and Honorary Consultant Endocrinologist,
University of Warwick and UHCW NHS Trust and Owen Booth
Head of Content, Diabetes UK.
The event can be seen at the hashtag #rfmhealth too.
Webinar 3: Alternative Approaches to Innovative Drug Pricing – 12:00pm on Wednesday, May 13, 2020. The third webinar will review Canada’s approach to managing drug prices with approaches used in other jurisdictions. A panel will discuss experiences with oncology therapies, rare disease drugs, and therapies for pandemics and other urgent situations as points of reference toward evolving alternatives to the proposed PMPRB guidelines.
Panel:
Martina Garau, Director, Office of Health Economics, UK;
Sandra Anderson, Senior VP, Innomar Strategies
PG Forest, Director, School of Public Policy, University of Calgary
Durhane Wong-Rieger, President & CEO, CORD
Moderator: Bill Dempster, 3Sixty Public Affairs
Breakout 2.2 Commissioning Quality Care: Tools to support the commissioning p...NHS Improvement
Breakout 2.2 Commissioning Quality Care: Tools to support the commissioning process - Stephen Callaghan:
Principal Consultant, EQE Health.
Associate Consultant, Hope Street Centre.
Visiting Lecturer, University of Chester.
ANP, A&E University Hospitals Aintree
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
Commissioning for outcomes,
Wednesday 21 January 2015 - 13.00 to 13.45
Hosted by Bob Ricketts CBE, Director of Commissioning Support Services and Market Development for NHS England.
Similar to How to commission for improving health outcomes: measuring quality along care pathways (20)
Understanding NHS financial pressures: visual resourcesThe King's Fund
This slideset contains key visual elements from our report, Understanding NHS financial pressures: how are they affecting patient care? Please feel free to share and re-use these graphics with credit to The King's Fund.
Nine characteristics of good-quality care in district nursing taken from interviews with patients, carers and staff.
We hope this framework and these slides will be a useful resource for you – please feel free to use them in your work, in documents and presentations.
As part of a joint learning network on integrated housing, care and health, The King's Fund and the National Housing Federation have produced a set of slides illustrating the connections between housing, social care, health and wellbeing.
We hope they will be a useful resource for you – please feel free to use them in your office, in documents or presentations.
District councils’ contribution to public healthThe King's Fund
Our health is primarily determined by factors beyond just
health care. These slides illustrate the ways in which district
councils influence the health of local people through their key
functions and in their wider role supporting communities and
influencing other bodies.
The King’s Fund Events organise more than 20 health and social care events each year. Our highly-regarded conferences attract leading speakers from the government, the NHS, local authorities and the independent and voluntary sectors.
Jos de Blok set up Buurtzorg – which means ‘neighbourhood care’ in Dutch – with a team of four nurses. Today there are nearly 8,000 Buurtzorg nurses in 630 independent teams, caring for 60,000 patients a year. Nurses in Sweden, Norway, Japan and the United States are adopting the Buurtzorg model.
Our infographics highlight some key facts and figures around leadership vacancies in the NHS and some of the difficulties NHS organisations face in recruiting and retaining people for executive positions.
Sharing leadership with patients and users: a roundtable discussionThe King's Fund
‘What more is possible when patients, service users and those delivering services share the leadership task in health and social care?’
We held a roundtable discussion with patient leaders and organisational leads to discuss this question. Our slidepack summaries the conversations, including the opportunities and challenges for patient leaders, and where and how to start shared leadership working.
Making the case for public health interventionsThe King's Fund
In partnership with the Local Government Association, we have produced a set of infographics that describe key facts about the public health system and the return on investment for some public health interventions.
We hope they will be a useful resource for you – please feel free to use them in your office, in documents or presentations.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
This slide set is the second of two looking at how Clinical Commissioning Groups (CCGs) can make the best use of measurement to support them to commission for improved outcomes.The first slide set introduced general concepts about approaches to measurement in health care, the uses of structure, process and outcome indicators, and how to achieve a good mix of indicators for commissioning.This second slide set follows on from that, and looks specifically at how commissioners can build up sets of measures along whole pathways of care.
