The benefits of Using AHP Data Standards Margaret Hastings MBA (Dist) FCSP Clinical Information Lead NHS GG&C AHP eHealth Lead Clinical Service Manager – Physiotherapy – West Dumbarton CHP

NHS } SCOTLAND The information presented is a simple summation of quarterly data returned in aggregate form by boards. In general, the figures supplied by boards comprise activity provided by hospital-based services. Care provided in the community is excluded except where that care is provided by hospital-based staff (an example is the chiropody figures, which exclude information on community-based staff). This is not thought to be universally the case, however, and it is possible that recording practice may vary between some boards, as for certain AHP specialties. For this reason, the figures are better viewed as indicative rather than precise counts of activity and any conclusions drawn from use of these data should take this into account. Allied Health Professionals and other Technical departments - new patients and total attendances (non-inpatients, non-day patients) _applic=CCC&p_service=Content.show& HomepageHomepage › Information and Statistics › Data Developments › AHP and OTD activityInformation and StatisticsData Developments

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NHS } SCOTLAND NHS } SCOTLAND 4 CHI Number Demographics (Structured Name, Postcode, Registered GP Practice, Gender) Profession Referral Reason Referral Source Referral Type Referral Date Referral response Date Health Problems Aetiology Objectives Caseload Status Date Complete Outcome Discharge Type Referral1 st ContactCare Episode Care Plans Clinical Outcome Scheduling Messaging Assessment Proforma Care Plan / Interventions Discharge AHP Pathway & Summary Dataset

NHS } SCOTLAND Patient Profile Clinical Profile IT Benefits - Safety, Experience, Performance Record structures Standards, Terminology, Identification Evidence Problem Identification Pathways, Delivery Confidentiality, Identification Metadata,message structures 5 Standards for ……

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NHS } SCOTLAND Uses of AHP Summary Dataset  Referrals by 1000 population  Caseload by 1000 population  Cases by disease groups  Cases by health problems  Demand management  Capacity management  Case management  Outcome analysis  Clinical Effectiveness  Research 7

NHS } SCOTLAND 8 Summary (January )  80% response rate  Total caseload on 14/9/05 was 844,000 cases – for every 6 people in Scotland 1 was a current AHP case  On census day 1 contact for every 89 people in Scotland Waiting Times (July)  2,609 AHP waiting lists in Scotland  1 in 50 people waiting for AHP 1 st contact  12 people waiting for every AHP in Scotland  94% of all patients seen within 18 weeks Describing AHP Cases & Service Evaluation (Sept)  Clinical data describing 39,895 cases was provided - 95% could be classified to ICF; ICD10; OPCS4  The NCDDP AHP Data standards could be recorded by the AHPs.  AHPs have very little overlap in the problems they work with – most of the top ten words used to describe conditions are unique to that profession. Census Reports 2006

NHS } SCOTLAND Demand, Capacity and Queues in AHP services Demand - all requests or referrals into the service. Need to know target population: AHP referral norms; patient pathways; referral protocols Demand - all requests or referrals into the service. Need to know target population: AHP referral norms; patient pathways; referral protocols Capacity – all resources required to do the work. Need to know Role profile - clinical sessions + professional sessions + management sessions; No. new pats / clinicians; Leave profiles Capacity – all resources required to do the work. Need to know Role profile - clinical sessions + professional sessions + management sessions; No. new pats / clinicians; Leave profiles Activity – is the work done and depends on Case Complexity; Case Weighting; Care Plan Delivery (includes care setting); Interventions; Activity – is the work done and depends on Case Complexity; Case Weighting; Care Plan Delivery (includes care setting); Interventions; Queues – result when demand has not Queues – result when demand has not been dealt with, resulting in backlog. been dealt with, resulting in backlog. Measured by waiting times Measured by waiting times

NHS } SCOTLAND Benchmarking Referrals Population Refs per annum Refs : 1000 population W.T.E. Refs : WTE CHP P CHP W CHP R CHP C CHP N CHP G CHP E CHP B CHP L

NHS } SCOTLAND % population on Rx

NHS } SCOTLAND Describing Clinical Care + Objective (AHP Data Standards) + Health Problem or Issue (ICF) + Aetiology (ICD10 / OPCS4) + Caseload Status or Outcome (AHP Data Standards) + Associated Professional Role + CHI number + Service Base 12

NHS } SCOTLAND ICD10 Diagnosis 1% Movement Functions 1% Muscle Function 4% Joints and Bone Function 13% Genital & Reprod. Function 3% Pain8% Walking difficulty 19% structure of heart 1% structure respiratory 4% structures shoulder 5% structure arm 5% structure pelvis 1% structure lower limb 15% structure trunk 18% Referred Problems by ICF

NHS } SCOTLAND Benchmarking Physio service in a CHP 2 week time diary described 324 cases in 5 Health Centres; 3 domiciliary teams and 1 rapid response team. Rapid Response patients had more diagnoses and health problems recorded

NHS } SCOTLAND 15 Top 10 Diagnoses CHP recorded Backache Muscuklokeletal pain Walking difficulty Muscuklokeletal disorder Joint symptom - shoulder Joint symptoms Fracture neck of femur Osteoarthritis Sciatica Torticollis CVA / Stroke 55% of total 55% of total Census

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NHS } SCOTLAND Caseload Status

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NHS } SCOTLAND Rehabilitation Model 4 - Intensive – multi-agency, care management 3 - Complex – care managed by lead prof. 2 -Basic Support 1 -Self Managed Care Multiple Diagnosis: Complex Health, Social Problems Few Diagnosis & Health, Problems Multiple Diagnosis: Health, Problems

NHS } SCOTLAND International Joanne Briggs Institute

NHS } SCOTLAND More Standards ……… Referral1 st ContactCare Episode Care Plans Clinical Outcome Joanne Briggs Institute

NHS } SCOTLAND 23 Use Data standards Structure record Mandate key data indicators for secondary uses AHPs need training in Coding and Classification AHPs need clinical systems to record structured clinical data which will output summary information! Remember the burden and costs of data collection Embedding Data Standards in Clinical Practice

NHS } SCOTLAND Benefits Clearer understanding of AHP case mix Clearer understanding of AHP case mix Right clinical resource can be matched to case complexity Right clinical resource can be matched to case complexity More real time clinical audit, evaluation and research More real time clinical audit, evaluation and research Service information derived from clinical recording Service information derived from clinical recording Demand, Capacity, Workload and Workforce data available to service Demand, Capacity, Workload and Workforce data available to service Improved patient care Improved patient care