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Author Topic: The Importance of Relevant Clinical Information  (Read 42 times)

Laxmikant Tyagi

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The Importance of Relevant Clinical Information
« on: May 12, 2015, 10:54:29 am »


While the original QIPP programme was initially designed to cover 2010/11, current planning assumptions are based on a continued squeeze up to 2021/22 to reduce spending from a current level of 8% of GDP to just over 6%. To consolidate the £3.8 billion Better Care Fund budget for 2015/16, providers are required to cut emergency and elective activity to free an additional £1.8 billion of NHS allocations. The current funding constraints are more severe and sustained than ever. They come during a major reorganisation and cannot be addressed by reduction of quality (4h A&E, RTT, 12h admission, 2w cancer, etc.) due to CQINN targets. In consequence, large deficits are now forecast for trusts and CCGs where unsustainable measures are in place (e.g. freezing pay, PbR tariff reductions, prescribing). In the face of this, trusts and CCGs need to think and act more collectively about their local health economy and seek guidance on how services in all local healthcare settings are provided.

To this end, they should rely on information that is clinically relevant and can drive clinical change and is not based purely on statistics and variances. Information for QIPP/CIP initiatives that is based on variances and statistics does not take into account real people with clinical needs. It often informs clinicians that there may be a certain number of patients that have similar conditions or that there are too many referrals, attendances or admissions based on national or local benchmarks. However, such information alone seldom leads to successful initiative implementations due to the cross over from statistical to clinical information domains. For example, weather data should be used to predict the weather, not the number of birds in the sky – although there might be a loose correlation.

On the other hand, QIPP/CIP information based on clinical information including patient history, presenting acuity and severity, and future risk scores can be mapped against service definitions of initiatives successfully implemented elsewhere. Identification of patient cohorts based on clinical metrics that are in need of a local service leads to successful services and better patient outcomes. Since no information domain cross-overs occurred (clinical information for clinical services), the “language” and service definitions are consistent supporting implementation and change management.

The challenge here is that there are hundreds of successfully implemented QIPP initiatives within the NHS with different service specifications making it hard to find the ones relevant for your CCG or provider trust. Also, without the ability to monitor ongoing implementations, incentives to encourage improvements are difficult to manage in the short term. A system is required that helps CCGs and trusts identify, impact-measure and monitor initiatives before they are included in medium to long term strategic planning or piloted for testing. Such a system should also have the ability to monitor ongoing initiatives on a monthly basis. Furthermore, this system should use clinical information to find clinical services, calculate the total opportunity and also allow demand simulations for many different scenarios (not just best and worst case).
The King’s Fund has highlighted the fact that health economy or region-wide service changes can be planned and progressed via collective action by national organisations and academic health sciences identifying and modelling service reconfiguration. With the provision of clear evidence based on clinical metrics, greater clinical engagement and leadership can be achieved leading to successful change management. In other words, by addressing these clinical drivers, unwarranted variations can be tackled and sustainable levels of change based on suitable QIPP/CIP initiatives can be achieved.

i5 Health as developed the Commissioning Opportunities (COP) report and tool-set that enables identification of QIPP/CIP, Co-Commissioning and BCF initiatives based on clinical metrics, not statistics, using de-identified local or regional activity data. By applying hundreds of service specification rules to a CCG’s or provider trust’s activity data, i5 Health has that ability to match real patients to real initiatives providing actionable results that lead to real results.
Laxmikant Tyagi

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