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Workshop: acute kidney injury
commissioning and primary care
Daniel Lasserson MA MD FRCP Edin MRCGP
Co-chair Measurement Workstream, Think Kidneys
Senior Interface Physician in Acute and Complex Medicine, Oxford University Hospitals NHS
Foundation Trust
Clinical Lead, Out of Hospital Care Network, Oxford Academic Health Science Network
12 November 2015
Who are we?
Importance of AKI
Overview of the Think Kidneys Programme
Measurement Workstream
Outcomes commissioning
Over to you……
| 2
Plan for the Workshop
| 3
What is acute kidney injury?
Acute kidney injury (AKI) is a rapid deterioration of renal function,
resulting in inability to maintain fluid, electrolyte and acid-base
balance. It normally occurs in the context of other serious illness
(e.g. sepsis) on a background of risk.
65% of AKI starts in the community
One in five emergency admissions to hospital will have AKI
Around 20% of AKI cases are preventable
Cost of AKI to the NHS is between £434m and £620m per annum
AKI is a global challenge – the NHS is the first health system to attempt to
tackle it
| 4
The size and scale of the problem
| 5
‘40000 excess deaths pa’ (Kerr et al April 2014)
Think Kidneys objectives
Develop and implement tools and interventions for
prevention, detection, treatment and enhanced recovery
Promote effective management of AKI
Provide evidence-based education and training
programmes
Highlight importance of AKI to commissioners, health
care professionals and managers
| 6
‘Think Kidneys’ AKI Programme
| 7
| 7
The UKRR applied for National Information Governance Board’s approval to collect
patient identifiable data for AKI patients in England
Developed final specification for the master patient index (MPI) enabling the UKRR
to identify core information about the extent of AKI in England
Ensured data transfer between Trusts and UKRR was feasible; tested data and refined
format; ensured alert and creatinine files were received by UKRR
Analysis in 3 phases –
1. Reporting of data completeness,
2. Adding of date of admission to core data set and establishing link with HES,
3. Reporting data at patient level, CCG level, Trust level including incidence, progression of AKI and
other outcomes
| 8
Measurement workstream….work to date
Discuss with HSCIC future linkage to obtain other core data items
Link UKRR AKI dataset of RRT requirement in UK to obtain data
regarding need for RRT and non-recovery of AKI
Link with National Diabetes and CKD audit during 2016
Identify which Trusts compliant with the Patient Safety Alert, then work
with Detection to check variability and reliability of data collected
Analyse demographic information demonstrating size of at risk group
by linking with other registries/networks
Identify whether interventions have had an impact
Consider downstream consequences for AKI
| 9
Measurement workstream….next steps
Five domains of NHS Outcomes Framework
Preventing people from dying prematurely
Enhancing quality of life for people with LTCs
Helping people to recover from episodes of ill health
Ensuring that people have a positive experience of care
Treatment in a safe environment and protection from
harm
| 10
NHS England CCG Outcomes Indicator set 2015/6
| 11
NHS England CCG Outcomes Indicator set 2015/6
| 12
NHS England CCG Outcomes Indicator set 2015/6
| 13
NHS England CCG Outcomes Indicator set 2015/6
No AKI outcomes in Public Health Indicator outcome set
For each patient with AKI
• Where were they managed?
– Acute trust
– Community
• Which CCG were they in?
• Which acute hospital (if admitted)?
• Mortality
• Did their creatinine return to baseline?
– If so, when?
| 14
What can the Measurement Workstream deliver?
For each acute hospital trust
• Mortality
– Age, AKI stage, measures of clinical complexity
• Return of creatinine to baseline level
– Time to return
| 15
What can the Measurement Workstream deliver?
For each CCG
• Proportion of patients with AKI who are admitted
• Mortality
– Age, AKI stage, measures of clinical complexity
• Return of creatinine to baseline level
– Time to return
| 16
What can the Measurement Workstream deliver?
Data Availability
–Local authority level
–CCG level
–Provider level
| 17
Commissioning for Outcomes after AKI
Can we select outcomes for commissioning?
• None of these are patient reported outcomes – is there one?
If so should they be….
–Monitored?
–Incentivised?
| 18
Commissioning for Outcomes after AKI
• Uses and abuses of performance data
• Dr Foster Ethics Committee Report
– Data quality is as important as ‘hitting the target’
– Measure the context and the indicator
– Avoid thresholds
– Be open
| 19
Outcomes contracts
Dan Lasserson
Co-chair, Measurement Workstream
Senior Interface Physician in Acute and Complex
Medicine
Oxford University Hospitals NHS Foundation Trust
Daniel.Lasserson@ouh.nhs.uk
| 20
Thank you
www.linkedin.com/company/think-kidneys
www.twitter.com/ThinkKidneys
www.facebook.com/thinkkidneys
www.youtube.com/user/thinkkidneys
www.slideshare.net/ThinkKidneys
www.thinkkidneys.nhs.uk

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Patient First Conference AKI Outcomes Dan Lasserson

