1. Division of Primary Health Care An evaluation of the effectiveness of ‘care bundles’ as a means of improving hospital care and reducing re-admission for patients with chronic obstructive pulmonary disease (COPD) WEBEX 13 July2015 Dr James Calvert

2. Division of Primary Health Care Aims of the Webex….. Update on progress Issues from colleagues in each institution Any other business

3. Division of Primary Health Care Site Recruitment

4. Division of Primary Health Care First steps Identify an executive sponsor –Ask them to identify resource – money or people You need a team. Develop and tabulate a project plan Understand the current service using measures such as process mapping Collect baseline data and agree a data collection plan Design & test interventions

5. Division of Primary Health Care The right team Team members should be drawn from across the patient pathway and should: understand the pathway; be able to influence the decision making process; be prepared to test and implement changes across the pathway; be mandated to take decisions regarding changes/improvements in their respective areas. Should include an analyst/member of the audit department

6. Division of Primary Health Care First steps Identify an executive sponsor –Ask them to identify resource – money or people You need a team. Develop and tabulate a project plan Understand the current service using measures such as process mapping Collect baseline data and agree a data collection plan Design & test interventions

7. Division of Primary Health Care Different Levels of Mapping Enters OPD All Internal Processes Leaves OPD Sees admin Sees nurse Sees Consultant Has Tests Sees Consultant Etc etc High Medium Enters room Takes history Asst with undress Take weight, BP etc Etc Leaves room Asst patient onto scales Zero scales Take reading Etc Low Etc

8. Division of Primary Health Care Analysing the map Are we doing the right thing? (is it clinically effective) Are we doing them in the right order? Is the right/best person doing it? How co-ordinated is the patients journey? What information do we give to patients at what stage? Is the information useful? Baseline measurement: how often / how many / how much?

9. Division of Primary Health Care First steps Identify an executive sponsor –Ask them to identify resource – money or people You need a team. Develop and tabulate a project plan Understand the current service using measures such as process mapping Collect baseline data and agree a data collection plan Design & test interventions

10. Division of Primary Health Care Two sets of data Process data – necessary as part of bundle implementation –The Care Bundle Project will involve regular data collection via the BTS audit system: –https://audits/brit-thoracic.org.uk Outcome data for project evaluation – will be collected (and paid for) by UoB team

11. Division of Primary Health Care Process Data Plan for on-going manual data collection (where, when and how) Manual data collection informs process performance and is essential to ensure changes being made to processes achieve the intended outcomes.

12. Division of Primary Health Care If you don’t measure, you wont know… If the changes made have actually made a difference If it is an improvement How much difference the change has made If the improvement has stayed in place? – sustained How well the current testing is performing Whether aim has been reached How much variation there is in data/process

13. Division of Primary Health Care …………..when starting to measure: Seek usefulness not perfection Measure the minimum. The goal is improvement and not a new measurement system. Aim to make measurement part of the daily routine. Don’t let measure issues delay the start of your improvement work / PDSA cycles.

14. Division of Primary Health Care Data Entry Download the data collection forms to assist with collection of the data items Ensure you are registered for the BTS audit system and have access to the online Care Bundle data collection forms For each patient record or each set of monthly or yearly data click on the relevant link and add the data to the correct period.

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16. High Level Data – Derived from HES Data

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18. Data entry

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20. First steps Identify an executive sponsor –Ask them to identify resource – money or people You need a team. Develop and tabulate a project plan Understand the current service using measures such as process mapping Collect baseline data and agree a data collection plan Design & test interventions

21. Division of Primary Health Care ACT What changes can be made for the next cycle (adapt change, another test, implementation cycle?) PLAN Objective Prediction Plan for change (who, what, when, where) Plan for data collection (who, what, when, where) Carry out the change Document observations Record data DO Complete analysis of data Compare results to predictions Summarize knowledge gained STUDY How to use the PDSA Cycle Segmentation Useful allies Huddles not meetings Quick & dirty wins

22. Division of Primary Health Care Repeated Use of the PDSA Cycle Hunches Theories Ideas Changes That Result in Improvement AP SD A P S D AP SD D S P A DATA Very Small Scale Test Follow-up Tests Wide-Scale Tests of Change Implementation of Change What are we trying to accomplish ? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement Spread Sequential building of knowledge under a wide range of conditions 22

23. Division of Primary Health Care ≤ 20 implementation sites (COPD care bundle) ≤ 20 comparator sites (usual COPD care) QUANTATATIVE DATA 24 months - 12 months before and after implementation RESOURCE USE AND COST DATA Level 1: Hospital-level aggregated data Level 2: Individual-level patient data Level 3: Case-study data QUALITATIVE DATA From point of admission including post discharge follow up ≤ 30-90 days ≤8 implementation sites (COPD care bundle) ≤ 8 comparator sites (usual COPD care) ≤ 3-5 implementation sites (COPD care bundle) ≤ 3-5 comparator sites (usual COPD care)

24. Division of Primary Health Care Further meetings Second face to face meeting 11 th September –Review project plans and progress Feedback from each intervention site –Trouble shoot issues Opportunity for additional input if generic problems have become apparent

25. Division of Primary Health Care Project Information Project Website http://www.bristol.ac.uk/copd NIHR CRN Portfolio http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=17828 Dr. Anne Daykin, Project Co-ordinator: Anne.daykin@Bristol.ac.uk Problems with data entry: Carebundles@brit-thoracic.org.uk