Local and national uses of data

Local and national uses of data

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  Local and nationaluses of data Ramani Moonesinghe, Associate National Clinical Director for Elective Care, NHS England
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  National data, localimprovements? Ramani Moonesinghe Associate National Clinical Director for Elective Care, NHSE Director, NIAA Health Services Research Centre, Royal College of Anaesthetists Nuffield Trust /Health Foundation Data event 1 Nov 2016
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  Warning • I’m goingto be controversial • All views are mine and not attributable to: – NHS England – Royal College of Anaesthetists – The Health Foundation – The NIHR – Anyone else quite frankly!
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  What are wecurrently using data for? • Monitoring / inspection: – Care Quality Commission – Quality accounts • Improvement – National clinical audits – NHS Right Care – Getting it right first time (GIRFT)
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  CHALLENGES IN USINGDATA
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  1. ACCESS ANDDISSEMINATION
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  The data areall there! • NHS Right Care: – By CCG – Atlases of variation
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  The data areall there! • GIRFT: – Trust and specialty level – Seeks to change practice, (e.g. prosthesis choice) in order to improve patient outcomes (e.g. infection rates). – Data synthesis, “deep dive” visits and recommendations – Follow up with “implementation tools” • i. regular publication of provider-level performance data via a dashboard (clinical level intervention); • ii. tailored written feedback to underperforming providers (top down intervention) and • iii. commissioning levers to change behaviour (commissioner level intervention).
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  Top down vs.bottom up? • Top down? – NHS England / Dept of Health / CQC – External organisations e.g. Dr. Foster • Bottom up? – National Clinical Audits
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  2. FACE VALIDITY
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  Face validity • Structureand process – Validity of metrics – Accuracy of data – Trust in the data e.g. case ascertainment rates • Outcome and cost – Risk adjustment – “Value” = quality / cost
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  Value: NHS Rightcaredefinitions • Allocative value – how well are assets distributed between population sub-sets – Between programmes e.g. between cancer and respiratory – Between systems in each programme e.g. between asthma and COPD in the respiratory programme – Within each system, e.g. between prevention, drug therapy, rehabilitation and long term care for people with COPD • Technical value: how effectively do allocated resources achieve valid outcomes for all the people in need within the population – different from efficiency • Personalised value: how well does an outcome relates to the values of each individual
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  Efficiency vs. value? •Knee arthroscopy – Efficient (lots of surgery) – ? Value (?benefit) – ? Savings to be made through shared decision making etc?
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  3. IMPROVEMENT BASEDON DATA
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  Supporting local improvement •What are we aiming for? – Top quartile? – Avoidance of being an outlier? – Continual improvement? – Striving for perfection? • Do our methods support local improvement? – Evidence-based approached – Where are the resources?
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  Quality improvement cyclefor national audits
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  Evidence-based Improvement principles: Iverset al Cochrane SR 2014 Data should be valid & recent • Behaviour should be targeted which is likely to be amenable to feedback • Recipients should be capable and responsible for improvement • Presentation should be multi-modal including either text and talking or text and graphical materials • Delivery should come from a trusted source • Feedback should include comparison data with relevant others • Performance target should be provided • Goals set for the target behaviour should be aligned with personal and organizational priorities • Goals for target behaviour should be SMART & have clear action plan
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  4. MAXIMISING OPPORTUNITIES
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  Maximising opportunities • Bigresource investment – National clinical audits • NHSE budget • local investment – Do we get maximum value? – Monitoring vs. improvement? • Combining datasets • Breaking specialty silos
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  National data, localimprovements? @rmoonesinghe [email protected]