Integrated Care Pathways (ICPs)

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Integrated Care Pathways (ICPs)

• Ali El-Ghorr
• Rosie Cameron
• www.nhshealthquality.org

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Overview

• Background
• What are ICPs
• NHS QIS Work Programme
• Results of scoping exercise

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Integrated Care Pathways
A way to compare planned care with care
actually given
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Policy Context
Kerr report (2005)
Delivering for Health (2005)
Need to improve access, quality and efficiency
of NHS services
62 days cancer target 9 weeks for
diagnostics 16 week target for cardiac
intervention 18 weeks whole patient journey
target for cataracts 18 weeks for outpatients 18
weeks for inpatients and day cases
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National Policy on ICPs
National standards will be developed for
Integrated Care Pathways (ICPs) for the main
diagnoses - schizophrenia - bi-polar
disorder - dementia - depression -
personality disorder by late 2007.
Source Delivering for Health (2005)
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National Policy on ICPs
NHS Boards to develop local ICPs to meet National
Standards by 2008. Implementation of the
standards will be accredited by NHS Quality
Improvement Scotland.
Source Delivering for Health (2005)
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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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Key Features

• Multidisciplinary / multi-agency
• Part of the clinical record
• Defined beginning and end
• Evidence based and best practice
• Service user focused
• Measurable outcomes
• Record and act on variation from ICP

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How QIS ICP Project will operate
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Toolkit for ICP development
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Timeline
Jan-06 Ap-06 Jul-06 Oct-06 Jan-07 Ap-07 Jul-07 Oct-07 Jan-08 Ap-08 Jul-08 Oct-08
Project Initiation                        
Recruit Steering Gp / Subgps                        
Scoping exercise                        
Generic standards for ICPs                        
Evidence summaries                        
Combine                        
Local ICPs                        
Develop accreditation tool                        
Accreditation
Communication plan                        
Standards
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Implementation

• Clinical Leadership
• Management support
• Whole system acceptance
• Reduced duplication of records
• Ease of use
• One person responsible for each ICP
• Simple variation tracking
• Continued education programme

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• Local Board

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• Local Board

Mental Health Integrated Care Pathways
This series of Integrated Care Pathways serve as
a guide to treatment and progress. Professional
Judgement should always be used and
will override, but any variations in care must be
clearly documented.
Contact person name_at_nhs.net
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List of contents
Generic elements
Admission Assessment Nursing / AHP
notes Medical notes Results Care
Plans Condition specific elements Bipolar
disorder Dementia Depression Personality
disorder Schizophrenia Generic
elements Discharge Outcome measuring
tools Variance analysis
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Depression
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Depression
Stepped Care model
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Variation Analysis
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ICP Scoping Visits
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Scoping Visits

• 15 visits to all NHS Board areas in April/May 06
• Scoping questionnaire sent out to each board area
  prior to visit
• Visit objectives
• Follow up to questionnaire
• Meet key people
• Discuss additional aspects of ICP development
• Learn from peoples experience to date

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Key Findings

• 14/15 NHS Board areas had done some work on what
  they perceived as ICPs
• 1 NHS Board area had systems and processes in
  place that could be easily developed into an ICP

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What ICPs have they done?

• Admission/discharge- 11
• Perinatal- 8
• Schizophrenia- 4
• Depression- 3
• Rehab- 2
• Early Intervention- 2
• Forensic- 3
• Personality Disorder- 1
• Transfer- 3
• Detox- 2
• Falls management- 1
• ECT- 1
• Generic Process ICP- 3
• Dementia- 2

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Key Issues

• Variation analysis
• Issues re development and implementation process
• Key Challenges and messages given

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Variation Analysis

• A variety of variance recording tools
• Few examples of variance information feeding
  service development
• Many had no variance analysis at all
• Some used access databases
• 1 had IT system fully operational
• Several had paper based forms

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Development and Implementation issues

• 8/15 boards had identified ICP people
• Mostly it was part time or part of a wider remit
• Very few had an ICP strategy
• Lack of commitment at corporate level
• Resource intensive system to develop ICPs
• Most success was dependent on enthusiastic
  individuals
• Very little evidence of IT support or systems
• Development was successful but implementation and
  ongoing review was difficult.

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Conclusions

• ICPs a tool for continuous improvement
• Ambitious programme
• Short timescale
• NHS Boards required to deliver ICPs
• NHS QIS working in partnership with Boards

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