  • 1. Workshop: acute kidney injury commissioning and primary care Daniel Lasserson MA MD FRCP Edin MRCGP Co-chair Measurement Workstream, Think Kidneys Senior Interface Physician in Acute and Complex Medicine, Oxford University Hospitals NHS Foundation Trust Clinical Lead, Out of Hospital Care Network, Oxford Academic Health Science Network 12 November 2015
  • 2. Who are we? Importance of AKI Overview of the Think Kidneys Programme Measurement Workstream Outcomes commissioning Over to you…… | 2 Plan for the Workshop
  • 3. | 3 What is acute kidney injury? Acute kidney injury (AKI) is a rapid deterioration of renal function, resulting in inability to maintain fluid, electrolyte and acid-base balance. It normally occurs in the context of other serious illness (e.g. sepsis) on a background of risk.
  • 4. 65% of AKI starts in the community One in five emergency admissions to hospital will have AKI Around 20% of AKI cases are preventable Cost of AKI to the NHS is between £434m and £620m per annum AKI is a global challenge – the NHS is the first health system to attempt to tackle it | 4 The size and scale of the problem
  • 5. | 5 ‘40000 excess deaths pa’ (Kerr et al April 2014)
  • 6. Think Kidneys objectives Develop and implement tools and interventions for prevention, detection, treatment and enhanced recovery Promote effective management of AKI Provide evidence-based education and training programmes Highlight importance of AKI to commissioners, health care professionals and managers | 6
  • 7. ‘Think Kidneys’ AKI Programme | 7 | 7
  • 8. The UKRR applied for National Information Governance Board’s approval to collect patient identifiable data for AKI patients in England Developed final specification for the master patient index (MPI) enabling the UKRR to identify core information about the extent of AKI in England Ensured data transfer between Trusts and UKRR was feasible; tested data and refined format; ensured alert and creatinine files were received by UKRR Analysis in 3 phases – 1. Reporting of data completeness, 2. Adding of date of admission to core data set and establishing link with HES, 3. Reporting data at patient level, CCG level, Trust level including incidence, progression of AKI and other outcomes | 8 Measurement workstream….work to date
  • 9. Discuss with HSCIC future linkage to obtain other core data items Link UKRR AKI dataset of RRT requirement in UK to obtain data regarding need for RRT and non-recovery of AKI Link with National Diabetes and CKD audit during 2016 Identify which Trusts compliant with the Patient Safety Alert, then work with Detection to check variability and reliability of data collected Analyse demographic information demonstrating size of at risk group by linking with other registries/networks Identify whether interventions have had an impact Consider downstream consequences for AKI | 9 Measurement workstream….next steps
  • 10. Five domains of NHS Outcomes Framework Preventing people from dying prematurely Enhancing quality of life for people with LTCs Helping people to recover from episodes of ill health Ensuring that people have a positive experience of care Treatment in a safe environment and protection from harm | 10 NHS England CCG Outcomes Indicator set 2015/6
  • 11. | 11 NHS England CCG Outcomes Indicator set 2015/6
  • 12. | 12 NHS England CCG Outcomes Indicator set 2015/6
  • 13. | 13 NHS England CCG Outcomes Indicator set 2015/6 No AKI outcomes in Public Health Indicator outcome set
  • 14. For each patient with AKI • Where were they managed? – Acute trust – Community • Which CCG were they in? • Which acute hospital (if admitted)? • Mortality • Did their creatinine return to baseline? – If so, when? | 14 What can the Measurement Workstream deliver?
  • 15. For each acute hospital trust • Mortality – Age, AKI stage, measures of clinical complexity • Return of creatinine to baseline level – Time to return | 15 What can the Measurement Workstream deliver?
  • 16. For each CCG • Proportion of patients with AKI who are admitted • Mortality – Age, AKI stage, measures of clinical complexity • Return of creatinine to baseline level – Time to return | 16 What can the Measurement Workstream deliver?
  • 17. Data Availability –Local authority level –CCG level –Provider level | 17 Commissioning for Outcomes after AKI
  • 18. Can we select outcomes for commissioning? • None of these are patient reported outcomes – is there one? If so should they be…. –Monitored? –Incentivised? | 18 Commissioning for Outcomes after AKI
  • 19. • Uses and abuses of performance data • Dr Foster Ethics Committee Report – Data quality is as important as ‘hitting the target’ – Measure the context and the indicator – Avoid thresholds – Be open | 19 Outcomes contracts
  • 20. Dan Lasserson Co-chair, Measurement Workstream Senior Interface Physician in Acute and Complex Medicine Oxford University Hospitals NHS Foundation Trust Daniel.Lasserson@ouh.nhs.uk | 20 Thank you www.linkedin.com/company/think-kidneys www.twitter.com/ThinkKidneys www.facebook.com/thinkkidneys www.youtube.com/user/thinkkidneys www.slideshare.net/ThinkKidneys www.thinkkidneys.nhs.uk

Editor's Notes

  1. Focused on: Who: who is at risk, vulnerable population, important triggers When: when do people sustain AKI, how is early diagnosis supported How: how should AKI be managed, prevention+treatment+recovery What: what do people need to know, public patients/carers, professionals