NHS Improvement, profile picture
Uploaded byNHS Improvement
1,487 views

Breakout 1.3 Improving COPD Care in the West Midlands - Colin Gelder

The document analyzes COPD admissions across the West Midlands, detailing non-elective hospitalizations, associated costs, length of stay, and readmission rates from 2007 to 2010. It highlights significant variations in COPD care metrics among different PCTs and presents potential cost savings if admission rates were reduced to the national average. Recommendations for improving COPD care and reducing hospital admissions are also discussed.

Embed presentation

Download to read offline
Improving COPD Care in the West Mildands Colin Gelder Clinical Lead Respiratory Midlands Region, NHS Midlands & East 1
2
3
Purpose of Data Purpose of Data 4
West Midlands Non-Elective COPD Admissions 3.5 2009/10 Admissions per 100,000 population 3.0 >2 fold variation 2.5 2.0 1.5 1.0 0.5 0.0 West Midlands COPD Non-Elective Admissions COPD admissions per 1000 population COPD admissions per 1000 registered pts Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 2.1 2.3 2.2 146 155 140 - - - - - - SHA 2.0 2.2 2.2 147 154 143 - - - - - - Herefordshire PCT 1.5 1.5 1.4 117 109 98 1 1 1 23 16 22 Heart Of Birmingham Teaching PCT 1.6 1.6 1.5 229 237 215 4 2 2 31 23 27 Warwickshire PCT 1.6 1.6 1.6 133 126 119 5 3 3 35 30 36 Shropshire County PCT 1.7 1.8 1.7 110 118 108 6 5 4 45 44 42 Telford and Wrekin PCT 2.0 2.3 1.8 127 134 101 9 9 5 74 79 49 Worcestershire PCT 1.5 1.9 1.8 122 147 130 3 6 6 30 54 52 South Staffordshire PCT 1.5 1.7 1.8 109 121 127 2 4 7 24 36 55 North Staffordshire PCT 2.1 2.1 2.0 128 122 108 10 8 8 82 73 70 Solihull Care Trust 2.0 2.4 2.1 139 164 136 8 12 9 73 89 77 Dudley PCT 2.1 2.4 2.2 160 169 149 11 11 10 83 87 86 Wolverhampton City PCT 2.1 2.3 2.2 156 162 149 12 10 11 84 84 88 South Birmingham PCT 2.3 2.6 2.4 151 167 150 13 13 12 94 100 96 Coventry Teaching PCT 1.9 2.1 2.4 135 142 156 7 7 13 71 72 98 Sandwell PCT 2.8 3.0 2.7 170 176 157 14 14 14 119 117 115 Walsall Teaching PCT 3.0 3.0 2.7 194 181 153 17 16 15 129 119 116 Birmingham East and North PCT 2.9 3.1 3.0 212 226 210 15 17 16 122 123 124 Stoke On Trent PCT 3.0 3.0 3.3 163 162 166 16 15 17 125 118 133 5
Coventry PCT COPD Admissions West Midlands non-elective COPD hospitalisation costs COPD tariff per 1000 population COPD tariff per 1000 registered pts Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 4.2 4.6 5.1 297 314 329 - - - - - - SHA 4.1 4.6 5.1 297 315 336 - - - - - - Heart Of Birmingham Teaching PCT 3.4 3.3 3.5 495 500 491 6 2 1 43 23 25 Herefordshire PCT 3.1 3.1 3.5 241 227 238 3 1 2 27 15 26 Shropshire County PCT 3.3 3.4 3.8 212 220 239 5 3 3 36 27 31 Warwickshire PCT 3.3 3.6 4.1 272 271 297 4 6 4 35 39 41 Worcestershire PCT 2.8 3.5 4.2 219 268 301 1 5 5 13 38 45 Telford and Wrekin PCT 3.9 4.6 4.2 244 271 238 7 9 6 61 76 46 North Staffordshire PCT 4.4 4.0 4.4 263 231 239 11 7 7 87 58 55 South Staffordshire PCT 2.9 3.5 4.6 212 245 320 2 4 8 18 32 66 Solihull Care Trust 4.1 5.1 4.8 286 349 311 10 12 9 77 100 72 Dudley PCT 4.0 4.3 5.0 298 303 334 8 8 10 68 67 73 Wolverhampton City PCT 4.6 4.8 5.2 334 331 348 12 11 11 93 84 83 Coventry Teaching PCT 4.0 4.6 5.7 279 308 366 9 10 12 73 79 100 South Birmingham PCT 4.9 5.7 5.8 328 367 369 13 13 13 104 109 106 Sandwell PCT 5.5 5.7 6.2 332 332 358 15 14 14 116 111 110 Walsall Teaching PCT 6.5 6.8 6.8 426 407 381 17 16 15 133 131 119 Birmingham East and North PCT 6.2 6.9 7.0 452 501 493 16 17 16 129 132 124 Stoke On Trent PCT 5.5 6.0 7.2 304 320 362 14 15 17 115 116 127 6
