We’re highlighting four projects, all funded through our Innovating for Improvement programme, that are testing new approaches to using data for quality improvement. One project has just concluded, while the other three have just begun. All show real promise for the ways innovative use of data can transform and improve patient outcomes.
The Valentine Health GP Partnership in South East London, like most GP practices, faces rising demand. Patients can experience long waits for appointments and may struggle to see their own GP.
As part of their Innovating for Improvement project, the practice identified that more personalised care for the most frequent users of GP services (those with over 15 clinical contacts per year) could improve both the quality and sustainability of the care they receive, as well as reducing the number of GP appointments needed by these patients.
Working with the data analytics team at the Health Foundation, the medical records of over 25,000 patients were analysed to gather demographic and clinical information about the highest users. Detailed interviews with some of these patients then explored their recent experiences of using the practice.
Following this investigation, the practice has designed and delivered a range of interventions, including:
- Tagging the medical records of frequent users to ensure they are seen consistently by one doctor or a small team of identified clinicians
- Training staff in using non-medical approaches – such as motivational techniques – where clinical avenues have been explored and excluded
- Improving data coding and regular data analysis to identify new frequent users.
The practice identified 65 patients to take part in the project. Although some clinicians were slow to engage with the new interventions, the evaluation found that patients receiving the interventions had, on average, 4.3 fewer contacts per year when compared to other frequent users. People working at the practice felt that some patients benefited from improved quality and continuity of care, and some experienced greater satisfaction from the improved relationships built with patients.
Dr Rebecca Rosen, who led the project says, ‘Our project goes against prevailing pressures to see patients faster and faster, and instead gives patients more continuous and personally tailored care.
‘We are analysing our practice data in quite simple ways at this stage. I think there is more we can do with data to spot patients who are becoming high users earlier and work with them to prevent their problems from deteriorating.’
A project which began this month in North East Lincolnshire aims to reduce the number of suicides, and improve patient safety, by using an innovative presentation of data.
Leading the project is NAViGO Health and Social Care CIC (NAViGO), a not-for-profit social enterprise that provides mental health care and support to people in the area.
The project combines national data on suicide/premature mortality risk factors (from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness), with locally collected data on service users’ circumstances. This information is presented to clinical staff in mental health services via a data dashboard, making it easier for them to identify patients at risk of self-harm or suicide.
The dashboard displays patients in order of those at highest risk, flagging up wherever a contact is overdue. By also including physical health information, the project encourages collaboration between secondary, primary and mental health care. Where there are gaps in a patient’s record, this acts as a prompt for clinicians to refer to other areas for testing or treatment – leading to improved outcomes for patients.
Lisa Denton, NAViGO Head of performance and business support, says, ‘We don’t believe data from the National Confidential Inquiry is being used proactively like this anywhere else in the country.
‘From a staff perspective it’s already immensely rewarding. Clinicians are seeing all this data that they routinely collect actually be put to practical use, and it gives non-clinical members of staff the opportunity to save lives. That’s what we all come to work to do but sometimes people who are not at the front line don’t get to see the direct impact we can make.’
A new project starting this month will use data analysis to establish a much deeper understanding about the associations between long-term health conditions and social and economic factors.
Citizens Advice South Liverpool (CASL) and NHS Liverpool Clinical Commissioning Group (CCG) will share and link their data, analysing it against different variables to identify which patients with long-term conditions would benefit the most from additional non-clinical interventions. These people can then be referred to the Liverpool Advice on Prescription in Primary Care project (Liverpool APP).
Run by CASL in partnership with the CCG, this service helps to alleviate poverty and hardship among people with long-term conditions and/or mental health problems. It allows primary care teams to address underlying causes of ill health, for example financial hardship, housing difficulties, debt, domestic abuse, social isolation and fuel poverty, and refer people for advice and support.
This approach will initially be piloted within the Liverpool Integrated Respiratory Service, testing how this type of service can work in a specialist clinical care setting. A trained advisor from Liverpool APP will be based in respiratory services to help with initial assessment and onward referrals.
Dr Janet Bliss, Liverpool CCG clinical lead for long-term conditions and the development of Liverpool’s new community model, says, ‘The facility to triangulate clinical risk factors with socio-economic factors isn’t routinely available in any part of the country. Our partnership with the CASL provides us with the opportunity to develop this for Liverpool. We have put a lot of thought and effort into linking data, and using risk stratification tools to help identify patients who would benefit from proactive and multi-disciplinary care.
‘This project now gives us the opportunity to join up innovations in data analysis, with the successful work we’re doing in the APP service, to reduce the adverse impact of social and economic risk factors on people’s health and well-being. The opportunity to generate an in-depth understanding of the combined impact of clinical and non-clinical factors – well, it jumped out at us.’
An estimated 60,000 people in Scotland have a rheumatology diagnosis.
This project, led by Healthcare Improvement Scotland, will focus on improving quality of care for rheumatology patients, and increasing self-management. The project team will pilot a quality registry in two health board clinics in Scotland, reaching a minimum of 200 patients.
Quality registries, which capture individual patients’ problems, treatments and outcomes over varying periods of time, have been found to be a successful way of improving care in other countries such as Sweden.
In this pilot, patients will be able to log their own symptoms via an online tool, which clinicians will then view and add to from their dashboard at the clinic. Clinical interventions, review or assessment will be triggered based on the measures reported on by patients.
The registry will provide clinical teams with information for benchmarking and evaluating change, and will support quality improvement initiatives and cost management. Importantly, it will also increase patient involvement and self-management.
Dr Martin E Perry, Consultant Physician & Rheumatologist, says, ‘This is a once in a generation opportunity to better understand how rheumatic diseases affect people in Scotland. The success of a similar system in Sweden has also provided information about national prescribing, disease trends and impact on social care. So we hope to create a system that allows more patient autonomy for triggering review, more information for clinicians seeking to improve quality of care and a resource for academics and researchers.’