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Care Pathways and Packages (Overview and history)

Care Pathways and Packages (Overview and history). Jon Painter Programme Director Northumberland Tyne and Wear NHS FT. Main elements of the CPP Model. Individual patient needs Anxiety / Relationships / Hallucinations / Living conditions etc. Mental Health Clustering Tool

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Care Pathways and Packages (Overview and history)

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  1. Care Pathways and Packages(Overview and history) Jon Painter Programme Director Northumberland Tyne and Wear NHS FT

  2. Main elements of the CPP Model Individual patient needs Anxiety / Relationships / Hallucinations/ Living conditions etc. Mental Health Clustering Tool Standardised summary of individual needs Cluster Global description of combination & severity of individual needs Care Packages Individually negotiated care plan informed by NICE Guidance Quality and Outcome Metrics Triangulated measurement of process and effect Local/national Tariff Derived from joint understanding of accurate costs

  3. Starting point • Managers, psychiatrists, nurses, social workers, OTs, psychologists • Acute inpatient services, community MH Teams & rehabilitation services • Different parts of the service using different concepts to describe their casemix(functioning, risk, etc.) • Often more reflective of service / service response than the patient (inpatient/outpatient, low/medium security) • Clinicians recognised that patients weren’t getting what they needed, they got the best of what was available (idiosyncratic referral pathways and care packages)

  4. Participatory action research questions: • What information do professionals use to decide on care package to be offered? • Is it possible to develop a shared language based on patient need? • Is it possible to develop simple care packages to meet needs?

  5. Mental Health Clustering Tool Standardised summary of individual needs Needs identified as important to care planning:

  6. Cluster analysis (example) A diagram summarising how cases group together at different levels of distance (distance is standardised onto a new scale) Used to identify the number of clusters to define in the 2nd stage of cluster analysis

  7. Cluster Global description of combination & severity of individual needs Score MHCT Scales

  8. Cluster Global description of combination & severity of individual needs Validation - clinical homogeneity • Case presentations • Score profiles • Treatment aims • Interventions • Concurrent clinical data • CPA status • Diagnosis • Medication • Gender • MHA status • Time known to services

  9. Cluster Global description of combination & severity of individual needs Initial results • 13 statistically derived groups with good clinical face validity • Balance between membership criteria and coverage • 85% of patients allocated, remainder were not a homogeneous group but variations on existing clusters

  10. Cluster Global description of combination & severity of individual needs Subsequent cluster developments: • Disaggregation of low-end non-psychotic cluster • Disaggregation of stable psychosis cluster • Addition of organic clusters • Removal of substance misuse cluster • Refinements to some score profiles • Improved coverage (90-95%)

  11. Making profiles clinically useable (The mean is only half the story)

  12. Cluster Global description of combination & severity of individual needs Common features: complexity, chaos & engagement, distinguished by level of substance misuse Relatively straightforward presentations, clusters progress primarily according to symptom severity Clusters increase in terms of symptom severity & level of secondary disability Cluster dictated by virtue of first episode rather than symptom severity Stage of dementia, level of cognitive impairment and frailty Clusters progress primarily according to complexity Acuity

  13. Care Packages Individually negotiated care plan informed by NICE • Content of care packages should reflect NICE Guidance etc. • BUT must also reflect local position (historic investment, previous organisational approaches to care pathways etc.) • Must allow for innovation rather than locking in any particular practice • As a result exact content and format will vary • Any approach must provide clarity to all stakeholders (Patients, carers, staff, commissioners).

  14. Care Packages Individually negotiated, NICE-informed care plan Initial cluster-specific expectation of care Refined by condition/diagnosis, evidence, guidance etc Final negotiations according to availability & patient choice

  15. Quality and Outcome Metrics Triangulated measurement of process and effect Payment for demonstrable quality Payment for assumed quality

  16. Quality and Outcome Metrics Triangulated measurement of process and effect Key: MHMDS: Mental Health Minimum Data Set MHCT: Mental Health Clustering Tool PREMS: Patient Reported Experience Measures PROMS: Patient Reported Outcome Measures CROMS: Clinician Reported Outcome Measures

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