This document discusses using linked health data to identify problems and improve patient outcomes and efficiency. It describes an example where data on epilepsy patients was analyzed across multiple hospitals, finding wide variability in referrals to seizure clinics and follow-up care. A simple pathway was then implemented at three sites to ensure epilepsy patients seen in the emergency department received a neurology appointment within two weeks. Individual reports were provided to hospitals, and the document suggests this approach could also be applied to issues around alcohol use and COPD.

1. The Problem Collaboration
Tony Marson
Keith Bodger
University of Liverpool

2. Are we the
problem?

3. What are the
problems we
want to fix?

4. We want to fix
poor patient
outcomes and
inefficiency

5. Unplanned care
(Epilepsy, COPD)
Alcohol

6. Step 1
• Use linked routine health data
–Hospital episode statistics
–GP prescribing
–Investigation results

7. Iterative change in a ‘learning health
system’
Identify
problems/
questions
Engage
clinical
community
Analyse
data
Identify and
agree
changes
Implement
changes
Are clinicians
interested?
Do we have
data to
analyse?
Can this be
done? is there
budget?

8. Example from Epilepsy
• Maps on to
– North West Coast CLAHRC
– Neurology Vanguard
• Early win for CHC

9. • 4,544 attendances
• Wide variability across
sites
• <50% first seizures
referred to a seizure clinic
• < 50% of ‘known epilepsy’
under active follow up
• Inadequate assessments in
emergency departments
National Audit of Seizure Management in
Hospitals

10. Patients don’t have equitable
access to services!

12. Hospital Episode Statistics
• Dirty data, primary purpose is for
reimbursement
• Heavily dependent upon coding
• Risk of ‘garbage in – garbage out’
• Mainly process rather than outcomes
• Need clinical/NHS experience to spot the
obvious
• Need complex algorithms to identify cohorts

13. Neurology appointment after
attending ED
These patients
were older, more
deprived, had
longer stay,

14. Cheshire and Mersey Pathway
• Implement simple pathway to NHS Trusts
affiliated to the Walton Centre
Patient
attends
ED
Epilepsy /
neurology
appt
Patients identified and put on
pathway.
Nurse employed to make
sure it happens at 3 sites
Appointment within 2
weeks

15. Individual hospital reports

16. Individual hospital reports

18. We can apply the same principles
to alcohol and COPD