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Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance

Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance. Using Information and Data to Evidence Impact and Improvement Susan Bishop, QuEST Pete Knight, JIT Linda Semple, QuEST. 4 Pillars of Public Service Reform. Prevention

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Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance

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  1. Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance Using Information and Data to Evidence Impact and Improvement Susan Bishop, QuEST Pete Knight, JIT Linda Semple, QuEST

  2. 4 Pillars of Public Service Reform • Prevention • a decisive shift towards prevention • Place • a greater focus on 'place' to drive better partnership, collaboration and local delivery • Person • investing in people who deliver services through enhanced workforce development and effective leadership • Performance • more transparent public service culture which improves standards of performance.

  3. Reshaping Care Pathway

  4. Preventative and anticipatory care Proactive care and support at home Effective care at times of transition Hospitals and long stay care homes Enablers SCOTLAND % % % % % 2011/2012 Change Plans 19 27 24 23 7 2012/2013 Change Plans 23 25 28 16 8 2012/13 projected spend at Mid Year 25 27 24 12 12 Change Fund allocation shift

  5. Reshaping Care Core Measures • Originate from • partnership measurement of progress with Change Fund Plan implementation • Community Care Outcome Benchmarking Network consultation • COSLA and Chief Execs feedback • Intended to focus on key points along the pathway • Mid-year returns showing that the B (and C) measures are still not well used or understood

  6. So what?

  7. A Measures A1. Emergency inpatient bed day rates for people aged 75+ (NHS HEAT 2011/12) A2.a. Patients whose discharge from hospital is delayed; andb. Accumulated bed-days for people delayed A3. Prevalence rates for diagnosis of Dementia (NHS QOF). A4. Percentage of people aged 65+ who live in housing, rather than a care home or a hospital setting (ISD). A5. Percentage of time in the last 6 months of life spent at home or in a community setting A6. Experience measures and support for carers from the Community Care Outcomes Framework

  8. Explore what makes them easy to use

  9. B Measures • Anticipatory and preventive • Proportion of people 75yrs and over living at home with ACP shared with OOH • Waiting times between request for housing adaptation, assessment of need and delivery • Proportion of people 75yrs and over with telecare package • Responsive/flexible home carer and carers • Measure of dependency before and after reablement • Respite care for older people per 1000 pop

  10. B Measures • Demand for acute care • Rates of 65+ conveyed to A&E with principal diagnosis of a fall • Effective flow in acute care • Proportion of frail emergency admissions who access specialty unit within 24 hrs • Use of long term residential care • Use of long term care homes and continuing care

  11. C Measures • Per capita weighted cost of accumulated bed days due to delayed discharge • Cost of emergency inpatient bed days for people over 75 per 1000 population over 75 • A measure of the balance of care ( eg split between spend on institutional and community- based care)

  12. Explore what makes them challenging to use

  13. Demonstrating the impact of anticipatory care planning • Anticipatory care plans were in place for 1,994 people, including 923 (46%) care home residents, of whom 1,251 survived to follow-up. • The evaluation measured the impact of anticipatory care planning on unscheduled hospital admission and OBD rates. • Of the 1,251, the Scottish Patients at Risk of Readmission or Admission (SPARRA) scores for 827 could be identified and these were matched with a control group with similar SPARRA scores • Overall increases in emergency admissions and bed days for the control were 51% and 49% respectively, compared to reductions of 38% and 49% respectively in the anticipatory care plan cohort. • Savings varied by risk score with the highest scores achieving the smallest reductions. • One of the three CHPs in NHS Highland experienced an increase in bed days in the ACP cohort, whilst the other two reported significant reductions.

  14. Demonstrating the impact of falls prevention

  15. Appreciative enquiry • What has your best experience of using information and data to evidence impact and improvement been? • What helped it to be that way? • What will take it to the next level?

  16. Questions?

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