Transcript Slide 1

Quality and Safety in
Private Healthcare
Andrew Vallance-Owen
Group Medical Director
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Quality – The Target
Appropriate, cost-effective care and treatment
whose outcomes will benefit the patient
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Quality – The Target
Where ‘appropriate’ means:
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The right treatment
At the right time
Managed by the right person
In the right place
The Cochrane Principle
“Best clinical practice often represents
best financial value in healthcare”
Cochrane AL (1999) Effectiveness and Efficiency.
Random Reflections on Health Services. March. 3rd Edition. Royal Society of Medicine
Press, London. ISBN 1-85315-394-X
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Professor Jack Wennberg and Professor Elliott Fisher
Dartmouth Medical School
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Compared with the lowest use areas, people in the highest use areas get ten times as
many prostate operations, six times as many back operations, seven times as many
coronary angioplasties and ten times as many hospital days if they have heart failure
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What predicts the rate is the number of specialists per capita. The more doctors, the
more consultations
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High use did not mean better quality of care and outcomes. In fact, for many measures,
quality and outcomes were best in the low-use areas
National Institute for Health and Clinical Excellence
(NICE)
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An independent organisation responsible for providing national guidance on the
promotion of good health and the prevention and treatment of good health
Guidance is developed using the expertise of the NHS and the wider healthcare
community, including NHS staff, healthcare professionals, patients and carers,
industry and the academic world.
NICE Produces Guidance in Three Areas
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Health technologies - including new and existing medicines, treatments and
procedures
Clinical practice - appropriate treatment and care of people with specific
diseases and conditions
Public health - guidance on the promotion of health and the prevention of ill
health
Implementation of NICE Guidance
“Once NICE publishes clinical guidance, health professionals and the organisations that
employ them are expected to take it fully into account when deciding what treatments to
give to people.”
“To develop NICE interventional procedures guidance, NICE reviews evidence and collects
and analyses information. By providing guidance on how safe procedures are and how well
they work, NICE makes it possible for new treatments and tests to be introduced into the
NHS in a responsible way.”
A Guide to NICE 2006
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Speciality networks
Driving the Quality agenda forward
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BUPA’s Role
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BUPA seeks to be at the forefront of developments in quality based contracting
We have a responsibility to set and monitor standards. This is in the members’
interests
We have built the credibility to challenge
Approved Cancer Hospitals
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BUPA spends $35m AUD per year on the diagnosis and treatment of breast and bowel
cancer
BUPA was the first UK insurer to develop a national network of quality assured
hospitals for breast and bowel cancer
Currently over 130 BUPA Approved Breast and 120 BUPA Approved Bowel Cancer
Hospitals
10/05
Why is BUPA’s accreditation process for cancer units important?
A study in the British Journal of Cancer states that
“Local recurrence rates were 57% lower and the risk of death from breast cancer was 20%
lower for women treated in specialist units…the surgical management in specialised breast
units is more often adequate, local and regional recurrence rates are lower, and survival is
correspondingly better.”
Of those who applied to be an approved cancer hospital just
64% have been able to meet the standards we seek
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Case Management
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Nurses micro manage treatment & work with providers to ensure delivery of
appropriate, cost effective care
32 experienced nurses and 29 expert advisors
Manage complex care – diseases and cases
– critical care
– cancer care
– rehabilitation
– back pain
– medical cases & psychiatry
BUPA Initiatives do change clinical practice
– Wisdom Teeth Extraction
– Hysterectomy
Supported Decisions - BUPA Healthline
24 hour health Information Service made up of :
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A team of specialist nurses, available 24/7
Supported by research based health information
Confidential service
Triage via a comprehensive symptom assessment
Information on specific health topics & Travel advice
Self help groups & Fact sheets
Home Treatments
Advice on medications
Patient Satisfaction Survey
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Monthly survey to approx 5,000 randomly selected members who have had an inpatient
or day case episode of care asking them for feedback about their hospital stay.
Key themes below:
– 85% of members rated the overall service provided by the hospital as excellent or
very good;
– 94% of members said that the overall service met or exceeded their expectations;
– 74% of members rated the overall level of comfort as excellent or very good;
– 84% of members rated the hospital as very clean;
– 80% of members rated the nursing staff as excellent or very good for each of the
five questions relating to them (e.g. attitude/efficiency)
Clinical improvement cycle
Set
Standards
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Compare Practice with
standards
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Peer Review
Improve Standards
Measure Outcomes
Improve Practice
Peer Review
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BHL in-patient mortality (QIP indicator 3.1); deaths as % of in-patient discharges, 2005
1.4
1.2
UK Ind. Mean +2 SD
UK Ind. Mean
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BHL Mean
Rate (%)
Rate %
0.8
0.6
0.4
0.2
0
AL
BR
BU
CB
CD
CL
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GP
HP
HT
HW
LA
LC
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Hospital
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MN
NC
NW
PK
PT
RD
RG
SB
TW
WA
WL WR
BUPA Hospitals rates for clinical indicators
(Most indicators <0.5% of discharges)
1.0
0.9
% Surgical Deaths
% Transfers
0.8
% Re-ops
% of total discharges
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
Hospital
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BUPA Hospitals rates for clinical indicators
(What about the other 99.5% of patients?)
100
90
% Surgical Deaths
% Transfers
80
% Re-ops
% of total discharges
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60
50
40
30
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10
0
Hospital
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Functional Outcome Measurement
Why SF-36?
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Thoroughly validated and reviewed
Suitable for most surgical, medical and psychiatric treatment
Measures physical and psychological health status
Risk-adjusts
Reliable process for collecting data
Does not impose extra work on clinicians
The SF-36 Survey Process
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The baseline questionnaire is completed by the patient at admission
A follow-up questionnaire is sent to the patient at twelve weeks after the treatment
The participation of the patient is entirely voluntary
Patients cannot be identified by their doctors
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BUPA Hospitals top-20 therapeutic procedures
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BUPA Hospitals top-20 therapeutic procedures
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Professor Sir Cyril Chantler
Chairman, Great Ormond Street Hospital
“Medicine used to be simple, ineffective and safe
now it’s complex, effective, and potentially dangerous”
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BUPA
Vision
“Caring for the lives in our hands”
Mission
“To help our customers liver longer, healthier and more productive
lives”
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