Dr Sella Anant

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8 Νοε 2013 (πριν από 4 χρόνια και 1 μήνα)

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Dr Sella Anant

(Senior Public Health Information Analyst)

Department of Public Health

NHS Kingston


GPs’ Performance Monitoring: Aims & Objectives

Aims:


The NHS Kingston has aims to assure and demonstrate to the local
community; patients and taxpayers that General Practitioners are able
to deliver best possible care for them.


The QOF measure, encourage and support clinical care and improving
patients experience


NHS Kingston aims to demonstrate that investment in the general
practice is delivering good healthcare by monitoring GPs’ Performance


Objectives:


Assessing achievement of individual practice and exploring the ways to
improve healthcare delivery services and developing strategies to improve score
points and achieving financial rewards


Assessing individual GP practice performance within the Clusters /PCT


Monitoring Performance and Comparison at Local, Regional and National
Level
-
Benchmarking


Assessing the outcome of QOF data analysis and providing training and
Support to the needed GP practices.


Quality Management and Analysis System (QMAS)

What is QMAS?



Quality Management and Analysis System (QMAS) is a national IT
system has been developed newly in England to support Quality and
Outcome Framework (QOF).



The QOF was introduced as part of the new General Medical Services
(GMS) contact from 1
st

April 2004. General practises were invited to
participate voluntarily and there are large proportion of them are
involving in it.



There are many Personal Medical Service (PMS) practices also
participating in the scheme. The NHS Connecting for Health (CfH)
developed the QMAS. This use general practice data and calculate QOF
achievement for individual practices’.



What is QOF



Quality and Outcome Framework (QOF)

What is QOF?



The QOF is facilitating to assess rewards to each GP practice. There are 146 indicators
available QOF helps to assess measurement of achievement and depth of care.


There is maximum 1000 practice score points allocated. Practice scores points are
allocated on the basis of achievement.


The QMAS calculated each practice’s achievement against national targets. Based on the
outcome this will give feedback about the delivery quality of patient care at General
Practice, PCT and SHA level and they are represented by rewards points which are being
translated into financial terms into earnings in sterling pounds.


The QMAS ensure consistency in calculating quality that they have achieved, diseases
prevalence and linked to payment system.


Therefore, all payment system are linked to new GMS contact monitored and
implemented by QMAS in England.



QMAS provided QOF achievement and diseases prevalence data.



The system automatically extract data from each general practices in England and pool
them in the system and allow producing report at different level. Prevalence tables are
being produced from each end of financial year submission data.





QOF Data Structure

Four Domains :QOF


Clinical domains


Organisational domains


patient experience domain


Additional services domain

Note:
Each of the domain consist of set of measures of achievements referred as
indicators

and practice score points can be
compared with their level of achievements.


1. Clinical domains (
76 indicators in 11 diseases conditions )


Coronary Heart Diseases,


Left Ventricular Dysfunctions,


Stroke and Transient Ischemic attack,


Hypertension


Diabetes Mellitus


Heart Failure


Chronic Obstructive Pulmonary Diseases


Epilepsy


Hypothyroidism


Cancer


Mental Health


Asthma


Obesity and smoking
-

secondary prevention of cardiovascular diseases




QOF Data Structure

2. Organisational Domains (
56 indicators in five areas )


Records


Information


patients communications


education training



medicine management


clinical and practice management





3. Patient Experience Domain
(two main areas namely)


Patient survey


Consultation length







4. Additional Services Domain
(four different areas)


Cervical screening


Child health surveillance


Maternity services


Contraceptive services







Data Download/ Data Processing




Data were extracted from national Quality and Outcomes
Framework (QOF) (e.g.: financial year 2009/2010 )


QOF data is integrated with GMS and PMS contracts.


The QOF data are being collected from GP practices and
managed by QMAS.


QMAS system helps to calculate QOF achievement for each
practice.


QOF data were extracted from the QMAS for the financial
year ending March.


Extracted data were analysed with Microsoft Excel and results
are being presented in the form of figures, Tables and Charts.
Data were illustrated with appropriate statistical calculation.


GP Practices in Kingston were compared with overall PCT and
nationally figures.


QOF Data


QOF data has number of patients on registers each clinical
domain, percentage practice achievement, prevalence based on
their practice activity and percentage of exception reporting.


There is no patient level data is available in QMAS. However,
aggregated data are being pooled for each practice level which
can be identified by GP Codes.



There are limitation to identify patients with multiple
conditions.


National Health Application and Infrastructure Services / the
National General Practice Payment System supply the practice
list to QMAS.


Patient’s exceptions reporting criteria are sets out in the GMS
contact.


Therefore, practice can exclude specific patients in calculating
QOF achievement scores based on following reasons: suitability
for treatment for specific diseases, newly registered patients,
newly diagnosed with a conditions or informed dissent.


