Managing Long Term ConditionsWhat information is available to help you and your organisation

Healthcare Efficiency Through Technology 2014

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The King’s Fund

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The National Picture

• National Institute for Health and Care Excellence (NICE)– Quality Standards, Technology Appraisals,

Guidelines; social care, public health, healthcare

• Public Health England (PHE)• Office for National Statistics• NHS England• Department of Health• Health and Social Care Information Centre

The prevalence of longstanding illness among men increased overall from 40 per cent in 1993 to around 44 per cent between 1997 and 2003, but appears to have decreased gradually over the last few years; it was 35 per cent in 2012. Among women, prevalence increased from 40 per cent in 1993 to 47 per cent in 2004, but has since decreased and was 41 per cent in 2012.

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1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003a 2004 2005 2006 2007 2008 2009 2010 2011 20120

5

10

15

20

25

30

35

40

45

50

Percentage with Long Standing Illness

Men Women

All

Source: Health Survey for England 2012, Trend Tables, Table 11

Population Level Health Information

More women than men reported chronic pain

• Overall, 31% of men and 37% of women reported this. The prevalence of chronic pain increased with age, from 14% of men and 18% of women aged 16-34 to 53% of men and 59% of women aged 75 and over. (Source HSE 2011, Chapter 9)

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16-34 35-44 45-54 55-64 65-74 75+

0

10

20

30

40

50

60

70

Men

Women

Age group

Per

cen

t

Figure 9APrevalence of chronic pain, by age and sex Base: Aged 16 and over

• Chronic pain is defined as pain or discomfort that troubles a person all of the time or on and off for more than three months. It has been shown to be associated with a number of negative outcomes including depression, job loss, reduced quality of life, impairment of function and limiting daily activities.

Less affluent people more likely to report chronic pain.

• Those living in the lowest income quintile of equivalised household income were more likely to report having chronic pain (40% of men and 44% of women) than those in the highest income quintile (24% of men and 30% of women respectively) (Source HSE 2011, Chapter 9)

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• Chronic pain is defined as pain or discomfort that troubles a person all of the time or on and off for more than three months. It has been shown to be associated with a number of negative outcomes including depression, job loss, reduced quality of life, impairment of function and limiting daily activities.

Highest 2nd 3rd 4th Lowest

0

5

10

15

20

25

30

35

40

45

50

Men

Women

Equivalised household income quintile

Pe

rce

nt

Relationship between longstanding illness and mental health

• 34% of men and 42% of women with a longstanding illness had a high GHQ-12 score; by contrast, just 7% of men and 11% of women with no longstanding illness reported probable mental ill health. (Source: HSE 2012)

• The 12-item General Health Questionnaire (GHQ-12) is a widely used and validated measure of mental health.

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Mental Health Minimum Dataset

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Proportion of people who feel supported to manage their long-term condition

CCG Outcomes Indicator Set and NHS Outcomes Framework

Nationally 65.6% of people feel supported

CCG variation from 53.9% in Brent to 75.4% in Newcastle North and East

Other indicators:• Health Related Quality of Life

for Carers, aged over 18 years

• Health Related Quality of Life for People with Long Term Conditions (and NHSOF)

• Unplanned hospitalisation for Chronic Ambulatory Care Sensitive Conditions

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Emergency Admissions for Alcoholic Liver Disease

CCG Outcomes Indicator Set

Other Indicators:• Under 75 mortality rates from

cardiovascular disease; from respiratory disease; from liver disease; from cancer

• Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s

NHS Outcomes Framework Indicators:• Excess under 75 mortality rate in

adults with serious mental illness• Employment of people with

long-term conditions and mental illness

• Emergency admissions for people with long-term conditions

Quality and Outcomes Framework (QOF)

• The primary use of QOF is an incentive payment scheme. Its main objective is to improve the quality of care patients receive by rewarding practices for this care. It is a voluntary scheme that most practices participate in – 8020 in 2012/13.

• At HSCIC we use this data for secondary purposes and publish recorded prevalence, points achieved and exceptions for each general practice that takes part.

• One of the domains (Clinical) within QOF deals primarily with long term conditions. There are 20 in total of these for 2013/14 and they include Cancer, Dementia, Coronary Heart Disease, Mental Health and Stroke.

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Quality and Outcomes Framework (QOF)

An example of data derived from QOF

• HSCIC publish the QOF annually• All results are publicly available through www.hscic.gov.uk/qof• There is an online database of the latest years results at

www.qof.hscic.gov.uk• The next results for 2013/14 QOF data will be published on the 28th October

2014

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31 Mar 2007 31 Mar 2008 31 Mar 2009 31 Mar 2010 31 Mar 2011 31 Mar 2012 31 Mar 20130.00%

0.10%

0.20%

0.30%

0.40%

0.50%

0.60%

0.40% 0.41% 0.43%0.45%

0.48%0.53%

0.57%

Dementia Prevalence in England

Diabetes – The National Diabetes Audit

Age and Gender of Patients with Type 1 Diabetes

Age and Gender of Patients with Type 2 Diabetes

Mortality Analysis: 2011-2012

• Linked NDA patients to death registrations using the MRIS service

• Between 1 January 2012 and 31 December 2012 people with all types of diabetes were 37.5 per cent more likely to die than their peers in the general population.