As long-term and chronic conditions come to dominate the need for, and delivery of, health care, measurement at individual organisation level becomes increasingly inadequate as a marker of quality since these conditions require care that straddles several care organisations and settings.There are growing moves internationally towards a pathway approach to quality measurement, where sets of quality measures are compiled that jointly describe a whole pathway of care for a particular population or group of patients. There is also growing interest in this approach in this country.
In this slide set, a care pathway is defined as the journey a patient with a particular condition follows through care. The condition could have several stages, and require care at various times and in various types of care settings, depending on the condition.This is different to ‘clinical pathways’, the term used to describe a recommended set of clinical processes as defined by the evidence or by clinical guidelines.
Although there are three Outcomes Frameworks – for the NHS, Public Health and Social Care – the government recognises the importance of aligning outcomes across these frameworks and setting shared outcomes with shared accountability for delivery. Better outcomes will often be delivered through integrated services, especially for those with long-term conditions. The NHS Outcomes Framework for 2012/13 emphasises the need for alignment, collaboration and integration. Among the many aims of the Department of Health’s new Information Strategy is the use of information and linked care records to support integrated care. It sees the consistent application of nationally specified information standards, inter-operability of local information systems, and record linkage across services as the route to having fully linked records across health and social care. In addition to the many other benefits that could accrue when these proposals are fully realised, they could enhance the measurability of quality along pathways to support more informed commissioning and improvements in the delivery of care and outcomes.
The approach to quality measurement hitherto of measuring individual aspects of care – for example, re-admission rates for stroke – is increasingly inadequate for an NHS coping more and more with the needs of patients with chronic and complex conditions. This has led to a growing move towards measuring quality along care pathways.
Measuring quality across care pathways has many uses. It is critical for planning local health care services and for facilitating co-ordination and integration of care across multiple providers and care settings. This facilitates improvements in care quality, including from a patient perspective. It is also useful for tracking inter-dependencies in the health care system. For example, the quality of primary care for diabetes can impact on the use and outcomes of secondary care. In addition, it offers opportunities to identify cost savings and productivity improvements. Many cost-saving service improvements involve shifting care and intervention earlier in the patient pathway, such as preventive measures, improvements in primary and community care that result in fewer unplanned hospital admissions, or improving post-discharge follow-up to reduce re-admissions. Measurement along whole pathways is useful for identifying and acting on these sorts of improvement opportunities.It can also inform the commissioning of integrated care packages from a consortia of providers. Various forms – formal and informal – of organisational partnerships aiming for integrated care can use this approach to develop shared sets of quality measures.
Fundamentally, pathway measures need to cover all key stages in the patient pathway. For each of these, they will also need to cover all three domains of quality, that is, effectiveness, safety and patient experience.This slide describes the stages in a pathway, from the initial stage of primary prevention, through diagnosis and referral to treatment, secondary prevention, support and follow-up, and end of life care. These stages will of course vary depending on the condition or patient group.
In line with the stages identified in the previous slide, pathway measures will need to cover all associated environments or care settingsThese again will vary by condition, but are likely to span some of those listed here.
Where possible within the constraints of data availability, measurement along pathways should capture the five domains in the NHS Outcomes Framework. In following this structure, CCGs will be able to link their measurement strategies to the overarching national framework for measuring outcomes improvement – which will also be reflected in the Commissioning Outcomes Framework. The five domains map to the three broad domains of quality – clinical effectiveness, patient experience and safety. These elements of quality apply in all care settings and cover aspects of care that matter to patients and impact on outcomes.The NICE quality standards, and associated measures, can inform the choice of indicators, and the Commissioning Outcomes Framework indicators should be included.Where relevant, the domains in the Public Health Outcomes Framework and Adult Social Care Outcomes Framework should also be taken into consideration.International quality frameworks, such as that of the US Institute of Medicine, also include other important dimensions such as timelines, access, equity and efficiency.
