Cardiovascular Intelligence Pack
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Cardiovascular intelligence pack CCG: NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG March 2015 Version 1.2 Contents 1. Introduction 3 2. CVD risk • The narrative 9 • The data 10 3. Stroke • The narrative 33 • The data 34 4. Diabetes • The narrative 47 • The data 48 5. Kidney • The narrative 54 • The data 55 6. Heart • The narrative 65 • The data 66 7. Outcomes 84 8. Appendix 90 This document is valid only when viewed via the internet. If it is printed into hard copy or saved to another location, you must first check that the version number on your copy matches that of the one online. Printed copies are uncontrolled copies. 2 CVD Intelligence packs Introduction 3 CVD Intelligence packs This CVD Intelligence Pack has been compiled by the National Cardiovascular Intelligence Network in collaboration with GPs and nurses in primary care Dr Matt Kearney Dr Chris Arden Prof Ahmet Fuat Dr Matt Fay Dr Yassir Javaid Prof Kamlesh Khunti Ms Jan Proctor –King Prof Ruth Chambers Dr Clare Hawley Dr Kathryn Griffith 4 CVD Intelligence packs From Data to Intelligence to Action Why and How to use this CVD Intelligence Pack Every year in England there are around 150,000 premature deaths. A quarter of premature deaths are due to cardiovascular disease. Two thirds of premature deaths could be avoided through improved prevention, earlier detection and better treatment. High quality primary care is crucial for improving outcomes in CVD because primary care is where much prevention and most diagnosis and treatment is delivered. This cardiovascular intelligence pack is a powerful resource for stimulating local conversations about quality improvement in primary care. Across a number of vascular conditions, looking at prevention, diagnosis, care and outcomes, the data allows comparison between CCGs and between practices. This is not about performance management because we know that variation can have more than one interpretation. But patients have a right to expect that we will ask challenging questions about how the best practices are achieving the best and what average or below average achievers could do differently and how they could be supported to perform as well as the best. The intelligence pack has several sections – CVD prevention and hypertension, stroke and AF, diabetes, kidney and heart disease and heart failure. Each section has one slide of narrative that makes the case and asks some questions. This is followed by data for a number of indicators, each with benchmarked comparison between CCGs and between practices. Use the pack to identify where there is variation that needs exploring and to start asking challenging questions about where and how quality could be improved. We suggest you then develop a local action plan for quality improvement – this might include establishing communities of practice to build clinical leadership, use of audit tools to get a better understanding of the gaps in care and outcomes, agreeing local protocols and consensus approaches, assessing training and education needs, and exploring new ways of delivering care. 5 CVD Intelligence packs Data and methods This slide pack compares the clinical commissioning group (CCG) with CCGs in its strategic clinical network (SCN) and England. Where a CCG is in more than one SCN, it has been allocated to the SCN with the greatest geographical or population coverage. The slide pack also compares the CCG to its 10 most similar CCGs in terms of demography, ethnicity and deprivation. For information on the methodology used to calculate the 10 most similar CCGS please go to: http://www.england.nhs.uk/resources/resources-for-ccgs/comm-for-value/ The 10 most similar CCGs to NHS Eastbourne, Hailsham and Seaford CCG are: NHS Fylde & Wyre CCG NHS Lincolnshire East CCG NHS Isle of Wight CCG NHS South Devon and Torbay CCG NHS West Norfolk CCG NHS Great Yarmouth and Waveney CCG NHS North Norfolk CCG NHS North Derbyshire CCG NHS Wyre Forest CCG NHS North Staffordshire CCG The majority of data used in the packs are taken from the 2013/14 Quality and Outcomes Framework (QOF). Where this is not the case, this is indicated in the slide. All GP practices that were included in the 2013/14 QOF are included. Full source data are shown in the appendix. For the majority of indicators, the additional number of people that would be treated if all practices were to achieve as well as the average of the top achieving practices is calculated. This is calculated by taking an average of the intervention rates (i.e. the denominator includes exceptions) for the best 50% of practices in the CCG and applying this rate to all practices in the CCG. Note, this number is not intended to be proof of a realisable improvement; rather it gives an indication of the magnitude of available opportunity. 