• Among those with Type 1 diabetes, mortality was 129.5 per cent greater than would be expected if they had the same mortality rates as the general population in England and Wales

• People with Type 2 diabetes were 34.5 per cent more likely to die

The range of CCG/LHB care process completion in England and Wales, 2011-2012

Eight care processesᶜ

HbA1cᵇ

Urine albuminᵃ

Smoking

Foot surveillance

Cholesterol

BMI

Serum creatinine

Blood pressure

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Percentage of patients

Careprocess

Increasing prevalence of complications in England and Wales

 Complications observed in 2011-2012 Total expectedComplications

ObservedComplications

Additional complications

Additional risk of complication among people with diabetes

Angina 66,755 117,278 50,523 75.7%

Myocardial Infarction (heart attack) 18,574 28,812 10,238 55.1%

Heart Failure 47,019 81,452 34,433 73.2%

Stroke 26,184 35,120 8936 34.1%

Renal Replacement Therapy (ESKD) 5,869 15,415 9546 164.3%

Minor Amputation (below the ankle) 1,343 5,869 4526 336.9%

Major Amputation (above the ankle) 1,033 3,319 2286 221.4%

The NDA linked to HES data

This chart shows which CCGs have higher than expected rates of heart failure in diabetics, taking into account the background complication rate and demography of their CCG. This utilises the NDA diabetes registrations and data from HES

NDA – Practice Level ReportsTable 3: Treatment target achievement rate for all patients in EXAMPLE MEDICAL CENTRE and England and Wales by treatment target, audit year and diabetes type

All diabetesᵃ Type 1 Type 2

2009-2010

2010-2011

2011-2012

2009-2010

2010-2011

2011-2012

2009-2010

2010-2011

2011-2012

HbA1c <48mmol/mol (6.5%)ᵇ

Your practice 25.4% 23.9% 20.4% 2.0% 4.4% 2.2% 27.4% 25.5% 22.0%

England & Wales 25.0% 24.8% 24.7% 7.1% 6.8% 6.5% 26.7% 26.4% 26.2%

HbA1c ≤58mmol/mol (7.5%)ᵇ

Your practice 63.6% 62.0% 57.7% 22.4% 17.8% 21.7% 67.3% 65.6% 60.7%

England & Wales 63.3% 63.3% 62.7% 28.7% 28.1% 27.0% 66.6% 66.5% 65.8%

HbA1c ≤86mmol/mol (10.0%)ᵇ

Your practice 93.8% 93.0% 91.1% 79.6% 73.3% 71.7% 95.1% 94.6% 92.7%

England & Wales 92.5% 92.1% 91.9% 83.2% 82.4% 81.9% 93.4% 93.0% 92.8%

Target BPᶜ Your practice 48.9% 49.8% 48.5% 47.7% 60.5% 53.5% 49.1% 48.9% 48.2%

England & Wales 35.2% 36.2% 38.8% 49.1% 49.9% 51.9% 34.0% 35.0% 37.7%

BP <140/80ᵈ Your practice 59.9% 57.6% 60.3% 54.5% 67.4% 55.8% 60.4% 56.9% 60.7%

England & Wales 43.9% 44.6% 48.1% 54.7% 55.3% 57.9% 42.9% 43.7% 47.3%

Cholesterol <4mmol/L

Your practice 30.6% 40.0% 38.6% 17.8% 29.3% 34.1% 31.7% 40.8% 39.0%

England & Wales 40.0% 40.7% 40.4% 30.5% 30.4% 29.7% 40.8% 41.6% 41.3%

Cholesterol <5mmol/L

Your practice 68.2% 75.9% 75.5% 53.3% 68.3% 68.3% 69.6% 76.5% 76.0%

England & Wales 77.7% 77.6% 77.0% 72.6% 72.0% 71.1% 78.3% 78.1% 77.5%

Meet all treatment targetsᵉ

Your practice 24.7% 23.7% 21.2% 12.5% 9.1% 13.6% 25.9% 24.9% 21.9%

England & Wales 19.3% 19.7% 20.8% 11.9% 11.8% 11.8% 19.9% 20.3% 21.5%

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Prescribing Information

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Drugs used in Diabetes prescribed in the community in England

1991

/92

1993

/94

1995

/96

1997

/98

1999

/00

2001

/02

2003

/04

2005

/06

2007

/08

2009

/10

2011

/12

0

5

10

15

20

25

30

35

40

45

Prescription Items (millions)

1991

/92

1993

/94

1995

/96

1997

/98

1999

/00

2001

/02

2003

/04

2005

/06

2007

/08

2009

/10

2011

/12

£0

£100

£200

£300

£400

£500

£600

£700

£800

Net Ingredient Cost (£mil-lions)

Items Cost

Diabetes All Prescriptions Diabetes All Prescriptions

10 year % change 105% 61% 119% 20%

5 year % change 38% 25% 29% 2%

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What data are available?

• Workforce• Primary Care• Secondary Care• Mental Health• Community Services• Prescribing• Population Health• Social Care• Patient Experience• Patient Reported Outcomes Measures• Clinical Audit• Clinical Indicators...etc

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Useful Links

• Compendium of Population Health Indicators

http://www.hscic.gov.uk/article/1885/Compendium-of-Population-Health-Indicators• Indicator Portal

http://www.hscic.gov.uk/indicatorportal• Publication Calendar

http://www.hscic.gov.uk/pubs/calendar• Data Tools

http://www.hscic.gov.uk/article/1662/Tools

Connect with us

www.hscic.gov.uk@hscicwww.slideshare.net/hscic

0300 303 5678