QUALITY HEALTHCARE for HOMELESS SERVICES

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QUALITY HEALTHCAREforHOMELESS SERVICES

• Jane Gray
• Consultant Nurse
• Leicester Homeless Healthcare

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Benchmarking Sharing Comparing practice

• How health services measure their performance is
  an essential factor in establishing quality care.
  
• Benchmarking is a necessary process which
  involves comparing your practice services with
  your peers in similar services.
• Every service can identify what it does well and
  where it needs to improve by comparing practice
  with its peers.
• Benchmarking questions what you are doing,
  identifies opportunities for improvement and may
  provide the incentive needed for implementing
  change
• Benchmarking is not new! The benchmarking process
  outlined in 'The Essence of Care' (DoH 2003)
  helps practitioners to take a structured approach
  to sharing and comparing practice, enabling them
  to identify best practice and to develop action
  plans to remedy poor practice.

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Benchmarking Homeless Healthcare

• High Quality Care for All
• We use our resources for the benefit of the
  whole community, make sure that no-one is
  excluded or gets left behind. We accept that some
  people need more help, that difficult decisions
  have to be taken, that when we waste resources
  we waste other peoples opportunities. We
  recognise that we all have a part to play in
  making ourselves our communities healthier
• David Nicholson CBE, NHS Chief Executive

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The Operating Framework(DoH, December 2008)

• Allocations published for the next 2 yrs (but
  plan is for the next 5yrs)
• There is 5.5 growth for the NHS for the next 2
  yrs but .
• Beware there is much less for 3-5 yrs
• However, there is sufficient money in the system
  to deliver quality care for EVERYONE!
• Challenges
• Productivity Efficiency
• Value for Money
• Reduce Waste
• Improve Quality
• Work together with Partners Patients
• Power needs to sit close to the Patient

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The Operating Framework(DoH, December 2008)

• Look at PROMS (Patient-Reported Outcome Measures)
• PROMs were recently identified by Lord Darzi in
  his report
• .. make these patient-reported outcome measures
  a stronger part of our approach to clinical
  quality
• (Lord Darzi, Our NHS Our Future DoH
• Oct 2007)
• The new Standard NHS Contract for Acute Services
  introduced a requirement from April 2009 to
  report on PROMs

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So what is a PROM?

• A PROM is written or verbal information you
  receive from a patient about an aspect of care
  that your service provides.
• The patients experience of treatment care is a
  major indicator of quality so there has been a
  huge expansion in the development application
  of questionnaires, interview schedules and rating
  scales that measure states of health illness
  from the patients perspective.
• Patient-reported outcome measures (PROMs) provide
  a means of gaining an insight into the way
  patients perceive their health the impact that
  treatments or adjustments to lifestyle have on
  their quality of life.
• These instruments can be completed by a patient
  about themselves, or by others on their behalf.

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How to do PROMS

• PDSA

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Clinical Audit

• Clinical audit is a quality improvement process
  which can improve patient care and outcomes by
  carrying out a systematic review and implementing
  any necessary changes.
• Aspects of patient care including structure,
  processes and outcomes are selected and
  evaluated against explicit criteria and where
  necessary, changes are implemented at an
  individual, team or service level.
• Further monitoring can then be used to confirm
  the improvements in healthcare delivery.

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The Audit Cycle
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Example of Clinical Audit cervical smears

• Criteria DoH advise that all eligible women aged
  25-64 years are called offered a smear at least
  every 5 yrs.
• Standard In Leicester women aged 25-45 are
  offered a smear every 3yrs 46-64yrs every 5
  yrs.
• Observe practice collect data Look at pt
  list, identify women. Who has had a smear? Anyone
  missed why? Appropriate action? Recall/follow
  up?
• Compare practice with criteria / standard
• Implement changes to meet above
• Re-audit

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Quality Outcomes FrameworkQOF

• The Quality Outcomes Framework (QOF) is a
  voluntary annual reward incentive programme for
  all GP surgeries in England, detailing practice
  achievement results. It is not about performance
  management but resourcing and then rewarding good
  practice.

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Quality Outcome FrameworkQOF

• The QOF contains five main components, known as
  domains. Each domain consists of a set of
  measures of achievement, known as indicators,
  against which practices score points according to
  their level of achievement.
• 100 1000 possible points
• England average 96.8
• PCT average (Leicester) 92.5
• Leicester Homeless 81.9
• www.qof.ic.nhs.uk

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Quality Outcome FrameworkQOF Domains

• Clinical Care has 80 indicators across 19
  clinical areas (e.g. asthma, diabetes, CHD, heart
  failure, hypertension)
• Organisational has 43 indicators across five
  organisational areas records and information
  information for patients education and training
  practice management and medicines management.
• Patient Experience has 4 indicators that relate
  to length of consultations and to patient surveys
  
• Additional Services has 8 indicators across 4
  service areas which include cervical screening,
  child health surveillance, maternity services,
  contraceptive services
• Holistic Care is a measure of the breadth of
  care across the clinical domain

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Leicester Homeless Service

• Clinical care we deliver is enhanced by
• Significant Event Analysis (Incident Feedback
  form)
• Audits of standards of care
• Monitoring prescribing trends
• Recording sharing mortality data
• QOF (including GPAQ (general practice activity
  questionnaire)