Commissioning view of immunoglobulin

1. Commissioning view of immunoglobulin Malcolm Qualie Head of Health Policy East Midland Specialised Commissioning Group

3. Immunoglobulin prescribing approval process

4. Aims of the National Immunoglobulin Database • Initial aims [in 2007] • To allow more accurate assessment of immunoglobulin use for • forecasting and tendering • To provide an accurate picture of prescribing by indication and a tracking mechanism of individual batches of immunoglobulin for safety purposes • These aims developed further [in 2008] • With the publication of the Model Commissioning Policy by the NSCG, • there is now an explicit desire to link immunoglobulin use to payment at the PCT or SHA level through the records contained in the database • Current position going into 2012.....

5. Updated guidelines Commissioning perspective

6. Selection criteria and outcomes “Increased clarity regarding patient selection criteria and the need for prescribers to report clinical outcome after treatment are strongly supported”

7. Effective IAPs “Effective Immunoglobulin Assessment Panels (IAPs) are important to monitor adherence to these new selection criteria in routine clinical practice”

8. Database Information Service

9. East Midlands Specialised Commissioning Group Bespoke immunoglobulin prescribing reports East Midlands Specialised Commissioning Group has incorporated a requirement for National Immunoglobulin Database entry as a condition for payment. Bespoke immunoglobulin prescribing reports are generated from the commissioners’ portal on the database, which document the total volume and cost of each product prescribed per Trust. These data are used to calculate the ‘spend’ entered onto the database. Payments are withheld from the Trust if the spend and the actual volume used do not correlate.

13. Efficacy monitoring “The update specifies the outcome(s) measures, but not the degree in improvement of outcome(s) required to constitute treatment success” Commissioners will work with expert clinicians to refine these outcomes to provide defined ‘treatment success’ measures where possible.

14. Stopping criteria “For most diseases the treatment duration is short term (<3 months). The treatment episode ends at 3 months; treatment re-initiation will be regarded as a new treatment episode, based on a new IAP decision”

15. Modulating use in large volume indications Patients with ongoing ITP beyond 12 months (chronic ITP) should not normally be treated with long-term immunoglobulin as there are alternative approaches. To reflect this, immunoglobulin in chronic ITP is now a Grey indication

16. Modulating use in large volume indications “For patients on long-term immunomodulatory doses, attempts should be made to reduce the dose, by increasing the dosing interval or by using reduced dose, or both, and, for patients with a high BMI, adjusted-body-weight dosing is used”

17. The future of the National Immunoglobulin Database and commissioning of immunogobulin

18. Enhanced database functionality • Enhanced commissioner reporting tools will facilitate: • monitoring of prescribing patterns • identification of individual cases which • do not meet the selection criteria • tracking of cases that do not have • (appropriate) outcome measures. • There will be automated email alerts and automatic stopping rules through database locking to prevent inappropriate unsanctioned use. • This will make it possible to link payment for immunoglobulin to appropriate prescribing as recorded in the National Immunoglobulin Database.

19. Supporting SCG transition & delivery ‘Minimum Take’ specialised services 2012/12 Although the new arrangements for specialised services will not come into place in full until April 2013, the NHS Transitional Oversight Group (TOG) for specialised services has agreed to a stepped implementation with a nationally consistent approach to commissioning for many of the services from April 2012 (‘minimum take services). SCGs will commission a consistent sub-set of the Specialised Services National Definitions Set (‘Minimum Take’ services) from April 2012, with the remainder being commissioned from April 2013.

20. Supporting SCG transition & delivery Specialised Services National Definition Set

21. National Immunoglobulin Database – linking prescribing with payment • Timeline of mandated requirements from commissioners • 1st April 2012 • ‘New treatment episode’ at 3 months to be recorded in short term cases if immunoglobulin is to be continued • 1st April 2013 • Annual review for long-term users • Outcome measures reported

22. Developing a quality dashboard for immunoglobulin

23. What is a Quality Dashboard? • A graphic array of information that demonstrates an organisation’s performance in a number of designated areas of quality • It is meant to be visual, constructed in a way that it is intuitively meaningful to a variety of readers • The minimum amount of space is used to demonstrate the information • The focus remains on the outcome rather than the process delivering change

24. Why is a dashboard useful? • A dashboard in a car is visualised whilst driving. Changes in measurement parameters can lead to immediate corrective action. The aim for a quality dashboard is that it becomes part of the day-to-day work of service provision. The frontline staff delivering care should be able to freely see the dashboard to see the quality benefits of service change. • The dashboard is a strong tool to facilitate discussion between commissioners, the organisation, and the clinical team to focus on interventions that make a measurable change to care quality. • The focus is on the delivery of improvement from the established baseline. This is opposed to the identification of ‘failure’ to meet a fixed critical threshold.

25. Define measures • Measures should be meaningful to the clinical staff in the service and patients experiencing the care • The outcomes can be compared with nationally established benchmarks but this is not a requirement • Outcomes may include critical national initiatives • Measure variables that relate to the delivery of the improved outcome • Variables can include publicly reported data; progress on local initiatives; patient satisfaction; patient complaints and potential litigation; significant incidents; workforce issues, such as retention; and peer review summaries • A good number of variables for each clinical system is 10 to 20. Each variable should have a meaningful corresponding number, trend, percentage or a ranking against providers of comparable size as a way to measure progress

26. Run Chart • The most common form of data presentation will be a run chart of the parameter score plotted over time. As 7 data points are required to demonstrate a change more frequent data points are preferred.

27. Statistical Process Control • An SPC chart is the preferred method to demonstrate a data parameter allowing a focus on not only modifying a median position but on the reduction of variability

28. Draft immunoglobulin measures

29. Draft immunoglobulin measures

30. Draft immunoglobulin measures

31. Draft immunoglobulin measures

32. 10 minutes to comment on draft measures

33. MDSAS IVIG Support How to contact MDSAS about the IVIG Database 0161 277 7917 support@mdsas.com

34. Thank you for listening and have a great Christmas! Rob.Hollingsworth@MDSAS.com 0161 277 7917 In need of IT Services? Contact us - support@mdsas.com or visit our website www.mdsas.com