Integrated Care Pathways

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Integrated Care Pathways
Integrated Care Pathways for Mental Health An
over view your part in variance reporting
(debate). Mark Fleming Linda McKechnie David
Thomson National ICP Coordinators NHS Quality
Improvement Scotland
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Delivering for Mental HealthCommitment 6

• NHS QIS will develop the standards for ICPs
  for schizophrenia, bipolar disorder, depression,
  dementia, and personality disorder by the end of
  2007. NHS Board will develop and implement ICPs
  and these will be accredited from 2008 onwards.

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Definition

• An ICP determines locally agreed
  multidisciplinary practice, based on guidelines
  and evidence where available for a specific
  patient/client group. It forms all or part of the
  clinical record, documents the care given, and
  facilitates the evaluation of outcomes for
  continuous quality improvement.
• Source National Pathways Association, 1998

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Definition

• A way to compare planned care with care actually
  given
• 
  NHS QIS 2007

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Key Features

• Multidisciplinary / multi-agency
• Part of the clinical record
• Defined beginning and end
• Evidence based and best practice
• Patient focused
• Measurable outcomes
• Variance analysis

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Variances

• What are variances?
• If care is not delivered as planned the reason
  (variance) is completed on the ICP
• Compare planned care against care actually given

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What is variance analysis?

• A summary of reasons when care is unable to be
  delivered as planned
• Examine trends, patterns of variance and identify
  if something needs to change as a result
• e.g training needs, provision of services,
  pathway changes.

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Benefits of Variance Analysis

• Highlight issues which the service can resolve
• Help clinicians understand better why care might
  not have been delivered as planned
• Identify gaps in service provision and training
  needs
• Highlight areas where extra resources may be
  required
• Identify differing practices and reasons behind
  these
• Clinicians receive routine feedback on
  performance /activity and practice
• Identify areas of development for care pathway
• Provide important information for clinical
  governance reporting/audit/meeting standards

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What is it really!!!

• Real time clinical audit within a Governance
  Framework??

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Tier 4 SEHD / NES / NHS QIS national redesign
Governance
Tier 3 NHS board level leading to service
redesign
Performance Management
Tier 2 clinical team level leading to local
service improvements
Local ICP
information
Management of variance / decision making
Tier 1 patient variance leading to
individual care redesign
Values base/Evidence base/good practice
Mechanism for tracking variations from plan
Assessment
Care Planning
Care Delivery

• Social needs
• Recovery approach
• Interventions
• Talking therapies
• Admission/transfer
• Review follow up

• Measurement
• of outcomes

information
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Perceptions can differ!
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We think things are working but is there a better
way of doing it?
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How do we gauge the experience? Let others know?
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How can we ensure the facility and opportunity is
available to collect variance in a meaningful
way?
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What measures could be put in place for BPD and
what are the challenges?

• Consistency of care
• Decisions on hospital admission
• Crisis management
• Medication management of symptoms
• Risk assessment and management
• Patient involvement in care planning
• DISCUSS/ASK
• ???

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