Missed opportunities mapping: computable healthcare quality

improvementBenjamin Brown

Trainee General Practitioner and PhD studentRichard Williams, John Ainsworth, Iain Buchan

Medinfo, Copenhagen, 21st August 2013

@BenjaminCBrown Benjamin.Brown@manchester.ac.uk

Current practice

Missed Opportunities Mapping

“failure to deliver a quality standard of clinical care that likely contributes to an adverse outcome that may otherwise have been avoided if it had been achieved”

Software

Ainsworth J, and Buchan I. COCPIT: A Tool for Integrated Care Pathway Variance Analysis. Studies in health technology and informatics. 2012: 180: 995–9.

Demo: hypertension and CVDWorld-leading cause of death More deaths <75 years that any other condition UK and NW England performs worse than anywhere in developed world

90% of MI risk attributable to modifiable risk factorsOne of most important is HTN

1/3 adult UK population have HTN - most prevalent risk factor and LTC

Clear guidance abundant2010 UK national health survey: >40% remain ↑BP44% of patients do not receive guideline rx

Therefore, when a hypertensive patient suffers a CVD event it is reasonable to ask:

Was there a missed opportunity for this to have been prevented/postponed?

What was the association with patient demographics, deprivation and co-morbidities?

Demo: methods

• Salford, UK - 3rd highest preventable mortality from CVD• Fully integrated EHR > 232K people, 53 GPs and 1 hospital• All HTN patients suffering CVD events between 2007-12• Whether or not achieved HTN management standards prior

Headline figures

• 3718 patients with CVD events• 1186 (32%) – last BP ≥ 140/90• 1323 (36%) – average BP ≥ 140/90• 382 (10%) – unmeasured two years prior• Estimated cost £3.1M ($4.9M)

Unc

ontr

olle

dDeprivation MultimorbidityGenderEthnicityAge

Unm

easu

red

Uncontrolled

Unmeasured

Uncontrolled

Unmeasured

Conclusions

• A new model for QI• New computational approach• Translatable to multiple clinical scenarios

• Demonstration study• Real-life data to test model• Directly implementable clinical information

• Further work• Generalisability• Clinical significance• Virtuous circle

Thank you for listening

AcknowledgementsDr Matthew Sperrin, Biostatistician

Dr Tim Frank, Academic GPDr Washik Parkar, GP

Dr Steve Little, CardiologistProfessor Simon Capewell, Cardiovascular epidemiologist

Dr Artur Akbarov, Biostatisician

@BenjaminCBrown Benjamin.Brown@manchester.ac.uk