Beruflich Dokumente
Kultur Dokumente
Ian Arnott
Consultant Gastroenterologist, Edinburgh &
Clinical Lead, IBD Audit
Stuart Bloom
Consultant Gastroenterologist, London &
Chair, IBD Registry
Timing
Title
Speaker(s)
11.00
11.05
David Barker
11.15
11.40
Helen Terry
11.50
12.10
IBD research
Keith Bodger
12.25
13.00
Close
#ibdintheuk
What we want. . .
A world class level of care and
treatment for anyone with IBD
wherever they live in the UK
Defining excellence
The definition of quality in health care,
enshrined in law, includes three key aspects: patient safety
clinical effectiveness
patient experience
A high quality health service
exhibits all three
NHS Five Year Forward View Oct 2014
Defining excellence
t
s
i
l
a
i
c
e
Sp
s
e
s
nur
Access to
treatments
Access
to
services
n
o
i
t
p
i
r
c
Pres
s
e
g
r
a
h
c
. . .plus many others
Defining excellence
Defining excellence
Poll
Which of the following have made the
biggest difference in driving excellence
in care?
1. Introduction of the IBD Standards
2. IBD Audit
3. Developing our own quality improvement
programme locally
4. Involving patients in the development of services
5. IBD nurses
6. Better use of technology to collect and assess
clinical data and patient outcomes
Poll
If you could only use one tool to
measure/ benchmark excellence in
your IBD Service, what would it be?
1.
2.
3.
4.
IBD Audit
IBD Standards
NICE Quality Standard
Regular collection and assessment of clinical
data and patient outcomes/satisfaction
5. None of the above
Creating excellence
+
Clinicians
=
Patients
Poll
Making the UK IBD
Standards a reality in all
IBD Services across the
UK will require:
More consultants
More specialist nurses
Accreditation of IBD services
A redesign of your local IBD
service
A miracle
Thank You
It takes time to
create excellence.
If it could be done
quickly more
people would do it
John Wooden
Basketball coach
IBD in the UK
improving patient outcomes and
experience
ibdregistry.org.uk
Questions
Do you have a means of data capture which allows
you to easily obtain your colonoscopy caecal
intubation rate?
Yes/No
Yes/No
Yes/No
ibdregistry.org.uk
ibdregistry.org.uk
ibdregistry.org.uk
ibdregistry.org.uk
ibdregistry.org.uk
Questions
Do you have a system for identifying patients who
have been on steroids for >3 months?
Yes/No
Yes/No
Yes/No
ibdregistry.org.uk
ibdregistry.org.uk
ibdregistry.org.uk
ibdregistry.org.uk
ibdregistry.org.uk
ibdregistry.org.uk
ibdregistry.org.uk
ibdregistry.org.uk
Patient Summary
MDT
Flareline
Nursing support
Drugs
Biologics
IMM monitoring
Steroids
5-ASA
Cancer Surveillance
system
Bones
Letters
GP
Patient Summary,
information etc.
Virtual clinics
ibdregistry.org.uk
ibdregistry.org.uk
ibdregistry.org.uk
Conclusions
How do you use data?
Can you use it more effectively to improve:
Patient outcomes?
Quality of patient care?
Service development?
Research?
ibdregistry.org.uk
IBD in the UK
improving patient outcomes and
experience
Mr Omar Faiz
50
51
William Farr
Florence Nightingale
54
55
OPTION 1 CENTRALISATION OF
CARE
The volume outcome effect in surgery
Less effect
Large effect
Colon
Kidney
Stomach
Oesophagus
Pancreas
Lung
56
N=5,771 pouch
procedures
OPTION 2 QUALITY
IMPROVEMENT
Dr Atul Gawande MD
60
61
62
OPTION 3. REPORTING
OUTCOME
CONCERNS
-Only elective
-Only
perioperative
-May reflect
hospitals
- Better than
surgeon
-Doesnt account
for case-mix
63
Bruce Keogh
Medical Director of the National Health Service in England
Pouch activity
1977)
69
70
71
Summary
IBD Standards
Thank you
74
IBD in the UK
improving patient outcomes and
experience
Designing Patient-centred
Services
Feedback, consultation or co-design. At
what point is it most useful to engage with
patients to re-design services to better
meet their needs?