Essentially, there are three broad approaches for measuring quality along pathways. Firstly, you can simply bring together indicators from available data sets that you judge make up the important and typical elements of the care pathway for a particular condition or group of patients and present the data together to profile the quality of local services at a community level. While it doesn’t enable the tracking of individual patients, it serves as a useful proxy, makes optimal use of available data sources and avoids adding to the burden and cost of new data collection. Secondly, data sets for different care settings or different databases can be linked using patient identifiers such as the NHS number. This offers possibilities for analysis not otherwise available – for example, linkage of inpatient and outpatient records, or linkage of health and social care records. This can be done locally by commissioners, and is also undertaken nationally by authorised agencies such as the Information Centre.Thirdly, new bespoke data is collected so that missing parts of the pathway can be captured. In each case, the choice of indicators selected for analysis should be guided by the involvement of patients and carers, and of clinicians, in order to ensure that the whole has legitimacy and ownership by these key stakeholders.
Indicators typically cover discrete, stand-alone elements of the services provided to patients in particular care settings. In the absence of comprehensive, linked, cross-sectoral, patient-level data, using data sets in conjunction with each other to simulate a pathway provides an alternative. A basket of indicators for local communities from disparate data sources can be ‘stitched’ together to capture as many elements of care as possible, depending on the data sources available for particular pathways. This then makes it possible to examine the inter-relationships between these indicators at local level.This approach provides an ‘ecological’ perspective of the quality of care for particular conditions or patient groups in local health economies, and serves as a useful proxy for pathway data for individual patients.Some examples of the major national data sets are given here. It is noteworthy that the Information Strategy promotes the increasing use of record linkage across these data sets.
A series of pathway intelligence profiles for stroke, chronic obstructive pulmonary disease and maternity have been developed by NHS London Health Programmes. These complement the health needs assessment toolkit designed to support London’s commissioners with their health intelligence requirements. These profiles can be used by commissioners to plan and deliver services, and to monitor quality along the care pathway. For further details, see:http://www.londonhp.nhs.uk/health-intelligence/
Here, data for chronic obstructive pulmonary disease is shown for a London local authority, starting with population data, then moving into indicators on prevention, treatment (in both general practice and secondary care), final outcomes and costs. Looking at the data in this way, benchmarked against other local authorities and the England average and best, helps to show where performance might need particular focus in order to improve overall outcomes.
These examples demonstrate how commissioners can use currently available indicators to gain a profile of the quality of care in the local community. The indicators span the pathway from primary prevention, through various stages of health care, to final outcomes.The examples also illustrate the lack of routinely available data for some stages in the pathway and dimensions of care. This constraint will apply to pathway indicators for other population groups and conditions also. Furthermore, data availability is not uniform, with more data available for some stages (for example primary and hospital care) and dimensions of care than for others. However, the drive towards increased use of data from the national clinical audits, as announced in the Information Strategy, will help to address many data gaps. Although these examples are limited to health care data, social care indicators could be added in as appropriate.
The example of maternity illustrates that care pathway indicators can also be useful in contexts other than long-term conditions.
The second approach to making the most of available data for measuring quality along pathwaysis to link different data sets together. This can significantly enhance the utility of the separate data sets. Data linkage is only possible for data sets comprising individual patient records – rather than those (such as the Quality and Outcomes Framework and prescribing data) that are aggregated.Although a variety of approaches have been used to date to link records, the NHS number will become the norm for record linkage, as set out in the Department of Health’s Information Strategy – in which data linkage plays a prominent role, in particular for promoting integrated care.There are some important examples of linkage at a national level. For example, Linking Hospital Episode Statistics (HES) with Office for National Statistics (ONS) mortality death records enables deaths after discharge from hospital to be tracked – as with the new Summary Hospital-level Mortality Indicator (SHMI). Linkage of HES with Patient Reported Outcome Measures (PROMs) enables comparison of clinical outcomes with patient feedback about their health status. Linking cancer registration data with HES, to enable analysis of cancer outcomes in relation to patients’ use of hospital cancer services.Because data linkage involves the use of patient identifiers, information governance issues must be adequately addressed when linkage is undertaken locally.
