National COPD Programme Building QI into Your Audit from the Start Prof. Mike Roberts Royal College of Physicians Barts Health/ UCLPartners On behalf of the team

Programme Overview 3 plus 2 year programme Commissioned & funded by HQIP Led by the Royal College of Physicians (RCP) working in close partnership with – British Thoracic Society (BTS) – British Lung Foundation (BLF) – Primary Care Respiratory Society (PCRS-UK) and – Royal College of General Practitioners (RCGP)

Programme Workstreams Primary care audit – Collection of clinical audit data from General Practice patient record systems looking back over a year. Spring 2015 then annual. Secondary care snapshot audit – Admissions to hospital with COPD exacerbation process and outcomes at 30 and 90 days. Organisation and Resources over data collection period. Spring 2014 & Pulmonary rehabilitation snapshot audits – Service quality and patient outcomes over 3 months. Includes resources and organisation. Jan 2015 start. Repeat PREM – One year development work exploring the potential/feasibility for Patient Reported Experience Measures to be incorporated into the programme in the future. Patient identifiable data linked across the workstreams and to external sources such as HES and ONS

Measures - Process and Outcome Primary care e.g. compliance against NICE standard- diagnosis confirmed, smoking cessation, annual review, referral to PR, correct treatment etc. Secondary care e.g. Essential investigations and interventions in first 24 hours, integrated discharge. Pulmonary Rehab e.g. Compliance with BTS standards, completion, better QoL, improved exercise capacity. Mortality, Hospital Stay, Readmission.

UK COPD Audit Progression hospitals process and outcomes hospitals process/outcomes + organisation and resources % all UK Trusts (as per 2001) % of all UK Trusts process/outcomes + resources and organisation + patient experience + primary care record 2010 Euro Audit of hospital care & resources

Audit is a quality improvement process

UK National COPD Audit % patients with pH< 7.35 Receiving Ventilatory Support by Individual Units

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Quality indicators for North West SHA acute units ( ) Acute unitOrg scoreNIVPREDSLTOT Site Site Site Site Site Site Site Site Site Site Site Site Site Site

Hospital Report

NICE Management Guidelines for COPD NICE COPD Quality Standards DH Outcomes Strategy for COPD NHS COPD Commissioning Toolkit

Over Time Some resources have increased Wider service provision But Little evidence of improved processes But Length of stay reduced Readmissions have increased Mortality remains high

What Have We Done Differently? Acknowledge QI is key Establish a QI group Look for links with external organisations Emphasise to participants the QI opportunities Suggest QI options to participants Engagement, engagement, engagement! ‘Make it as easy as possible to do the right thing for the patient’

Engaging with Professionals Radical Message Kept simple (but with significant range of consequences) Balanced with the good Something that appeals to professionals and patients alike Strap line – ‘Who Cares Matters’ Supported by National Professional bodies

Engaging Commissioners CCG/LHB Level Reports- what do you want to see? CCG engagement (e.g. via CCG Champion Networks of partner organisations) Identifying CCG priorities Targeted messaging Benchmarking against NICE standards Potential for peer review (e.g. accreditation of Pulmonary Rehabilitation)

National Engagement All Party Parliamentary Group on Respiratory Health NHSE Domains NHS Wales – Policy leads (NCA; Respiratory; Primary Care; Adult & Children’s Health) National Respiratory Director NHSE – Head of Patient Experience NHSIQ

Engaging Patients and Carers British Lung Foundation – Including network of Breatheasy Groups Patient involvement groups – professional bodies (e.g. RCP PIU) The plain English version Conferences and newsletters And in an ideal world patient access to their own data!

Summary Reporting of data has limited impact Acknowledging QI is critical element at outset Having a QI strategy Engaging key parties We have no resource or contract to deliver QI Over to you- Health Quality Improvement Partnership

To Find Out More If you would like to register to receive updates: Or visit: #COPDaudit #COPDwhocares?