The UK experience. Adrian Jacobs. Director of Primary Care Torbay Care Trust

Transkript

1 The UK experience Adrian Jacobs Director of Primary Care Torbay Care Trust

2 Chronic Disease Management in The Model the UK Some of the evidence Kaiser Beacon Site The New GP Contract

3 Drivers for change

4

5 CASTLEFIELDS HEALTH CENTRE (UK) 15% reduc n unplanned admissions 31% reduc n hospital LOS (6.2 to 4.3) Total hospital bed days fell by 41% Significant savings Better patient experience Improved integration + more appropriate referrals

6 VETERANS ADMINISTRATION (USA) 35% reduction urgent care visit rate 50% reduction hospital bed days

7 EVERCARE (USA) 50% reduction unplanned admissions without detriment to health Significant reductions in medications 97% family and carer satisfaction High physician satisfaction

8 NHS-ADAPTED EVERCARE 3% of target pop n = 30% unplanned admissions for that age group many admissions avoidable (urinary tract infection, dehydration, ADR) 55-87% high risk pop n not accesssing DNs & Social Services polypharmacy

9 NW LONDON SHA Case mgt releases significant capacity 29% total medical specialities bed days used by 65+ with 2+ unplanned admissions. Reduc n occupied bed days % = up to 1.15m for PCTs

10 NW LONDON SHA (cont) Reduction A&E adult attendances 2-3% Reduction GP activity for 75+ up to 53% home visits; 82% OOHs; 19% general appts. To set up case mgt - 173k per PCT

11 Population Management: More than Care & Case Management Targeting Population(s) Redesigning Processes Intensive or Case Management Level 3 Highly complex members Measurement of Outcomes & Feedback Assisted Care or Care Management Level 2 High risk members Usual Care with Support Level % of a CCM pop 11

12 The Headline Differences between KP and the UK KP use one third of the bed days as the NHS for 11 leading causes of hospital admission. The main source of the difference is much shorter hospital length of stay. Length of hospital stay does not vary with age in KP

13 How does KP achieve these results? Active management of patients at all stages Explicit care pathways exist for major conditions like hip replacement These pathways specify how care should be provided on each day of treatment Hospitalists manage patients in hospital Discharge planners (often nurses) ensure patients leave as soon as appropriate

14 Self Care A high priority for KP Patients undergoing planned surgery such as hip replacement will receive information and training in rehabilitation and self care Intensive care and support is used to help keep people at home where appropriate Telephone contact is used extensively

15 Other points Unplanned hospital admissions are seen as a sign of system failure There is no divide between Primary and Secondary Care Strong Focus on Chronic Disease Management. Increasing emphasis on prevention of ill health KP invest heavily in Medical Leadership

16 Torbay

17 Impact of KP in Torbay Health Community approach to service development. Strategic focus on Chronic Disease aimed at avoiding unplanned admissions Changing the way we use our community hospitals Focus on better use of information Strengthen clinical leadership

18 Torbay Themes New GP Contract Local Enhanced Scheme Community Hospital From GP to Nurse Led facility Unscheduled Care Group Yellow folder scheme Alternatives to admission scheme Integrating GP OOH and Accident and Emergency Care Pathways

19 Future Focus for Work with KP Clinical Leadership Owning and driving change Better Use of Information Managing performance Self Care Patients as partners in care

20 The New UK GP Contract Moving away from: buying process Payments linked to numbers of clinical staff Moving towards Evidence based outcomes through the Quality and Outcomes Framework (QoF)

21 How does it work? Basic payment for Essential Services 1050 points (currently 120/point per average practice) can be earned by meeting quality standards Directed Enhanced Services Local Enhanced Services

22 QoF Domains Organisational Clinical Additional Services Patient Experience

23 What has QoF delivered? 90% of practices have achieved 90% of the targets. A really good database on what is happening in a number of clinical areas. e.g: - Average achievement for CHD - 84% of patients have a recorded BP of 150/90 or less in the previous 15 months

24 Emerging Evidence Small Practices seem to deliver better care Our highest cost prescriber has the lowest referral rates and the lowest prevalence of CHD and the lowest unplanned admission rates. We seem to be containing Unscheduled Admissions Torbay has the lowest Out of Hours unscheduled admissions rate in Devon

25 In Conclusion We have to get serious about improving the management of chronic disease. No change is not a viable option. Change can only be delivered by an integrated approach. Primary Care is the key