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What is the Primary Care Benchmarking Project?. The new Primary Care Benchmarking Project is a tool that reports volumes of key marker tests, calculating testing rates per relevant patient group (where applicable) and analysing the impact of service usage on secondary care outcomes. - PowerPoint PPT Presentation
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What is the Primary Care Benchmarking Project?
• The new Primary Care Benchmarking Project is a tool that reports volumes of key marker tests, calculating testing rates per relevant patient group (where applicable) and analysing the impact of service usage on secondary care outcomes. – Test data collected for 27 key marker tests done for Primary Care– Data reported by Provider, by GP Practice, and by CCG– Data mapped to GP patient populations in a range of disease/condition
specific registered populations– Demographic factors such as deprivation index and age profiles– Number of admissions, number of bed days and cost of admissions
mapped from HES data to provide outcomes measures– Relevant guidance (eg NICE) included as targets/benchmarks, in addition
to the ability to include any locally agreed targets/benchmarks
What is it for?
• Enables labs to work with their customers and CSUs to:– Monitor service usage, eg volume of requests– Analyse the impact of appropriate requesting on patient outcomes– Inform demand management (optimisation!) strategy planning– Provide evidence around best practice– Monitor progress over time, assess the impact of any interventions
• Key points/objectives are as follows:– Joint working, creating a partnership between provider and customer– Have a positive impact on demand management strategies– Provide new data for research– Make pathology the centre of the patient care pathway, and turn it into
the hub of patient care and improvement
Story so far
• Began as a joint initiative between Keele and Leeds (YCHI) in 2007• Originally intended for NHS IC (now HSCIC) to host, but business
case fell through• Barnes Quality review work in 2013 identified that this project
would still be a valuable tool, particularly once the review was launched (which happened January 2014).
• KUBS funded pilot in 2013 took data from two sites – UHNS and Wolverhampton – to prove concept
• Now looking to roll out the pilot to interested labs in an ‘offline’ setting, with a view to assessing the viability of an online (and more automated) system further down the line
First of the ‘headline’ examples
• Early analyses of the data are already showing some interesting findings: – GP practices who request HbA1c tests within the recommended re-test
interval according to NICE guidelines (1-2 tests per year) have 15.3 less diabetes-related emergency admissions per 1,000 patients than practices who request outside of the guidance.
– They also have 88.6 less bed days (for diabetes-related emergency admissions) per 1,000 patients
– Their cost of emergency admissions for diabetes is £37 per patient lower than those who request outside of the guideline.
• There is a genuine incentive for HbA1c tests to be requested on time
• In some cases, additional work can lead to savings in secondary care
Variability and Trends
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HbA1c Tests Per Patient on Diabetes Register, Compared With NICE Guideline (Calculated to Monthly Equivalent) - Monthly Trend Data For Selected GP
PracticeSum of Tests Per: Diabetes Mellitus (Diabetes) Register (ages 17+)
Sum of Benchmark: HbA1c per diabetes patient (NICE Guideline) MONTHLY EQUIV
Linear (Sum of Tests Per: Diabetes Mellitus (Diabetes) Register (ages 17+))
Variability and Trends
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01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12
2012 2013
Test
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HbA1c Tests Per Patient on Diabetes Register, Compared With NICE Guideline (Calculated to Monthly Equivalent) - Monthly Trend Data For Selected GP
PracticeSum of Tests Per: Diabetes Mellitus (Diabetes) Register (ages 17+)
Sum of Benchmark: HbA1c per diabetes patient (NICE Guideline) MONTHLY EQUIV
Linear (Sum of Tests Per: Diabetes Mellitus (Diabetes) Register (ages 17+))