1. Right from the start
2. When you have formulated some ideas to
explore with them
3. When seeking their views on your proposals
4. By asking for feedback on their experiences of
existing services.
Co-design
a process where professionals empower, encourage, and
guide users to develop solutions for themselves.
co-design encourages the blurring of the role between user
(patients) and professionals, and enables services and/or
care pathways to be developed together, in partnership
by encouraging the trained designer (professionals) and the
user (patients) to create solutions together, the final result
will be more appropriate and acceptable to the user
the quality of design increases if the stakeholders' interests
are considered in the design process.
Pan-Scotland
IBD Care
Delivery Plan
Framework
UK Standards for
Inflammatory Bowel
Disease
IT e Health
Strategy
Health
Economics
SIGN Guidance
Audit
IT Task
Group
Pilot
outcomes
Pilot work
streams
Service
redesign
Co designed
service
mapping
Pilot Working
Groups
Partners
e.g. TOC
IBD
Nurses
Nurse
GP
Dietician
Steering
Group Rep
Health Board
Patient Survey
http://www.crohnsandcolitis.org.uk/whats-new/scottish-ibd-patients-survey-results
Work stream
One
Description
Faecal
calprotectin is a
stool biomarker
for gut
inflammation.
FC could be
used to
differentiate IBS
from IBD
patients.
IBS patients
could then be
referred directly
to dietetics.
Outcomes
Measurement
1.
Primary care
uptake
IBS dietetic
referral
STT
endoscopy use
GI OPD use
2.
Colonoscopies
if GP did FC
% Referral GI
NSTT
Cost incurred
for FC
3.
Cost incurred
for IBS dietician
4.
5.
6.
All patients
presenting in
clinic with [X
]number of
IBD
symptoms to
have stool
specimen
sent for
Faecal
calprotectin
No. of times
advise
provided to
GPs to carry
out FC and
identify the
result
No. of
referrals to
IBS
No. of STT
Reduction in
OP clinic
attendance
Cost of
service
Lead
Milestone
Jobs/Notes
1. Literatur
e Search
Communi
ty FC
2. NHS
Highland
Lab FC
3. ??? Point
of Care
Testing
for GPs
4. Protocol
FCResultsGPS
5. Educatio
n GP
Surgeries
Two
Three
IBD MDT
Four
Ascertaining our
population
There is a need
for clear referral
processes for
both new and
return IBD
patients, 24/7.
These include
dedicated
telephone and
email
communications
& rapid
access/One Stop
clinics
We are uncertain
about the total
number of IBD
patients under our
care in NHS Highland
(and the Western
Isles). Without this
information, it is
impossible to plan
services. We need to
in OOH referrals
time for first referral
from GP to clinic
time to diagnosis
staff costs e.g.
IBD Nurses
Gastro
MDT routinely
operational
Care Navigator role in
place
Clinics (?
Consultations)
1.
No. of OOH
referrals
Measure time
to diagnosisreduce by how
much? ( this
can start of as
a fixed number
of weeks.
Consider how
these would be
counted i.e.
from symptom
presentation to
referral etc)
Costs
No. of MDT
mtgs
No. of
consultations
1.
better monitoring of
patients
2.
Shared decision
making/discussion
Holistic care
Biologics withdrawal
plan
Setting Up Costs
No of biologic
withdrawals
Patient opinion
on holistic care
better
Accurate
demographics of NHS
Highland patient
population
Information
available on
no. of patients
with IBD in
NHS H
currently being
treated
As above on
drug regime
2.
3.
4.
5.
1.
2.
