S164 day 1 - 1430 - what will you do to improve longer lives

Longer Lives and beyond…

Longer Lives

Don Sinclair, Julian Flowers &

Helen Shaw

Public Health England

Today’s session The story of the Longer Lives tool

Next steps for Longer Lives

Another related high priority project

Advice from the floor on user engagement

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Background

UK health performance: findings of the Global Burden of Disease Study 2010*

For both mortality and disability, overall health has improved substantially in absolute terms in the UK from 1990 to 2010… However, the UK performed significantly worse than the EU15+ [Australia, Canada, Norway & USA] for age-standardised death rates, age-standardised Years of Life Lost rates, and life expectancy in 1990, and its relative position had worsened by 2010… * Murray C et al, Lancet 2013; 381: 997–1020

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Longer Lives

A web tool designed:

• To show premature mortality from “big killers” in a simple and transparent way

• At upper tier local authority level (England)

• Benchmarked to the national average and similarly deprived areas

Also linked to causes, evidence and feedback

http://longerlives.phe.org.uk

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Landing Page Introduction to the website

Maps premature mortality across England

Local authorities can be selected by name, postcode or by clicking

Links to more details about the project, feedback page, and the current “hot topic” e.g. liver disease

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Ranked list of all

local authorities

Ranked list of premature

mortality for all local

authorities

Colour shows statistical

comparison with England

average

Toggle between premature

deaths per 100,000 people

and total premature deaths

for an area

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Similarly deprived

local authorities

Ability to compare a local

authority with other authorities

in the same socioeconomic

deprivation bracket

Ranks can be for overall

premature mortality or for

each individual cause

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Local Authority

Pages

Ranks are displayed and colour-coded

Links to information about the common causes and interventions for each disease type

Links to relevant PHE campaign pages for individuals interested in reducing their risk

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Example of a local authority

with high rates of premature

mortality

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Local Authority

Page

Causes of Premature

Mortality

Brief description of causes

Links to information about risk factors

Example case study demonstrating a successful population intervention

Links to further information about risk factors, NICE guidance and campaign resources for local authorities

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Preventing harm at population level

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Preventing harm at individual level

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Next steps

Data was updated in February with summary of how local authorities’ data had changed

• Make all data available at district level

• Disaggregate cardiovascular mortality

• Disaggregate cancer mortality

• Add suicides (& undetermined injuries)

• Add accidents

• Include comparators available in PHOF

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Further next steps

• Add trends where possible

• Add wider determinants and risk factors

• Improve links to information on causes

• Review comparators to find those most useful to local authorities

• Add more case studies with evidence of delivering health improvement

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Co-ordination – PHE & partners Process across the whole of PHE – linking with partners

(e.g. ADPH, LGA, HSCIC, NHS England)

• Synergy in PHE processes

• Increased efficiency

• Standardised quality assurance

• Best practice in visualising data

• Shared learning across all projects

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New Priority

In 2014, Secretary of State has a new priority to illustrate chronic diseases in primary care

• Based on Longer Lives website design

• Show data on home page at LA and CCG levels

• Map selection links to simplified profile for selected area, or to practice profiles

• Include summary measures or ratings of practices or other areas

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Aims

• Show variation in prevalence, activities and outcomes

• Highlight areas of better and less good practice

• Ease of use / transparency

• Ongoing development in response to feedback

• Start with diabetes as an important long term condition

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Purpose of rating CCGs & practices

• Increase accountability

• Aid choice

• Improve performance (of providers)

• Identify and prevent failures in the quality of care

• Public reassurance as to the quality of care

http://www.nuffieldtrust.org.uk/blog/should-there-be-ofsted-style-ratings-health-and-social-care-providers; accessed 23rd Feb 2014

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Ratings could improve accountability if… • Simple

• Valid

• Publicly reported

• Improve performance (of providers)

• Identify and prevent failures in the quality of care

• Public reassurance as to the quality of care

http://www.nuffieldtrust.org.uk/blog/should-there-be-ofsted-style-ratings-health-and-

social-care-providers; accessed 23rd Feb 2014

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Summarizing - ratings • Outlier approach (assurance tool)

• Z-score approach (CQC)

• Target exceedence

• Profiling

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Contextual information • Number of people with diabetes

• Obesity

• Deprivation

• Ethnicity (? South Asian)

• Age profile (%>50)

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Example QOF indicators –

Practice & CCG Outcomes

% of patients with diabetes in whom the last IFCC-HbA1c is 59 mmol/mol or less in the preceding 15 months

% of patients with diabetes in whom the last blood pressure is 140/80 or less.

% of patients with diabetes whose last measured total cholesterol within the preceding 15 months is 5mmol/l or less

Process

% of patients with diabetes whose notes record BMI in the preceding 15 months

% of patients with diabetes with a record of neuropathy testing in the preceding 15 months

% of patients with diabetes who have a record of retinal screening in the preceding 15 months

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Showing variation…?

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Diabetes control

Feet checked for nerve

damage

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Practice search

Selected practice on map – map shows

All in CCG RAG rated – shows initial indicator

Selected practice on map – shows

profile of indicators.

Clicking indicators on profile displays

on map

Area selection gives

CCG profile using call out box

Longer lives map

CCG profile based

On LLs

CCG map

Showing practice variation

Practice profile showing

all indicators

Wicked issues

• Roles and responsibilities/ ownership and coproduction

• Linking with other products

• Benchmarking (compared to who?)

• Colour schemes for presentation (RAG or BOB)

• Qualitative statements

• Getting user input/ feedback

• Simplicity vs. over-simplification

• Creating a summary metric/ rating

• Timescale….

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How can you help…. • Join the reference/ working group

• Feedback on design

• Feedback on indicators/ methodology

• Test prototypes

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Engagement • User input critical to success

• Accessible and transparent

• Iterative improvements

• Representation in governance

• Direct feedback

• PLEASE VOLUNTEER!

longer.lives@phe.org.uk

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Image via http://www.pgdba.org/wp-content/uploads/2013/06/we-need-you.jpg

Advice from the floor Who might use such a tool?

Which decisions would be made?

Which information would be required?

How should this information be presented for users?

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Please volunteer

longer.lives@phe.org.uk

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Image via http://www.pgdba.org/wp-content/uploads/2013/06/we-need-you.jpg