Analysis With Population Data
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£1,000
£1,200
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£1,600
GP5
581
GP5
593
GP5
600
GP5
610
GP5
586
GP5
604
GP5
603
GP5
608
GP5
583
GP5
587
GP5
606
GP5
591
GP5
588
GP5
592
GP5
589
GP5
605
GP5
601
GP5
607
GP5
595
GP5
582
GP5
598
GP5
579
GP5
597
GP5
599
GP5
596
GP5
580
GP5
590
GP5
611
GP5
585
GP5
594
Anonymised CCG 224
Diabetes Related Admissions Per 1,000 Patients Compared With Deprivation Score
Average of Diabetes Cost of Admissions Per Patient Average of GP Deprivation Score (IMD) Linear (Average of GP Deprivation Score (IMD))
Values
CCG Anonymised Name GP Anonymised Code
Average of Diabetes Cost of Admissions Per Patient Average of GP Deprivation Score (IMD)
Year Low Volume Practice Flag (Select 'No' To Exclude LVs) Test Name
Analysis With Population Data
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1.00
GP5
750
GP5
610
GP5
714
GP5
747
GP5
712
GP5
727
GP5
751
GP5
740
GP5
711
GP5
745
GP5
593
GP5
744
GP5
704
GP5
718
GP5
721
GP5
725
GP5
739
GP5
592
GP5
734
GP5
608
GP5
752
GP5
707
GP5
743
GP5
589
GP5
748
GP5
585
GP5
597
GP5
755
GP5
717
GP5
594
GP5
733
GP5
749
GP5
738
GP5
753
GP5
722
GP5
710
GP5
598
GP5
604
GP5
728
GP5
599
GP5
582
GP5
741
GP5
737
GP5
595
GP5
709
GP5
713
GP5
588
GP5
716
GP5
754
GP5
705
GP5
580
GP5
715
GP5
735
GP5
706
GP5
583
GP5
719
GP5
607
GP5
600
GP5
611
GP5
603
GP5
596
GP5
723
GP5
746
GP5
724
GP5
731
GP5
729
GP5
581
GP5
605
GP5
726
GP5
736
GP5
756
GP5
586
GP5
591
GP5
579
GP5
606
GP5
601
GP5
720
GP5
587
GP5
732
GP5
730
GP5
590
GP5
708
An
on
Thyroid Function Tests Per Patient on Hypothyroidism Register Compared With Percentage of Population Over 65
Average of Tests Per: Hypothyroidism Register Average of GP % Over 65 Linear (Average of GP % Over 65)
Values
GP Anonymised Code
Average of Tests Per: Hypothyroidism Register Average of GP % Over 65
Year Low Volume Practice Flag (Select 'No' To Exclude LVs) Test Name CCG Anonymised Name
Variability
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0
0.01
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0.09
0.1
GP5
610
GP5
713
GP5
738
GP5
736
GP5
586
GP5
611
GP5
592
GP5
732
GP5
754
GP5
729
GP5
717
GP5
588
GP5
743
GP5
722
GP5
608
GP5
724
GP5
600
GP5
714
GP5
735
GP5
745
GP5
741
GP5
605
GP5
726
GP5
609
GP5
599
GP5
591
GP5
601
GP5
583
GP5
706
GP5
728
GP5
603
GP5
747
GP5
709
GP5
720
GP5
731
GP5
595
GP5
739
GP5
723
GP5
746
GP5
607
GP5
604
GP5
756
GP5
598
GP5
744
GP5
597
GP5
594
GP5
730
GP5
715
GP5
740
GP5
590
GP5
593
GP5
606
GP5
582
GP5
737
GP5
596
GP5
589
GP5
721
GP5
733
GP5
734
Num
ber o
f Adm
issi
ons
Test
s Pe
r Pa
tien
t
Lithium Tests Per Patient on Mental Health (Bipolar) Register, Compared With Number of Bipolar Related Secondary Care Emergency Admissions
Average of Tests Per: Mental Health Register Average of Mental health - Bipolar Admissions Linear (Average of Tests Per: Mental Health Register)
Variability
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GP5
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GP5
598
GP5
728
GP5
710
GP5
741
GP5
739
GP5
595
GP5
745
GP5
726
GP5
709
GP5
610
GP5
743
GP5
593
GP5
756
GP5
751
GP5
735
GP5
718
GP5
744
GP5
749
GP5
594
GP5
585
GP5
722
GP5
755
GP5
730
GP5
607
GP5
740
GP5
716
GP5
712
GP5
747
GP5
704
GP5
727
GP5
753
GP5
719
GP5
592
GP5
738
GP5
582
GP5
596
GP5
579
GP5
580
GP5
737
GP5
707
GP5
715
GP5
708
GP5
717
GP5
754
GP5
599
GP5
591
GP5
603
GP5
711
GP5
733
GP5
725
GP5
604
GP5
705
GP5
589
GP5
732
GP5
714
GP5
734
GP5
752
GP5
586
GP5
721
GP5
608
GP5
736
GP5
748
GP5
606
GP5
609
GP5
746
GP5
601
GP5
731
GP5
723
GP5
611
GP5
729
GP5
597
GP5
590
GP5
720
GP5
587
GP5
706
GP5
713
GP5
583
GP5
588
GP5
605
GP5
724
GP5
628
GP5
581
Full
Blo
od
Co
un
t Te
sts
Per
1,0
00 P
atien
ts
Vit
amin
D T
ests
Per
1,0
00 P
atien
ts
Variability In Number of Vitamin D Tests Per 1,000 Patients (Compared with FBC Tests Per 1,000 Patients)
Vitamin D Full Blood Count
What will the outputs be?
• Proposed short summary report, one-page RAG coded dashboard, varies by target audience– One for each GP practice– One at CCG level– One at lab level
• Analysis tools provided so that further ‘drilling down’ into the data can be done in order to answer specific queries– Full training provided, of course!
