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A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

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Page 1: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

A managed care network for patients with neurological

impairment

Malcolm Macleod (Clinical Lead, Neurology)and

Derek Blues (MCN Manager)NHS Forth Valley

Page 2: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Models of organisation

• …for a disease? – epilepsy, MND, MS …

• …for all neurological diseases? – so no discrimination on the grounds of

prevalence

• …for all neurological impairments?– so no discrimination on the grounds of

organicity – what’s important are the symptoms not the cause

Page 3: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Diagnostic apartheid and QiS

• 5 “important” “diseases”– Epilepsy, PD, MS, MND, headache

• Either:– Other diseases (i.e. patients) not as much of a

priority (care already considered adequate, patients not as “deserving”)

– Other patients are as much of a priority, and due attention to generic standards will improve the quality of much of their care

Page 4: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

“Other patients are as much of a priority, and due attention to generic standards will improve the quality of

much of their care”

• Aspiration

• Inappropriate focus on disease specific standards will distract effort from other areas

• Some disease specific standards may have generic isoforms or homologues– Medicines reconciliation and timing

Page 5: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Opportunities in establishing an MCN

• Ensure an holistic approach to audit driven activities

• Sustaining existing MCN activities

• Broader platform for consultation

• Coherent input to planning and management

• Platform for research and audit

• Pooling and sharing of resources

Page 6: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Challenges in establishing an MCN

• Resources– Financial– Management and clinical energy

• Perceived reduction in services already covered by MCN

• Size of patient pools

Page 7: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

MCN

HEALTH

LOCALAUTHORITY

PATIENT AND CARER

VOLUNTARYSECTOR

PRIVATE SECTOR

What is an MCN?

Page 8: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Who is involved?

Clinical Lead

Protected Time

Need not be theRecognised expert

Page 9: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Who is involved?

MCN Manager

Dedicated resource

Support MCN project work

MCN Support

Page 10: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley
Page 11: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley
Page 12: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

What is an MCN?

A sensible way of organising for effective

team working

The chance to use one voice to influence

strategic direction

The focal point for service development for

a specific disease or for a particular area of care

Page 13: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Actions & outcomes

Information resourcesfor clinicians, patients and family members

Page 14: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Actions & outcomes

Development towards an MDT clinic for small patient groups who don’t have

access to any dedicated service

Page 15: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Actions & outcomes

Disease specific developments to meet gaps in the existing service

Page 16: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Actions & outcomes

CREATE SESSION – 17 JUNE 2010

Who gets it?

What conditions are we

talking about?

How manypeople ?

Who is involved inproviding the care?

What else can we do?

What is aNeurological condition?

What effects dothey have?

Questions

Opportunities for education

Page 17: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Actions & outcomes

Interaction with patientgroups and voluntarysector organisations

Page 18: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Contact details

01786 457256

[email protected]

Page 19: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Demands for data

• QiS Audit• Other national audits

– MS Register, SAIVMS, MND audit, BNSU audits• 18 weeks RTT compliance• Revalidation• Service design• Feasibility of research projects• Long term conditions framework and avaiodance

of admission• Scottish Patient Safety Program

Page 20: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Types of audit data

• Quantitative or qualitative (numbers or words)?

• Interval or continuous?

• Sample or population?

• Internal or external?

Page 21: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

A local solution to data management

• Principle: – a single patient data management system which will

serve these multiple demands for data

• Desirable characteristics:– Simple to use– Avoids duplication of effort– Adaptable to local needs– Secure– Common data definitions– Data available to those who need it

Page 22: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley
Page 23: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Ward referral: delay to opinion

Mean Wait > 24hrs Total % breach

April 19.3 2 4 50

May 33.0 8 17 47

June 14.3 3 21 14

July 21.8 5 14 36

August 56.8 3 5 60

September 34.9 2 12 17

October 18.4 5 13 38

November 12.7 3 9 33

31 95 33

Page 24: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Delay until letter despatched

nmean typing

max typing

mean checking

max checking

mean total

max total

Q1 139 22.6 35 3.0 12 25.5 42

Q2 225 11.1 146 7.0 35 18.0 146

Q3 219 16.5 69 4.9 27 21.4 73

Page 25: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Patients referred since 1st April within 3 weeks of tripping 18 weeks

CHI Investigation Date requested

xxxxxxxxxx NCS 24/09/2010

xxxxxxxxxx MRI spinal cord 29/09/2010

xxxxxxxxxx EMG 29/09/2010

xxxxxxxxxx FSH genetics 29/09/2010

xxxxxxxxxx MRI brain 29/09/2010

xxxxxxxxxx eyewitness 18/08/2010

xxxxxxxxxx MRI brain 05/10/2010

xxxxxxxxxx AChR antibodies 12/10/2010

xxxxxxxxxx EMG 12/10/2010

xxxxxxxxxx MRI brain 12/10/2010

xxxxxxxxxx CSF protein/ glucose/ cell count 18/08/2010

xxxxxxxxxx CSF protein/ glucose/ cell count 17/09/2010

xxxxxxxxxx ECG 20/08/2010

xxxxxxxxxx eyewitness account

xxxxxxxxxx NCS 20/08/2010

xxxxxxxxxx MRI spinal cord 15/09/2010

xxxxxxxxxx routine bloods 15/09/2010

xxxxxxxxxx MRI brain 13/10/2010

xxxxxxxxxx MRI brain 29/09/2010

xxxxxxxxxx MRI brain 12/10/2010

xxxxxxxxxx MRI spinal cord 12/10/2010

xxxxxxxxxx NCS 12/10/2010

xxxxxxxxxx ct angiogram 14/10/2010

xxxxxxxxxx MRI brain 14/10/2010

Page 26: A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

Other uses

• Record assent to be contacted for audit, research

• Disease specific activity statistics

• Disease specific audit reporting (BSNU)

• Linkage to specialist nurse held data systems

• Patterns of requesting investigations