[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

The NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre is funded by the National Institute for Health Research (NIHR) and is a partnership between the University of Manchester and Salford Royal NHS Foundation Trust

COCPIT: discovering missed opportunities in patient care Richard Williams

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

Introduction

•  Centre for Health Informatics, University of Manchester

•  HeRC

•  Farr Institute

•  Greater Manchester Primary Care Patient Safety Translational Research Centre

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

Introduction

•  COCPIT developed with NIHR CLAHRC funding 2009-2013

•  Collaboration for Leadership in Applied Health Research and Care - between

•  the University of Manchester

•  Greater Manchester PCTs

•  Greater Manchester Hospitals

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

Introduction

•  Salford

•  Borough of Greater Manchester

•  City in its own right

•  BBC - MediaCity

•  Demography

•  Population 218,000

•  High deprivation

•  Education below average

•  Crime above average

•  96.1% White (90.9% national average)

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

Introduction

•  Salford Integrated Record – a single database containing:

•  Primary care data from all GPs

•  Hospital data

•  A small dataset compared with others, but integration of primary and secondary care gives an edge

•  Salford PCT asked us to develop a prototype tool for discovering ‘Missed Opportunities’ in patient care.

•  This is COCPIT

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

Missed Opportunities

•  A missed opportunity is an instance of inadequate or lack of primary prevention

•  Failure to meet treatment targets

•  Missed diagnoses

•  Failure to collect information during encounters

•  No attendance

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

CVD prevention

•  Patient has never visited their GP

•  Patient visited GP but routine information such as smoking status or BP not recorded

•  Clinical indications of hypertension but no formal diagnosis

•  Diagnosis of hypertension but no treatment or failure to hit BP targets

Missed Opportunities

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

Cri$cal  Event  

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

COCPIT

•  Collaborative Online Care Pathway Investigation Tool

•  A system for:

•  Analysis of pathway variance

•  Identifying groups of patients

•  Perfect match for discovering missed opportunities

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

COCPIT

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

COCPIT

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

•  Realistically complex

•  High BP no longer restricted to “most recent”

•  > 3 BP readings in last 3 months, 2 of which > 150/90

•  > 4 BP readings in last 12 months, average > 140/90

Identifying Patient Groups

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

COCPIT – Latest News

•  Prototype evaluated by:

•  NICE

•  Health and Social Care Information Centre

•  University researchers

•  Heart Failure audit programme

•  Ourselves

•  NorthWest eHealth (NWeH) to integrate the tool with their existing FARSITE software and deploy to GPs in Greater Manchester, Northwest Coast and Northeast.

•  NWeH contact:

Bruce.Magill@manchester.ac.uk

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

COCPIT

Strengths

•  Query language is simple to use

•  Query language gives sufficient complexity to allow the user to identify any group of patients

•  Combining primary and secondary data makes it possible to discover many more missed opportunities

•  Combining primary care data from multiple GPs allows comparisons and the ability to find ‘practices like mine’

•  Visually appealing

•  Good name

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

COCPIT

Weaknesses

•  Very few end users want to create their own queries

•  Sharing models – although possible – is not straightforward

•  Too generic, not focused at any one group. Aimed to satisfy:

•  Researchers, GPs, data managers, clinical auditors

•  Can be used for research, clinical decision support, care pathway redesign, clinical audit

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

GM Primary Care PSTRC

•  GM PC PSTRC

•  Greater Manchester

•  Primary Care

•  Patient Safety

•  Translational Research Centre

•  NIHR funded for 5 years from August 2012

•  Four themes

•  Medication Safety

•  Multimorbidity

•  General Practice

•  Interface & Informatics

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

PSTRC – Interface & Informatics

Remit is to design a system that will:

•  Allow registered users to create and define rules e.g.

•  Patients should receive test X before procedure Y

•  Patients with condition A shouldn’t receive drugs B or C

•  Constantly monitor an EHR database for rule violations

•  Produce reports and provide alerts

•  Dashboard view

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

Patient Safety Dashboard

•  Builds on the query engine developed for COCPIT

•  We will supply the majority of rules for detecting missed opportunities and patient safety issues

•  But also allow the ability to develop your own

•  Targeted at 2 groups

•  GPs

•  Monitoring patient safety

•  Improving data quality

•  Compare with “practices like me”

•  CCGs

•  Monitor GP performance

•  Practice comparisons

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

0  

0.05  

0.1  

0.15  

0.2  

0.25  

0.3  

0.35  

0.4  

CKD  -­‐  BP  control   Diabetes  -­‐  BP  control   HTN  -­‐  BP  control   MI  -­‐  medicaAon   Stroke  -­‐  medicaAon  

My  pracAce   CCG  average  

Dashboard

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

Dashboard •  Protoype developed

•  Reviewed by GPs, CCG staff including pharmacists, and patients

•  Next iteration nearing completion

•  Plan to roll out via the Academic Health Science Networks (AHSNs)

•  Initially as clinical trials

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

Conclusion •  Systems like the patient safety dashboard

can work in isolation on a single practice’s data

•  Better with integrated primary and secondary data

•  Even better with primary and secondary data from multiple sources

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are: §  Introductory

should use the logo in the top right

§  Reporting on methods or results should use the logo in the bottom right.

To make it easier – this slide set includes examples of both. Headings or boxes used that are red should be: §  NHS Red

(Pantone 485) §  RGB: 216(r)

30(g) 5(b)

A partnership between

This presentation summarises independent research funded by the NIHR Greater Manchester Primary Care PSTRC The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health

Thank you richard.williams2@manchester.ac.uk