• Quarterly (or monthly if there is a genuine need) updates of workload data to get up-to-date trend monitoring information
• GP workshops/interactive sessions to ensure data are having a positive impact
Select GP Practice: X12345
ANONYMISED GP SURGERY
1 Anonymous Avenue, Anonymous Town, Staffordshire
STx xXX
NHS NORTH STAFFORDSHIRE CCG (05G) *National represents only the data in the system at time of publication
General Information X12345
NHS NORTH STAFFORDSHIRE
CCG (05G) National*
NHS NORTH STAFFORDSHIRE
CCG (05G) National*Practice Population Served 6,326 5,702 6,071 10.9% 4.2%Deprivation Index 28.53 34.29 28.09 -16.8% 1.6%% Patients With Long Standing Conditions 68.6% 58.3% 57.4% 17.6% 19.6%% Patients Under 18 17.6% 21.8% 20.7% -19.5% -15.0%% Patients Over 65 20.1% 16.2% 17.6% 24.2% 14.2%% Patients Over 75 8.8% 7.3% 8.0% 20.4% 10.9%% Patients Over 85 2.1% 2.0% 2.2% 2.8% -6.7%
Diabetes X12345
NHS NORTH STAFFORDSHIRE
CCG (05G) National*
NHS NORTH STAFFORDSHIRE
CCG (05G) National*Patients on Diabetes Mellitus (Diabetes) Register (17+) 448 324 345 38.1% 29.8%HbA1c Tests per Patient on DM Register 1.63 2.19 2.35 -25.6% -30.5%Microalbumin Tests per Patient on DM Register 0.74 1.45 1.48 -48.8% -49.9%Cholesterol Tests per Patient on DM Register 0.06 0.29 0.28 -77.5% -77.3%Number of Diabetes Related Emergency Admissions 106 79 80 33.6% 32.4%Number of Bed Days: Diabetes Related Emergency Admissions 694 515 523 34.9% 32.8%Bed Days Per Admission: Diabetes Related Emergency Admissions 6.55 6.50 6.43 0.7% 1.8%Total Cost: Diabetes Related Emergency Admissions £285,880 £212,222 £215,376 34.7% 32.7%
Cardiovascular Disease X12345
NHS NORTH STAFFORDSHIRE
CCG (05G) National*
NHS NORTH STAFFORDSHIRE
CCG (05G) National*Patients on Cardiovascular Disease Register 156 182 187 -14.4% -16.7%Cholesterol Tests per Patient on Cardiovascular Disease Register 0.18 0.65 0.58 -71.5% -68.0%HDL Tests per Patient on Cardiovascular Disease Register 6.46 5.92 6.68 9.2% -3.2%Triglycerides Tests per Patient on Cardiovascular Disease Register 1.88 3.30 2.75 -42.8% -31.4%Number of Cardiovascular Disease Related Emergency Admissions 255 200 208 27.6% 22.9%Number of Bed Days: Cardiovascular Disease Related Emergency Admissions 1,671 1,257 1,302 32.9% 28.3%Bed Days Per Admission: Cardiovascular Disease Related Emergency Admissions 6.55 6.36 6.23 3.0% 5.2%Total Cost: Cardiovascular Disease Related Emergency Admissions £688,260 £520,468 £539,286 32.2% 27.6%
Chronic Kidney Disease X12345Patients on Chronic Kidney Disease Register 214 173 198 23.9% 7.8%Microalbumin Tests per Patient on Chronic Kidney Disease Register 1.56 2.93 2.84 -46.8% -45.1%Number of Chronic Kidney Disease Related Emergency Admissions 47 30 32 57.5% 49.1%Number of Bed Days: Chronic Kidney Disease Related Emergency Admissions 488 262 284 86.3% 71.8%Bed Days Per Admission: Chronic Kidney Disease Related Emergency Admissions 10.38 8.86 8.82 17.2% 17.7%Total Cost: Chronic Kidney Disease Related Emergency Admissions £191,660 £104,423 £112,997 83.5% 69.6%
Heart Failure X12345Patients on Heart Failure Register 31 45 47 -30.4% -34.7%BNP Tests per Patient on Heart Failure Register 0.39 0.88 1.07 -55.8% -63.9%Cholesterol Tests per Patient on Heart Failure Register 0.93 1.95 2.77 -52.4% -66.4%Number of Heart Failure Related Emergency Admissions 43 32 34 36.2% 27.6%Number of Bed Days: Heart Failure Related Emergency Admissions 375 303 327 23.6% 14.7%Bed Days Per Admission: Heart Failure Related Emergency Admissions 8.72 9.66 9.61 -9.8% -9.3%Total Cost: Heart Failure Related Emergency Admissions £149,620 £119,956 £129,128 24.7% 15.9%
Thyroid Disease X12345Patients on Hypothyroidism Register 212 173 189 22.8% 12.4%TSH Tests per Patient on Hypothyroidism Register 2.58 6.51 5.94 -60.4% -56.6%Free T4 Tests per Patient on Hypothyroidism Register 0.11 0.30 0.29 -61.9% -60.5%Number of Thyroid Disease Related Emergency Admissions 38 24 25 58.1% 50.4%Number of Bed Days: Thyroid Disease Related Emergency Admissions 295 168 179 75.7% 64.4%Bed Days Per Admission: Thyroid Disease Related Emergency Admissions 7.76 6.82 6.84 13.8% 13.4%Total Cost: Thyroid Disease Related Emergency Admissions £119,120 £68,602 £73,192 73.6% 62.8%
Stroke X12345
Average data for: M83005 compared with:
KUBS Primary Care Benchmarking GP DataSummary Data for 2013
www.keele.ac.uk/benchmarking
Average data for: M83005 compared with:
Average data for: M83005 compared with:
How to report back to GPs?