NHS Kingston GP Practices &Clusters

GP Clusters

Poly System

Cluster/

RBK Neighbourhood

Ward

North

Kingston Town

Canbury

Grove

Norbiton

Tudor

Maldens and Coombe

Beverley

Coombe Hill

Coombe Vale

Old Malden

St James

South

South of the Borough

Chessington North & Hook

Chessington South

Tolworth & Hook

Surbiton

Alexandra

Berrylands

St Marks

Surbiton Hill

GP Practices Distribution & Clusters

Poly System

RBK Neighbourhood

Ward

Practice Code

North

Kingston Town

Canbury

H84010

Canbury

H84027

Tudor

H84033

Tudor

H84061

Tudor

Y02379

Maldens and Coombe

Old Malden

H84008

Coombe Vale

H84016

Coombe Hill

H84020

St James

H84042

St James

H84051

Beverley

H84607

Coombe Hill

H84609

Beverley

H84629

Old Malden

H84635

Coombe Hill

H84637

Outside Borough



H85055

South

South of the Borough

Chessington South

H84025

Chessington North & Hook

H84034

Chessington South

H84050

Surbiton

Surbiton Hill

H84015

Surbiton Hill

H84030

Surbiton Hill

H84049

Berrylands

H84053

Surbiton Hill

H84054

Surbiton Hill

H84058

Surbiton Hill

H84062

Alexandra

H84618

Surbiton Hill

H84619

Data Analysis Based on GP Clusters

1.
QOF Data

2. Conventional Data


NCHOD/ONS

3. Mosaic Data





QOF Data Analysis

Secondary Prevention of Cardiovascular Diseases

Coronary Heart Diseases

GP Practice Performance on Secondary prevention of coronary heart disease


Records







CHD 1.

The practice can produce a register of patients with coronary heart disease.

Diagnosis and initial management


CHD 2.

The percentage of patients with newly diagnosed angina (diagnosed after 1 April 2003) who
are referred for exercise testing and/or specialist assessment


Ongoing management


CHD 5.


The percentage of patients with coronary heart disease whose notes have a record of blood
pressure in the previous 15 months



CHD 6.


The percentage of patients with coronary heart disease in whom the last blood pressure
reading (measured in the previous 15 months) is 150/90 or less







CHD 7.

The percentage of patients with coronary heart disease whose notes have a record of total
cholesterol in the previous 15 months



CHD 8.

The percentage of patients with coronary heart disease whose last measured total cholesterol
(measured in the previous 15 months) is 5mmol/l or less







CHD 9.


The percentage of patients with coronary heart disease with a record in the previous 15
months that aspirin, an alternative anti
-
platelet therapy, or an anti
-
coagulant is being taken (unless a
contraindication or side
-
effects are recorded)






CHD 10.


The percentage of patients with coronary heart disease who are currently treated with a beta
blocker (unless a contraindication or side
-
effects are recorded)







CHD 11.


The percentage of patients with a history of myocardial infarction (diagnosed after 1 April
2003) who are currently treated with an ACE inhibitor or Angiotensin II antagonist









CHD 12.


The percentage of patients with coronary heart disease who have a record of influenza
immunisation in the preceding 1 September to 31 March

Data Analysis

Conventional Data Analysis

E.g . NCHOD/ONS

IMD

All Causes of Mortality Rate

SMR All Causes

Hospital Admission Rate

Hospital Admission Rate for CHD

SMR for CVD

SMR for CHD

Life
-
Expectancy


Figure Life-Expcetancy at Birth in Norbiton and Kingston Wards
by Gender (2004-2007)
65
70
75
80
85
90
Norbiton
Canbury
Grove
Chessington North and Hook
Beverley
Berrylands
Surbiton Hill
Chessington South
Coombe Hill
Tolworth and Hook Rise
St James
St Mark's
Alexandra
Old Malden
Tudor
Coombe Vale
Kingston upon Thames
Inner London
Outer London
London
England
Area
Life-Expectancy in Years
Use of Mosaic Data in GP Clusters


Benefits Claimants


Council Housing


Drugs Dealing


Mental Health


Pregnancy & Maternity Related Problems


Selected Key Diseases


Asthma
/Epilepsy/Hypertension/Falls/ Type 2 Diabetes


Anaemia


Kidney Diseases


Liver Diseases









Evaluation of GP Practices &
Clusters Performance

Type of Comparisons

Primary Care Data


QOF

Secondary Care Data


HES

Mosaic Data


Social, Health and Diseases

Outcome Data
-

Mortality/ Life
-
Expectancy

Putting in Clusters give better picture about



Understand the health situation in clusters


Able to compare Individual GP Practice performance



Discussion

QOF Data


Data download / time consuming


Data Quality issues


Under reporting


smoking/alcohol/ obesity


Diseases Driven Data


This is the better data source


Unable to trace co
-
morbidity with this data set


New way of Looking at data


GP Consortia



Type of data / clustering according to the




grouping



Conclusion


Organising data based on the GP Practices and its
cluster level is better way of illustrating the quality of
care provided by a GP practices.



Analysing Conventional data based on GP practices
clusters will give better picture about the health
situation and able to cross check with each others
outcome.


Using Mosaic data and grouping by GP clusters will
give better understanding about the local population.


All the above can be used combinable for future health
improvement development programme.

Questions?


Thank you