Developing Quality Indicators & Dashboards for Dementia

1. Developing Quality Indicators & Dashboards for Dementia Adam Cook South East Coast Quality Observatory

2. Team of 12 Provision of benchmarking Over 50 tools and products developed Skills development Analytical Measurement and interpretation Data quality improvement World Class Commissioning support Developing meaningful clinical metrics Focus on measurement for improvement rather than judgement The Quality Observatory

3. BANNED

4. Developing dementia metrics • Undertaken jointly with the NHS Information Centre • Dementia and Stroke • Commenced October 2007 • Regular meetings with a wide range of clinicians across South East Coast • Aim to develop metrics from existing electronic data sources to evidence • The quality of care provided • Whether national standards and recommendations were met • Whether agreed pathways are adhered to • Cost effectiveness of treatment • Variation between different providers • The impact of care in one part of the system further down the pathway • Where ‘best’ is delivered • Provide a balance of measures to prompt questions and discussion • Aimed to influence:- • Influence national developments and recommendations • The priority given to new data collections or mandatory collection of new fields on information systems • Linked to the National Dementia Strategy working group

5. The first meeting… • Describing data sets that were available: - • QOF • Programme budget • Acute Trust inpatient data • Mental Health inpatient data • Prescribing data • PCT population data • MHMDS (not used due to data quality issues – valuable for future) • Critical step as many clinicians were unaware of available data sources • Brainstorming: - • Areas to focus on • Potential indicators

6. The wish list……… • Actual numbers diagnosed compared to prevalence definite • Mapping the different types of activity within a system e.g. acute Trust admissions, community contacts, admission to acute mental health beds, day care attendances • Information on CT/MRI scans • The impact of memory assessment services • Duration of condition pre-diagnosis • Age at diagnosis • Impact of prescribed drugs • The cost of care in different areas

7. The Reality…… • Data sets not available to support all measures • Outpatients • Scans • Some information held in patients notes • Data quality poor in some areas • Some data sets available in theory, but difficult to obtain • E.g. prescribing data • However, some indicators could be produced • Spend on organic mental disorders • % practices that can produce a dementia register • % patients reviewed within past 15 months • Information on admissions to provider units • Comparison of predicted numbers vs numbers on register by GP practice • Combining these created a compelling story…. • Combination of SHA and CHKS analysis

8. Apparent disinvestment PCT Spend - dementia

9. QOF register - dementia • Utilised Alzheimer’s Society Dementia UK prevalence model • Comparison with numbers on dementia registers • Analysis to GP practice level (using practice profiles)

10. Acute Admissions

11. Challenging for local commissioners • “You can’t use the Programme Budget data – it’s wrong” • Disinvestment + evidencing relatively low levels of diagnosis • Significant sums being spent in secondary care • Could money be spent more effectively?? • Analysis has influenced the service models developed by local PCTs • Were commissioners aware of their ‘story’ • Prompted lots of discussion and debate

12. Are there inter-relationships?

13. Monitoring Tool – provider based

14. Monitoring Tool – commissioner based

15. Monitoring Tool – social care based

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18. Contact details nww.sec.nhs.uk/qualityobservatory Register as a user Adam Cook 01293 778846 Adam.cook@southeastcoast.nhs.uk