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Chris Packham Director of Public Health Nottingham

Quality improvement to ensure health gain (and Health Inequalities reductions) an example: commissioning cardiovascular risk management. Chris Packham Director of Public Health Nottingham. DH, Health inequalities intervention tool: view your gap. Health outcomes in context.

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Chris Packham Director of Public Health Nottingham

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  1. Quality improvement to ensure health gain (and Health Inequalities reductions)an example: commissioning cardiovascular risk management Chris Packham Director of Public Health Nottingham Nottingham City PCT

  2. DH, Health inequalities intervention tool: view your gap Nottingham City PCT

  3. Health outcomes in context Nottingham City PCT

  4. Nottingham City PCT

  5. QOF performance – cholesterol outcomes Nottingham City PCT

  6. Nottingham Nottingham City PCT

  7. Understanding unmet need and inequality Eg: Heart disease deaths and Statin prescribing by GP practice Nottingham City PCT

  8. Commissioning Healthcare for Best Outcomes Optimal Population Outcome Challenge to Providers Population Focus 5.Supported self-management 10. Engaging the public 13.Networks,leadership and coordination 4. Responsive Services 9. Accessibility 7. Local Service Effectiveness 2. Expressed Demand 1.Known Population Health Needs 6.Known Intervention Efficacy 12. Balanced Service Portfolio 3. Equitable Resourcing 8.Cost Effectiveness 11.Adequate Service Volumes Nottingham City PCT

  9. Design (Commissioning) challenges • How to stop the CVD risk programme work widening inequalities? • How to encourage people to turn up for assessment and then take part in interventions? Nottingham City PCT

  10. Mosaic Group F: people living in social housing with uncertain employment in deprived areas Eg: Social marketing methodologies Nottingham City PCT

  11. Local estimation NICE guideline 67 tool http://www.nice.org.uk/guidance/index.jsp?action=download&o=40777 QRISK 40-74 3% 40-54, 97% 55-74 Framingham 40-74 7% 40-54, 93% 55-74 But S Asian and AC groups may need DM case finding from age 30 ‘CKD’ From a population of 300,000… How many patients are we seeking for primary prevention? Existing CVD 11,000 For a population of 300,000, around 12,500 out of 35,000 55-74’s estimated at risk (Framingham) Getting the technical data right:understanding the CVD risk 40-74 task Nottingham City PCT

  12. our ‘Intervention’: first stage startedmost deprived quintile – 14 practices: 8000 patients 45-74 • Trained HCAs • Computer generated lists of at risk patients • 30% one or more risk factor recorded • ABPI partnership project • Called in, risk assessed, interventions agreed • Referred on the GP/PN as necessary • Outcomes monitored • Targeted using successive 5-year descending age bands Nottingham City PCT

  13. Results • first 2 months • attendance rate 73% (65% plus a further 8% on one reminder) • 260 seen all>20% • 40% already on treatment • About 50% sent to GP/PN to date • 1 in 5 put onto drug treatment immediately • 4% new Diabetics Nottingham City PCT

  14. Locally Enhanced Service for 55-74’s Option to use HCA model 40-54’s ?Alternative model Year one Hypertensives all ages BMI>35 Year two 55-74 one or more risk factor All BME 40-74 Year three Rest 55-74 our ‘Intervention’: second stage50 practices - 27,000 patients55-74 Nottingham City PCT

  15. Problems The DNAs Compliance Clinical buy-in Community awareness Must have supporting delivery Healthier Communities Collaborative Primary prevention HEAs on hospital and tertiary end Health trainers / PH nutrition teams / smoking cessation services Look carefully at primary care data Challenges and solutions Nottingham City PCT

  16. Population quality Empowering / Healthier Communities Collaboratives Decent Health Equity Audits Designed around populations as well as practices (eg BME) Individual care quality QOF Use Accepted interventions Guideline audits Patient satisfaction and accessibility Commissioning Healthcare for Best OutcomesNST – HI support team Prof Chris Bentley For both make sure the supporting community services are in place and part of patient pathways and at industrial scale Nottingham City PCT

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