This example shows how primary care and secondary care data can be linked to understand how patients are using services. Reporting Analysis and Intelligence Delivering Results (RAIDR) covers commissioners and practices in NHS North of Tyne. This project provides real-time data via monthly secondary uses service (SUS) updates linked with direct uploads from GP computer systems, to enable analysis of hospital admissions by practice and condition. It enables drilldown to individual patients, and cross-checking of diagnosis between practice and SUS records. The information is presented in graphical dashboards, and allows users to navigate, select and drill down to gain intelligence in a variety of ways, from high level trends to detailed patient level data.RAIDR provides health care professionals in commissioning and primary care with a single portal for information that integrates multiple standalone data sources. Further details are available at:http://www.raidr.co.uk/RAIDRleafletv8.pdf
This graph illustrates the prevalence of atrial fibrillation against admission rates for stroke for GP practices in Newcastle. Practices/CCGs using this sort of data can identify differences in admission rates for a given prevalence rate, and explore further what the reasons may be and how they can be tackled. Such information, obtained by linking data from primary and secondary care, can be used to reduce admission rates for different conditions, thereby saving the costs of unnecessary admissions. Many more dimensions of this type of analysis become possible with linked data, spanning different care settings. The GP Extraction Service (GPES), due to go live later in 2012, will for the first time provide a mechanism for extracting data from general practices in England. GPES offers an exceptional opportunity for linking data from general practice with secondary care records on a national basis.
In this project, using NHS number, data is routinely extracted and linked across a variety of local health care settings and a social care database. The system covers complex elderly and diabetic patients, and can be expanded to include other long-term conditions. Such systems enable health and social care professionals across care settings to see all relevant information about a patient’s care and history, to inform risk assessment, clinical decision-making and delivery of care to recognised standards. At a system level, it enables analysis of overall trends and variations.The business case for this system aims to recoup initial outlay (on IT systems and training) within two years, primarily by reduced admissions and unnecessary duplication of tests.Key to the effectiveness of any information system is its users – clinicians and managers, as well as patients – to ensure the system delivers usable information, while also mitigating patient confidentiality or other concerns. This system was co-designed by clinical end-users within the context of an integrated care pilot in which financial and other incentives are aligned for GPs to avoid admission.
This slide shows the metrics used for monitoring various dimensions of the performance of the project.
Torbay Care Trust is an exemplar in the linkage of health and social care records. Using NHS number, ithas linked inpatient, outpatient and A&E records with community services activity (such as community hospital, intermediate care and nursing) and incorporated adult social care services (such as care home placements, domiciliary care and day services). The trust is now moving to include GP practice records also. This has enabled it to produce a comprehensive profile of the health and social care usage of its residents. The linkage enables tracking of services according to age, diagnosis, area, GP practice, pathways etc. and over time. Patients can be tracked according to any criteria (such as those living in care homes or nearing end of life) and all this activity is costed. The IT platform allows clinicians, managers and commissioners to understand the totality of services that patients need and are receiving. The results are apparent in reduced use of inpatient and residential care, and associated costs. Torbay’s model is in line with that described in The Department of Health’s Information Strategy, whereby NHS number is used for comprehensive linkage of health and social care records at a local level. Next, we’ll look at the third way of measuring along pathways – new measurement to follow up or track back along a pathway.
Bespoke data collections can bridge gaps in routinely available national data sets, and offer additional scope for analysis. There are good examples – such as the national clinical audits – of primarily professionally-led initiatives to create pathway-based measures. The case study of London Cancer that follows uses a combination of both bespoke data collection and national data to drive local quality improvement, an initiative led by clinicians.However, bespoke data collections can add to the cost and burden of collecting data, and take time to establish.