How to report back to GPs?(both MUST be completed)
Actual Values
Key: U&E (or equivalent) Requests from A&E Your Lab ANON ANON ANON ANON Mean Your Lab Min 1stQ Median 3rdQ Max Mean Target Turnaround Time 60 60 60 60 120 72 60 60 60 60 60 120 64 Proportion of Target Met 71.00% 75.00% 93.00% 95.00% 97.60% 86.32% 71.00% 71.00% 90.00% 93.00% 95.70% 100.00% 91.39%
(Key: red=highest, green=lowest. This in no way implies that one is necessarily better than another)
% difference: your lab compared to..
U&E (or equivalent) Requests from A&E Your Lab ANON ANON ANON ANON Mean Your Lab Min 1stQ Median 3rdQ Max MeanTarget Turnaround Time 60 0% 0% 0% -50.0% -16.7% 60 0% 0% 0% 0% -50.0% -5.6%Proportion of Target Met 71.00% -5.3% -23.7% -25.3% -27.3% -17.7% 71.00% 0% -21.1% -23.7% -25.8% -29.0% -22.3%
(eg +10% means your lab is 10% higher than the lab or measure (eg mean) in question)
Three-year sample dataU&E (or equivalent) Requests from A&E Your Lab ANON ANON ANON ANON Mean Your Lab Min 1stQ Median 3rdQ Max Mean
2012/13 60 60 60 60 120 72 60 60 60 60 60 120 64Target Turnaround Time 2011/12 60 120 90 60 120 90 60 55 60 60 60 120 66
2010/11 60 120 90 22 120 82 60 22 60 60 120 120 802012/13 71.00% 75.00% 93.00% 95.00% 97.60% 86.32% 71.00% 71.00% 90.00% 93.00% 95.70% 100.00% 91.39%
Proportion of Target Met 2011/12 83.00% 90.00% 98.80% 95.00% 98.20% 93.00% 83.00% 49.23% 88.70% 93.63% 96.56% 100.00% 90.97%2010/11 83.70% 90.00% 98.50% 97.00% 98.00% 93.44% 83.70% 53.79% 87.01% 95.90% 99.30% 100.00% 90.91%
Your Peer Group Entire Group
Figure 4: Turnaround Times for U&E Requests from A&ESelected Lab: Cambridge University Hospitals NHS Foundation Trust
Your Peer Group Entire Group
Your Peer Group Entire Group
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Your Lab ANON ANON ANON ANON Mean
Your Peer Group
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Your Lab Min 1stQ Median 3rdQ Max Mean
Entire Group
How to report back to GPs?
• Needs to be short and to the point– No time to analyse more data or read in-depth reports
• Relevant comparisons need to be made– Within ‘peer group’– Within CCG– Within wider/national context?
• Workshops/interactive sessions need to involve representatives from the laboratory and CCG/CSU
• Who sends the data to GPs? – Keele to send direct?– Labs provided with the tools to engage with their own GPs/CSUs?
Will it make a difference?
• The next 12 months will tell us! – Pilot continuing with North Staffs and Wolverhampton
• Data to be presented to CSUs and GPs• Monitor improvements/changes over the course of the pilot
– Recommendation has been made within Lancashire CSU for their laboratories to join the pilot
– Extending the pilot out to other interested labs
• GP workshops at UHNS seemed to make a difference regarding requesting practice as part of the INTERCEPT study, suggesting that engagement between laboratory and customer (using data and evidence) makes a difference
Feedback
• Any feedback, suggestions and questions would be most welcome!
• Contact me for further information on [email protected] or 01782 733277.