1.
2.
3.
4.
1.
2.
3.
Stock take
what
happens
now
Prioritise
realistic
goalshierarchy
What is
needed to
implement
new
service ?
Start MDT
Scope
necessary
resources
Availability
clinicians
Implementat
ion
1.
Options
appraisal
2.
Costs
3.
Cloud
finance
through
local
Chapters for
ALBA Soft
National Registry
PICTS
ALBA Soft (GP
Data Mining)
Five
Maintaining care.
Six
Dietetic service
provision
Seven
Guided self
management and
peer support
GP-shared care
arrangements
Non traditional
clinics
with video and
tele clinics
( Guided self
management)
routine, scheduled
OPD
clinic appointments
Joint
medical/surgical/
dietetics/psych
clinics
transitional care
clinics
for juvenile onset
IBD
Link Nurses ?
Liaison Services ?
1.
[Cost of
implementation]
[LPLM]
proportion of
patients
in our NHSH
population
being supported to
take
up self
management.
routine primary and
secondary care
clinic
appointments
[ES/SS]
1.
2.
3.
4.
5.
6.
No. of:
a.
vc
b.
telephon
e
c.
outpatie
nt clinics
Direct and
indirect
costs/benefits
of above
No. joint clinics
held
Direct and
indirect costs of
3
No. of
transitional
care clinics
Direct and
indirect for 5.
1.
2.
Protocol
Development
Education
2.
3.
4.
5.
Patient
Education
Design
dedicated
protocol/path
way to
enable
Refer to
recommenda
tions [?]
Whats
Available
PICTS/Smart
Angus J M Watson
Professor of Colorectal
Surgery
NHS Highland
Daily data
Data based on
Harvey Bradshaw
Simple Clinical Colitic Index
Focus groups
Patients
Enthusiasm &
support
Transform clinical
encounters
Reassured by being
monitored
Increased contact
availability
Potential of new
technologies
Staff
Patient reported
data valuable
Integration of app
into healthcare
delivery good
app easy to use
See the potential
Outcomes
Deliverables
Project Activity
Standard A
High Quality Clinical
Care
Safe Care
1.
2.
1.
Prevention
Measurements
1.
1.
1.
Standard B
Local Delivery of Care
Primary Care
1.
Integrated Care
1.
1.
[1]
[2]
Crohns and Colitis UK Proposal to The Quality Unit, DG Health and Social Care (February 2013)
2020 Vision
UK-Wide ambitions
Capturing lessons
learned in Scotland
Adapting these to
address UK-wide
issues
Exemplar for other
long-term
conditions
Thank you!
Elaine Steven
Peter Canham
Shona Sinclair
Andrew Greaves
Angus Watson
Cath Stansfield
Pilot Working Groups
National Steering Group
Strategic Planning and Clinical Priorities
Team Scottish Government
IBD in the UK
improving patient outcomes and
experience
Dr Chris Calvert
Royal Devon and Exeter NHS
Foundation Trust
110
Digital Technologies
IBD Portal
Provide patients 24 hr secure access
to their IBD record
Bloods
Clinic letters
Disease monitoring tools
Secure email
Trusted health information
IBD Portal
Secure
Easy & appealing to use
Accurate education material
Integrated easily into routine practice
Barriers
Potential Benefits
Improve communication
Enhance patient empowerment
Improving capacity to take control of
their IBD
Improve knowledge
Promote shared decision making
Enhance safety
Timeline of Development
Apr 2012
Apr 2013
and
May 2013
Aug 2013
Nov-Apr 2014
Project commenced
Design, implementation
testing
Recruitment commenced
Recruitment stopped
Evaluation
Results
Results
90% perceived supported
management
32% helped with decision-making
29% shared access with family/friend
Use associated with disease activity
Increase access to IBD helpline from
users
Conclusions
Embrace technology and look at new
ways of delivering care
Design and implementation within
the NHS is entirely feasible
Carefully consider barriers to
implementation
Do Patient Portals actually change
clinical outcomes?
