The benefits of Using AHP Data Standards Margaret

The benefits of Using AHP Data Standards Margaret Hastings MBA (Dist) FCSP Clinical Information Lead NHS GG&C AHP e. Health Lead Clinical Service Manager – Physiotherapy – West Dumbarton CHP

NHS } Allied Health Professionals and other Technical SCOTLAND departments - new patients and total attendances (non-inpatients, non-day patients) Homepage › Information and Statistics › Data Developments › AHP and OTD activity The information presented is a simple summation of quarterly data returned in aggregate form by boards. In general, the figures supplied by boards comprise activity provided by hospital-based services. Care provided in the community is excluded except where that care is provided by hospital-based staff (an example is the chiropody figures, which exclude information on community-based staff). This is not thought to be universally the case, however, and it is possible that recording practice may vary between some boards, as for certain AHP specialties. For this reason, the figures are better viewed as indicative rather than precise counts of activity and any conclusions drawn from use of these data should take this into account. http: //www. isdscotland. org/isd/collect 2. jsp? p. Content. I D=1358&p_applic=CCC&p_service=Content. show&

www. datadictionary. scot. nhs. uk NHS } SCOTLAND

Scheduling Messaging Referral Assessment Proforma Care Plan / Interventions 1 st Contact Care Episode ü CHI Number ü Demographics (Structured Name, Postcode, Registered GP Practice, Gender) ü Profession ü Referral response ü Referral Reason ü Date ü Referral Source ü Referral Type ü Referral Date 4 } } AHP Pathway & Summary Dataset NHS SCOTLAND Discharge Clinical Outcome Care Plans ü ü Health Problems Aetiology Objectives Caseload Status ü Date Complete ü Outcome ü Discharge Type

NHS Patient Profile Problem Identificati on Pathways, Delivery Benefits - Safety, Experience, Performance 5 SCOTLAND Clinical Profile Evidence Record structures Standards, Terminolog y, Identificati on Metadata, message structures Confidentiali ty, Identificatio n IT } Standards for ……

NHS } Standards aid…… SCOTLAND

v. Referrals by 1000 population v. Caseload by 1000 population v. Cases by disease groups v. Cases by health problems v. Demand management v. Capacity management v. Case management v. Outcome analysis v. Clinical Effectiveness v. Research 7 } Uses of AHP Summary Dataset NHS SCOTLAND

} Census Reports 2006 NHS SCOTLAND Summary (January ) v 80% response rate v Total caseload on 14/9/05 was 844, 000 cases – for every 6 people in Scotland 1 was a current AHP case v On census day 1 contact for every 89 people in Scotland Waiting Times (July) v 2, 609 AHP waiting lists in Scotland v 1 in 50 people waiting for AHP 1 st contact v 12 people waiting for every AHP in Scotland v 94% of all patients seen within 18 weeks Describing AHP Cases & Service Evaluation (Sept) v Clinical data describing 39, 895 cases was provided - 95% could be classified to ICF; ICD 10; OPCS 4 v The NCDDP AHP Data standards could be recorded by the AHPs. v AHPs have very little overlap in the problems they work with – most of the top ten words used to describe conditions are unique to that profession. 8

• Demand - all requests or referrals into the service. } Demand, Capacity and Queues in AHP services NHS SCOTLAND Need to know target population: AHP referral norms; patient pathways; referral protocols • Capacity – all resources required to do the work. Need to know Role profile - clinical sessions + professional sessions + management sessions; No. new pats / clinicians; Leave profiles • Activity – is the work done and depends on Case Complexity; Case Weighting; Care Plan Delivery (includes care setting); Interventions; • Queues – result when demand has not been dealt with, resulting in backlog. Measured by waiting times

NHS } Benchmarking Referrals Refs per Population annum Refs : 1000 population W. T. E. SCOTLAND Refs : WTE CHP P 89610 4227 47 4. 3 983 CHP W 121000 6119 51 11 561 CHP R 177548 7189 40 11 631 CHP C 84200 1445 17 5 289 CHP N 102000 6329 62 11 585 CHP G 178563 8118 45 17 492 CHP E 125000 9475 76 14 682 CHP B 110000 4598 42 8 597 CHP L 57211 3167 55 4 880

} % population on Rx NHS SCOTLAND

NHS + Objective (AHP Data Standards) + Health Problem or Issue (ICF) + Aetiology (ICD 10 / OPCS 4) + Caseload Status or Outcome (AHP Data } Describing Clinical Care SCOTLAND Standards) + Associated Professional Role + CHI number + Service Base 12

Pain 8% Joints and Bone Function 13% Genital & Reprod. Function 3% Muscle Function 4% Movement Functions 1% structures shoulder 5% structure of heart 1% structure arm 5% structure respiratory 4% structure trunk 18% structure pelvis 1% structure lower limb 15% ICD 10 Diagnosis 1% Walking difficulty 19% } Referred Problems by ICF NHS SCOTLAND

2 week time diary described 324 cases in 5 Health Centres; 3 domiciliary teams and 1 rapid response team. Rapid Response patients had more diagnoses and health problems recorded NHS } Benchmarking Physio service in a CHP SCOTLAND

NHS Census } Top 10 Diagnoses SCOTLAND CHP recorded Backache Muscuklokeletal pain Walking difficulty Muscuklokeletal disorder Joint symptom - shoulder Joint symptoms Fracture neck of femur Osteoarthritis Sciatica Torticollis CVA / Stroke 15 55% of total

NHS } SCOTLAND

} Caseload Status NHS SCOTLAND

NHS } SCOTLAND

NHS 4 - Intensive – multi-agency, care management 3 - Complex – care managed by lead prof. 2 -Basic Support 1 -Self Managed Care } Rehabilitation Model SCOTLAND Multiple Diagnosis: Complex Health, Social Problems Multiple Diagnosis: Health, Problems Few Diagnosis & Health, Problems

NHS Joanne Briggs Institute } International SCOTLAND

NHS Referral 1 st Contact Care Episode } More Standards ……… SCOTLAND Clinical Outcome Care Plans Joanne Briggs Institute

burden and costs of data collection NHS } Embedding Data Standards in Clinical Practice Remember the SCOTLAND ü Use Data standards ü Structure record ü Mandate key data indicators for secondary uses ü AHPs need training in Coding and Classification ü AHPs need clinical systems to record structured clinical data which will output summary information! 23

NHS } Benefits SCOTLAND • Clearer understanding of AHP case mix • Right clinical resource can be matched to case complexity • More real time clinical audit, evaluation and research • Service information derived from clinical recording • Demand, Capacity, Workload and Workforce data available to service • Improved patient care