6 CVD Intelligence packs Why Does Variation Matter? A key observation about benchmarking data is that it does not tell us why there is variation. Some of the variation may be explained by population or case mix and some may be “Much variation is unwarranted – unwarranted – we will not know unless we it cannot be explained on the investigate. basis of illness, medical evidence, or patient preference” The strength of benchmarking lies not in the answers it provides but in the questions it generates for CCGs and Benchmarking is helpful because it highlights practices. variation. Of course it has long been acknowledged that some variation is inevitable in For example: the healthcare and outcomes experienced by 1. How much variation is there in detection, management, patients. exception reporting and outcomes? However, John Wennberg, who has championed 2. How many people would benefit if average performers research into clinical variation over four decades improved to the level of the best performers? and who founded the pioneering Dartmouth Atlas 3. How many people would benefit if the lowest performers of Health Care, concluded that much variation is matched the achievement of the average? unwarranted ie it cannot be explained on the 4. What are better performers doing differently in the way basis of illness, medical evidence, or patient they provide services in order to achieve better outcomes? preference and is accounted for by the 5. How can the CCG support low and average performers to willingness and ability of doctors to offer help them match the achievement of the best? treatment. There are legitimate reasons for exception-reporting. But ……. Excepting patients from indicators puts them at risk of not receiving optimal care and of having worse outcomes. It is also likely to increase health inequalities. The substantial variation seen in exception reporting for some indicators suggests that some practices are more effective than others at reaching their whole population. Benchmarking exception reporting allows us to identify the practices that need support to implement the strategies adopted by low excepting practices. CVD Prevention and Hypertension 8 CVD Intelligence packs The size of the prevention problem CVD Prevention • 2/3 of people are obese or overweight • 1/3 of people are physically inactive • 20% of people smoke but this rises to over 50% in some communities “The NHS needs a radical upgrade in prevention if it is to be • 5 million people have undiagnosed and untreated hypertension sustainable” • 40% of people with diagnosed hypertension receive 5 year Forward View 2014 suboptimal treatment • Only one in five people whose 10 year CVD risk exceeds 20% receive statins This is because England faces an epidemic of largely preventable non- communicable diseases, such as heart What questions should we ask in our CCG? disease, cancer, Type 2 diabetes and 1. For each indicator how wide is the variation in achievement and exception liver disease. reporting? 2. How many people would benefit if all practices performed as well as the best? 3. How can we support practices who are average or below average to perform as well as the best in: • Identifying people who are obese, inactive or smokers • Identifying and managing high CVD risk • Identifying and managing high blood pressure • Identifying and managing pre-diabetes 4. What is the quality of brief interventions we offer our patients? The WHO Global Burden of Disease 5. How available are preventive services such as weight management and Study (next slide) shows us that the smoking cessation? leading causes of premature mortality are tobacco, raised blood pressure, obesity, physical inactivity and poor The NHS Health Check is a systematic approach to identifying local diet. The radical upgrade in prevention people at high risk of CVD, offering behaviour change support and early needs population-level approaches. detection of hypertension, CKD, diabetes and pre-diabetes. Modelling But it also needs ongoing behaviour suggests that 75% uptake will lead to substantial reductions in premature change support and medical treatment mortality. for individuals during their repeated What proportion of our local eligible population is receiving the NHS contacts with primary care. Health Check and how effective is their follow up risk factor management in primary care? Source: Murray CJL, Richards MA, Newton JN, et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 2013;381:99-1020. DOI: http://dx.doi.org/10.1016/S0140-6736(13)60355-4 Hypertension observed prevalence compared to expected prevalence by CCG Comparison with CCGs in the SCN NHS Dartford, Gravesham and Swanley CCG 0.61 Graph NHS Medway CCG 0.59 NHS Eastbourne, Hailsham and Seaford CCG