Special Thanks
Crohns and Colitis UK
Renal Patient View
Prof. Turner & Dr Simpson
Renal Patient Association
Web developers Solid State Group
IBD in the UK
improving patient outcomes and
experience
IBD
managem
m
s
rk
ent
o
w
So
ho
e
m
h
e
ww
o
t
ave
r
e
t
ar
h
d
an
r!!
e
ar d
1. Electronic Health
Record
2. Personal Health
Record
3. Information System
Benefits to service
IBD Portal as a tool of self
management
Reduction in outpatient attendances
A 3rd Checker!
Tracking disease activity
Supporting biologic requests
Barriers to Implementation
Locally
Consultant time
My IT knowledge
IT department support
Patient Feedback
Somewhere to turn before Google
Better understanding of my disease - including
disease location and procedures
Greater understanding blood tests and results
Inter-transferable data from one medical
institution to another - I can just log in anywhere
I can document my medications and disease
pattern
Fantastic chronological database of treatments,
appointments and discussions with the care
team
Future Plans
Roll out the service to all patients at Salford
Royal to further evaluate its impact on
services
Implement the Portal into early adopting
hospitals
Evaluate the drivers and barriers to
implementation and develop a roadmap to
facilitate national roll out
Link the Portal with the National IBD
Registry
IBD in the UK
improving patient outcomes and
experience
IBD Research
Keith Bodger
University of Liverpool
Service
Deliver
y
Randomized
Controlled Trials
Real world
Observational data
Cost inputs
Efficacy
Effectiveness of
standard care
PMS
Web Portal
Existing
Systems
Web-based Tool
Pseudonymise
d data file
Receives and pseudonymises from HSCIC
Web Tool
databases
Hospital or GI
Dept IBD
database
e.g. Ascribe,
Ferring, Hospital
IBD Registry
PMS using
InfoFlex
software
Data extract
files from
web tool
returned to
Trust server
before upload
to HSCIC.
N
3
Web
Tool
access
(Registry data
set, national
Minimum dataset
Minimum dataset
Minimum dataset
Demographics
Trust A
Trust B
Trust C
Trust D
Trust E
Trust F
Age
Contacts
Medication
Trust A
Trust B
Trust C
Trust D
Trust E
Inpatient Care
Selected
centres
Missing
cases
Missing data
Research Designs
Service
Deliver
y
Conclusions
The IBD Registry offers an opportunity to serve
as a powerful vehicle to support service delivery,
audit and research
A secure ARK to host data for real-world
studies
Platform for prospective research an off-theshelf solution
Data content, structure, capture, linkage and
supporting analytics will continue to evolve
Key to success? Stakeholder engagement and
incentives
IBD in the UK
improving patient outcomes and
experience
Panel discussion:
the IBD Vision
getting there from here
Moderator: Jonathan Freedland
Jonathan Freeland
Executive Editor, The Guardian
Ian Arnott
Consultant Gastroenterologist, Edinburgh
& Clinical Lead, IBD Audit
David Barker
Chief Executive, Crohns & Colitis UK
& Chair, IBD Standards group
Cathryn Edwards
Consultant Gastroenterologist, Torbay Hospital, Devon
& Senior Secretary of BSG
Richard Russell
Paediatric Gastroenterologist, York Hill Hospital, Glasgow
& past-Chair, BSPGHAN
Jeremy Taylor
Chief Executive, National Voices
IBD in the UK
improving patient outcomes and
experience
IBD Registry
Sites can register now to use the IBD
Registry web tool
Registration forms available from
Simone Cort today
simone.cort@ibdregistry.org.uk
Presentations
All presentations available now
& video footage soon at
www.ibdregistry.org.uk
David Barker
Chief Executive, Crohns and Colitis UK
Chair, IBD Standards Group
IBD in the UK
improving patient outcomes and
experience