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Why? People want to stay in their home as long as possible NHS funding requires reduction in unplanned admissions Reducing patient harm New GP DES - Unplanned admissions Enhanced Service
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Risk Stratification and Medicines Optimisation
Helen LiddellLeeds South & East CCG
• Why Risk Stratification• What is Risk Strat?• Limitations of Risk Stratification• What implications for Medicines Optimisation
Why? • People want to stay in their home as long as
possible• NHS funding requires reduction in unplanned
admissions• Reducing patient harm• New GP DES - Unplanned admissions Enhanced
Service
4
The workload / cost distribution
Emergency admissions are draining resources. They account for the most cost and days
56% PBR budget is allocated to emergency care for
48%59%
84%
52%41%
16%
Spells Cost Days
Emergency Elective
160K £215M
Source: NHSIC. Data Leeds CCGs 11/12
What?Risk profiling a population
Risk profiling and case management• Individualised Care plans• Telehealth• Community Matrons• Case Managers – Elder Care Facilitators• Intensive support for LRCs• Third sector and voluntary organisations• Medicines Optimisation?
Limitations of tools
• Medicines costings are inaccurate• Coding errors• Rare and spurious conditions • Expense and time
Medicines Optimisation in targeted populations• In Care Homes• 4 or more medicines• with renal disease• Post discharge• Taking high risk medicines• Those identified by a risk prediction tool• Those with a particular condition• Those referred to a service
A vision of care services in 5 years
The House of Care model
Performance Measures•A measure to evaluate how well a programme, agency or service system is working.
•Three questions:•How much did we do? (quantity)•How well did we do it? (quality)•Is anyone better off as a result? (quantity and quality of effect or customer/client outcomes)•Performance measures tell us how well service providers are working as opposed to the impact on whole populations
From ends to means
ENDS
OUTCOMES“A condition of well-being for children, adults, families or communities”
PERFORMANCE MEASURES“A measure to evaluate how well a programme, agency or service system is working”
MEANS
INDICATORS“A measure which helps quantify the achievement of an outcome”
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Further opportunities?• More patient contact• Links with Community Pharmacies• Social Services• Intermediate Care Team• Hospital discharge pharmacists
Where does Medicines Optimisation fit in?