A case study of work currently underway through academic health science centre UCL Partners offers insights into some of the issues we have raised and how measures along pathways can be developed collaboratively across a local health economy.
UCL Partners brings together providers from across the health community, academia and the voluntary sector in the development of London Cancer, an Integrated Cancer System for North Central & North East London and West Essex. Its aim is to drive improvements in outcomes and experience for its patients.London Cancer’s is designing – with patients and clinicians – an integrated care pathway for each cancer, with associated metrics covering a range of outcomes. Some measures are common for all cancers, others are specific to a particular pathway. For specific tumour types, London Cancer has used information about existing good practice, published guidance and priority areas locally to inform metric development. The development of pathway measures has five phases: Specialist clinical development – bringing together local experts to define what good care looks like and how to measure it. Asking patients the same questions, and distilling the outputs provided by the membership of regional Cancer Partnership Groups to the things that matter to patients. Engaging with commissioners to identify commissioning metrics that link to whole pathway principles and align with the improvement goals of providers.Bringing partners from across the cancer community – patients and patient support groups, primary care, cancer specialists – to workshops to review and finalise the list of metrics.Consolidating the measures into a scorecard for each cancer pathway.
London has a very heterogeneous population, as this deprivation map shows. Earlier presentation of cancer results in a much higher likelihood of surviving to one year following diagnosis. One-year survival is used as a proxy measure for stage of diagnosis. These maps show that late presentation of cancer remains a major challenge in deprived areas within London Cancer.
Work with clinicians and service users generated a number of metrics on brain and central nervous system cancers which can be used by the Integrated Cancer System through its Brain/CNS Cancer Pathway Board to measure how good services are in the system, whether patients’ needs are being met, and compliance with best clinical practice. This slide shows a subset of the metrics. The aim is for the indicators to be reported for providers in London Cancer from 2012. Some measures have also been adopted by commissioners for cancer locally, so indicators will be shared with them to agreed submission deadlines. The intention is to make the data available to patients and the public once it has been validated.
While there are clear benefits and opportunities, there are also some challenges in measuring quality along pathways, which it is important to be aware of.Data gaps will constrain the measurement of quality along pathways. Examples are: data on risk factor and disease prevalence may be unavailable for local areas, data on primary and community care is patchy and incomplete, data is often not available for non-NHS providers. Data protection and patient confidentiality must be safeguarded. Using indicator sets that transcend organisational boundaries can raise issues of attribution and accountability that are less clear than when measuring performance for discrete organisational units. While some organisations may readily engage in initiatives to improve the performance of the health economy as a whole, others may seek only to optimise their own performance. Payment systems such as Payment by Results and Commissioning for Quality and Innovation (CQUIN) reinforce these challenges, especially when targets are missed. Measurement across organisations to facilitate joint working requires a different approach to that of performance management in organisations operating in isolation. Cross-organisational initiatives require a leadership and management style focusing on a systemic approach that fosters relationships between organisations and creates a shared vision of quality.Pathway measures for particular conditions are unsuitable for the growing number of patients with multiple conditions and co-morbidities. Initiatives that look at pathway measures for complex patients such as frail elderly patients can address this by developing clusters of measures reflecting the complexity of the patient mix rather than a linear care pathway that might be more suited to acute disorders.
In this slide set, we have outlined how measuring quality along care pathways can serve the needs of both commissioners and patients, by supporting improvements in quality, outcomes, cost-effectiveness and the provision of co-ordinated and integrated care. It can also support CCGs in their commissioning activities and joint working with local partners. Although we have given a limited range of examples here of how data has been used for measuring quality along pathways, many other examples of good practice in this area are available. The data available to CCGs also has much potential for further development for use in these ways.Information developments underway, in the pipeline, and as envisaged in the Information Strategy, will further enhance the possibilities for measuring quality along care pathways. The application of such approaches to measuring quality should be a priority for CCGs, especially in the context of tackling the needs of increasing numbers of patients with long-term conditions.