Commissioning the right COPD care for Londoners 7 November 2011 Royal College of Physicians.
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Transcript of Commissioning the right COPD care for Londoners 7 November 2011 Royal College of Physicians.
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Commissioning the right COPD care for Londoners
7 November 2011
Royal College of Physicians
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Case for change in London respiratory services
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Our aim is to improve the experience of Londoners with COPD and reduce the impact of the disease
NHS London Respiratory Team
Funded by DH 2010-13Clinically-led multi-disciplinary team (0.5 -1 day/week)
Community and hospital health professionalsPatient/carer voice and Programme Manager
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Right Care
Doing the right things …… and doing things right
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Value Framework
Health Outcomes
Patient definedbundle of care
CostValue=
Health Outcomes Cost of delivering
Outcomes
Porter ME; Lee TH NEJM 2010;363:2477-2481; 2481-2483
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What COPD 'costs' in London
• Spend £646m (or £17.m per pathfinder) on respiratory budget
• Including over £100m pa on COPD
• Plus £16m on lung cancer
• Respiratory programme budget expenditure up by average of 21% 2008/09-2009/10
• Varies between 1/3 – 2/3 on secondary care
• Inpatient cost per person per year ~ £5,000
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• Admission rate varies 1.9-4.9 per 1000 practice population
• Q1 2009/10 2nd highest cause of emergency admission
• Total bed days over 91,000 pa
• Average length of stay varies 4.9-8.6 days
What COPD 'costs' in London
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COPD ‘Value’ PyramidWhat we know so far…. Cost/QALY
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Londoners dying from smoking
‘1 in 5 deaths due to smoking’
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Why Commissioners need to invest in Pulmonary Rehabilitation in London
….May 2011
Now?
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Review of packsQ & A
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Earlier Diagnosis and Stopping Smoking
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Southwark PCT: Spend by practice ( £ per patient per year) on NRT + Varenicline
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Stop smoking in inpatients CQUIN Enablers
National VTE CQIN
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Stop smoking in inpatients CQUIN proposal
Numerator: all adult emergency and elective admissions from all specialities coded as F17.2 (narrative = dependent smoker, cessation advice given)
Denominator: all adult emergency and elective admissions coded as F17.1 (if the narrative accepted by coders is patient asked and confirmed that they smoke)
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Stop smoking in inpatients CQUIN proposal
Target levels
• Expect numerator to reflect the adult smoking prevalence in the local community (rates will be PCT-based not catchment based).
• Suggest minimum 20%
• CQUIN target: recording of 50% of those. That is, 10% of the adult hospital population. We would expect 90% of those 10% to receive advice to trigger CQUIN payment.
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Earlier Diagnosis and Stopping Smoking
1. Review and share data and select the questions you find most relevant
2. Prepare poster with 3 actions that you commit to
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Earlier Diagnosis and Stopping Smoking
• What is the smoking prevalence of your COPD and asthma population? The trends?
• If you don't know, how might you get the data?
• If you do know, how can you get the rate lower? Where are the smokers? Consider routine and manual workers, different ethnic groups, people with mental health problems
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• Do you accept the stop smoking as the treatment for COPD message?
• What does that mean for how stop smoking services are organised, delivered and monitored?– In the community– In hospitals
• What incentives are you prepared to consider eg LES, CQUINs
Earlier Diagnosis and Stopping Smoking
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• What is the trend in diagnostic rates for COPD?
• What is the spread of disability, in terms of MRC scores?
• How is the quality of spirometry assured?
• What comparative data do you have to share with practices?
Earlier Diagnosis and Stopping Smoking
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Responsible respiratory prescribing
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Responsible respiratory prescribing
1. Review and share data and select the questions you find most relevant
2. Prepare poster with actions that you commit to (with names)
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Responsible respiratory prescribing • Do you accept the LRT’s seven messages?
• If not, why not?
• What do you need to do differently?
• What do others need to do differently?
• How can you take it forward locally?
• What opportunities are there to tie in with medicines use reviews?
• How do you assure the competence of the professionals teaching inhaler technique?
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Reducing exacerbations and admissions
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Reducing exacerbations and admissions
1. Review and share data and select the questions you find most relevant
2. Prepare poster with actions that you commit to (with names)
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• What do you know about your admissions and readmissions for COPD? Number, trend over last three years; quality of coding?
• What do you know about length of stay?
• What proportion of your admissions for a COPD exacerbation were undiagnosed prior to admission?
• What patterns do you observe in admissions (people, times of year, times of week)?
Reducing exacerbations and admissions
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• How do your services match the demand?
• What is your reaction to the COPD discharge bundle – have you/could you implement it?
• How do you incentivise right care - eg continuity of care with a GP (Purdy)?
• Will you commit to describing right care to two (or more) colleagues?
Reducing exacerbations and admissions
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• What capacity do you have to offer all people admitted with MRC2 or above access to a PR programme?
• If you need to expand it, how will you do that?
• Are there other places that have similar problems to you that you can learn with/from?
Reducing exacerbations and admissions
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Proposed COPD discharge bundle CQUIN
• Numerator: Number of patients admitted for more than 48 hours coded: J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection OR
J44.1 Chronic obstructive pulmonary disease with acute exacerbation, unspecified
in first or second position and are discharged with a completed care bundle
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Proposed COPD discharge bundle CQUIN
• Denominator: Number of patients admitted for more than 48 hours with ICD10 code J44.0 or J44.1 in first and second positions
• Payment threshold: 75% in year one and 95% in year two 2012/13
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‘A call for action’ for Stop Smoking interventions in respiratory disease …