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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
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
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
“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
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
Challenges in establishing an MCN
• Resources– Financial– Management and clinical energy
• Perceived reduction in services already covered by MCN
• Size of patient pools
MCN
HEALTH
LOCALAUTHORITY
PATIENT AND CARER
VOLUNTARYSECTOR
PRIVATE SECTOR
What is an MCN?
Who is involved?
Clinical Lead
Protected Time
Need not be theRecognised expert
Who is involved?
MCN Manager
Dedicated resource
Support MCN project work
MCN Support
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
Actions & outcomes
Information resourcesfor clinicians, patients and family members
Actions & outcomes
Development towards an MDT clinic for small patient groups who don’t have
access to any dedicated service
Actions & outcomes
Disease specific developments to meet gaps in the existing service
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
Actions & outcomes
Interaction with patientgroups and voluntarysector organisations
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
Types of audit data
• Quantitative or qualitative (numbers or words)?
• Interval or continuous?
• Sample or population?
• Internal or external?
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
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
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
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
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