the problem collaboration
TRANSCRIPT
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The Problem Collaboration
Tony MarsonKeith Bodger
University of Liverpool
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Are we the problem?
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What are the problems we want to fix?
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We want to fix poor patient
outcomes and inefficiency
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Unplanned care(Epilepsy, COPD)
Alcohol
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Step 1
• Use linked routine health data–Hospital episode statistics–GP prescribing–Investigation results
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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?
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Example from Epilepsy
• Maps on to– North West Coast CLAHRC– Neurology Vanguard
• Early win for CHC
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• 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
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Patients don’t have equitable access to services!
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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
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Neurology appointment after attending ED
These patients were older, more
deprived, had longer stay,
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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
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Individual hospital reports
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Individual hospital reports
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We can apply the same principles to alcohol and COPD