Date post: | 01-Jan-2016 |
Category: |
Documents |
Upload: | randall-carpenter |
View: | 218 times |
Download: | 0 times |
Division of Primary Health Care
An evaluation of the effectiveness of ‘care bundles’ as a means of improving hospital care and reducing re-admission for patients with chronic obstructive pulmonary disease (COPD)
WEBEX 1 3 July2015Dr James Calvert
Division of Primary Health Care
Aims of the Webex…..
• Update on progress
• Issues from colleagues in each institution
• Any other business
Division of Primary Health Care
Site Recruitment
Division of Primary Health Care
First steps
• Identify an executive sponsor– Ask them to identify resource – money or people
• You need a team.• Develop and tabulate a project plan• Understand the current service using measures such
as process mapping• Collect baseline data and agree a data collection plan• Design & test interventions
Division of Primary Health Care
The right team
Team members should be drawn from across the
patient pathway and should:
• understand the pathway;
• be able to influence the decision making process;
• be prepared to test and implement changes across
the pathway;
• be mandated to take decisions regarding
changes/improvements in their respective areas.
• Should include an analyst/member of the audit
department
Division of Primary Health Care
First steps
• Identify an executive sponsor– Ask them to identify resource – money or people
• You need a team.• Develop and tabulate a project plan• Understand the current service using measures such
as process mapping• Collect baseline data and agree a data collection plan• Design & test interventions
Division of Primary Health Care
Different Levels of MappingEnters OPD
All Internal Processes
Leaves OPD
Sees admin
Sees nurse
Sees Consultant
Has Tests
Sees Consultant
Etc etcHigh
MediumEnters room
Takes history
Asst with undress
Take weight , BP etc
Etc Leaves room
Asst patient onto scales
Zero scales
Take reading
EtcLow Etc
Division of Primary Health Care
Analysing the map
Are we doing the right thing? (is it clinically effective)
Are we doing them in the right order? Is the right/best person doing it? How co-ordinated is the patients journey? What information do we give to patients at what
stage? Is the information useful? Baseline measurement: how often / how many /
how much?
Division of Primary Health Care
First steps
• Identify an executive sponsor– Ask them to identify resource – money or people
• You need a team.• Develop and tabulate a project plan• Understand the current service using measures such
as process mapping• Collect baseline data and agree a data collection plan• Design & test interventions
Division of Primary Health Care
Two sets of data
• Process data – necessary as part of bundle implementation– The Care Bundle Project will involve regular data collection
via the BTS audit system:
– https://audits/brit-thoracic.org.uk
• Outcome data for project evaluation – will be collected (and paid for) by UoB team
Division of Primary Health Care
Process Data
• Plan for on-going manual data collection (where, when and how)
• Manual data collection informs process performance and is essential to ensure changes being made to processes achieve the intended outcomes.
Division of Primary Health Care
If you don’t measure, you wont know…
• If the changes made have actually made a difference
• If it is an improvement
• How much difference the change has made
• If the improvement has stayed in place? – sustained
• How well the current testing is performing
• Whether aim has been reached
• How much variation there is in data/process
Division of Primary Health Care
…………..when starting to measure:
• Seek usefulness not perfection
• Measure the minimum.
• The goal is improvement and not a new measurement system.
• Aim to make measurement part of the daily routine.
• Don’t let measure issues delay the start of your improvement work / PDSA cycles.
Division of Primary Health Care
Data Entry
• Download the data collection forms to assist with collection of the data items
• Ensure you are registered for the BTS audit system and have access to the online Care Bundle data collection forms
• For each patient record or each set of monthly or yearly data click on the relevant link and add the data to the correct period.
Division of Primary Health Care
Division of Primary Health Care
High Level Data – Derived from HES Data
Division of Primary Health Care
Division of Primary Health Care
Data entry
Division of Primary Health Care
Division of Primary Health Care
First steps
• Identify an executive sponsor– Ask them to identify resource – money or people
• You need a team.• Develop and tabulate a project plan• Understand the current service using measures such
as process mapping• Collect baseline data and agree a data collection plan• Design & test interventions
Division of Primary Health Care
ACT
What changes can be made for the next cycle (adapt change, another test, implementation cycle?)
•
PLAN
• Objective
• Prediction
• Plan for change (who, what, when, where)
• Plan for data collection (who, what, when, where)
• Carry out the change
• Document observations
• Record data
DO
Complete analysis of data
Compare results to predictions
Summarize knowledge gained
•
•
•
STUDY
How to use the PDSA Cycle
• Segmentation
• Useful allies
• Huddles not meetings
• Quick & dirty wins
Division of Primary Health Care
Repeated Use of the PDSA Cycle
Hunches Theories
Ideas
Changes That Result in
Improvement
A PS D
APS
D
A PS D
D SP A
DATA
Very Small Scale Test
Follow-up Tests
Wide-Scale Tests of Change
Implementation of Change
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
Spread
Sequential building of knowledge under a wide
range of conditions
22
Division of Primary Health Care
≤ 20 implementation sites
(COPD care bundle)
≤ 20 comparator sites
(usual COPD care)
QU
AN
TATA
TIV
E D
ATA
24
mo
nth
s - 12
mo
nth
s be
fore
an
d a
fter
imp
lem
en
tatio
n
RE
SO
UR
CE
US
E A
ND
CO
ST
DA
TALevel 1: Hospital-level aggregated data
Level 2: Individual-level patient data
Level 3: Case-study data
QU
ALITA
TIV
E D
ATA
Fro
m p
oin
t of a
dm
ission
in
clud
ing
po
st disch
arg
e fo
llow
u
p ≤ 3
0-9
0 d
ays
≤8 implementation sites
(COPD care bundle)
≤ 8 comparator sites
(usual COPD care)
≤ 3-5 implementation sites
(COPD care bundle)
≤ 3-5 comparator sites
(usual COPD care)
Division of Primary Health Care
Further meetings
• Second face to face meeting 11th September– Review project plans and progress
• Feedback from each intervention site– Trouble shoot issues
• Opportunity for additional input if generic problems have become apparent
Division of Primary Health Care
Project Information
Project Website
http://www.bristol.ac.uk/copd
NIHR CRN Portfolio
http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=17828
Dr. Anne Daykin, Project Co-ordinator: [email protected]
Problems with data entry: [email protected]