West Midlands non-elective COPD hospitalisation length of stay COPD Length of stay Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 N a ti o n a l 8 .3 8 .0 7 .7 - - - - - - SHA 8.4 8.2 7.9 - - - - - - Solihull Care Trust 8.2 8.5 6.7 7 11 1 62 98 23 North Staffordshire PCT 8.7 7.2 6.8 10 4 2 101 34 27 Heart Of Birmingham Teaching PCT 8.7 7.8 7.2 11 9 3 102 62 46 Stoke On Trent PCT 7.4 7.1 7.3 5 3 4 30 29 51 Herefordshire PCT 8.4 7.7 7.4 8 7 5 73 58 55 Birmingham East and North PCT 9.5 9.1 7.6 14 13 6 130 130 65 Telford and Wrekin PCT 6.9 7.5 7.7 1 6 7 17 49 74 Dudley PCT 7.3 6.9 7.8 4 2 8 28 26 77 Sandwell PCT 7.2 6.6 7.9 3 1 9 23 21 91 Walsall Teaching PCT 8.6 9.7 8.1 9 17 10 87 142 97 Wolverhampton City PCT 9.3 8.3 8.1 13 10 11 123 93 100 Shropshire County PCT 9.7 9.4 8.2 17 16 12 139 138 102 South Staffordshire PCT 7.5 7.3 8.2 6 5 13 37 38 104 Worcestershire PCT 7.1 7.7 8.2 2 7 14 22 58 105 Coventry Teaching PCT 9.6 9.1 8.3 16 12 15 136 129 109 Warwickshire PCT 9.1 9.2 8.9 12 14 16 117 134 132 South Birmingham PCT 9.6 9.4 9.4 15 15 17 133 136 144 West Midlands non-elective COPD hospitalisation 28-day readmission rate COPD readmissions per spell Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 N a ti o n a l 0 .2 0 0 .2 1 0 .2 2 - - - - - - SHA 0.19 0.21 0.22 - - - - - - Herefordshire PCT 0.18 0.16 0.14 5 1 1 38 4 2 Solihull Care Trust 0.20 0.26 0.18 14 17 2 92 145 17 South Staffordshire PCT 0.18 0.18 0.19 6 5 3 39 18 21 North Staffordshire PCT 0.21 0.19 0.19 17 7 4 107 34 22 Heart Of Birmingham Teaching PCT 0.20 0.21 0.19 10 9 5 80 72 27 Telford and Wrekin PCT 0.20 0.22 0.20 9 11 6 76 80 42 Worcestershire PCT 0.15 0.22 0.20 3 12 7 17 87 47 Wolverhampton City PCT 0.14 0.18 0.21 1 6 8 5 27 54 Walsall Teaching PCT 0.20 0.22 0.21 11 14 9 81 100 55 Dudley PCT 0.15 0.16 0.22 4 2 10 18 7 66 Stoke On Trent PCT 0.20 0.21 0.22 12 10 11 84 78 83 Warwickshire PCT 0.19 0.20 0.23 8 8 12 73 54 86 Shropshire County PCT 0.15 0.16 0.23 2 3 13 12 8 88 Coventry Teaching PCT 0.20 0.17 0.24 13 4 14 91 14 104 Sandwell PCT 0.19 0.22 0.24 7 13 15 62 93 106 Birmingham East and North PCT 0.21 0.23 0.25 16 15 16 106 111 110 South Birmingham PCT 0.21 0.23 0.25 15 16 17 97 112 118 7
0.0 2.0 4.0 6.0 8.0 10.0 12.0 PCT average 14.0 West Midlands SHA report M86613 M86011 M86630 M86022 M86001 M86026 M86037 M86638 M86020 M86634 M86041 M86019 M86005 M86627 M86013 M86028 M86010 M86008 M86033 M86610 M86012 M86032 M86034 M86016 M86015 M86027 M84012 M86044 M86604 M86014 M86030 M86002 M86039 M86021 M86038 M86605 M86629 M86035 Level Data M86007 M86624 Figure 8.1: COPD non-elective hospitalisations per 1000 population by GP practice M86009 M86040 M86619 M86023 M86018 M86043 M86006 M86622 M86045 M86607 M86612 M86046 M86017 M86004 M86029 M86633 Making the Case for Change M86048 Y00140 M86003 M86603 M86617 Coventry: COPD Admissions Practice M86621 Page | 19 8
Savings if Non-Elective COPD Admissions Reduced to National Average £1,000,000 £800,000 £600,000 £400,000 £200,000 £- Savings if Non-Elective COPD Admissions Reduced by 20% (QIPP Target) £700,000 £600,000 £500,000 £400,000 £300,000 £200,000 £100,000 £- 9
PCT Cost Saving Potentials for COPD COPD COPD COPD admissions Cost per Admissions reduced Savings if average Savings if Savings if PCT Population Register admissions per 1000 population spell (£) if average admissions (£) admissions -10% (£) admissions -20% (£) National 54,003,337 829,767 116,130 2.2 2,350 0 0 27,286,400 54,572,800 SHA 5,707,214 86,020 12,299 2.2 2,350 26 61,292 2,890,700 5,781,400 Herefordshire PCT 180,142 2,649 259 1.4 2,436 0 0 63,100 126,200 Heart Of Birmingham Teaching PCT 313,934 2,218 476 1.5 2,288 0 0 108,900 217,800 Warwickshire PCT 546,003 7,527 899 1.6 2,488 0 0 223,700 447,400 Shropshire County PCT 295,342 4,688 504 1.7 2,222 0 0 112,000 224,000 Telford and Wrekin PCT 169,429 2,996 304 1.8 2,342 0 0 71,200 142,400 Worcestershire PCT 572,989 7,993 1,038 1.8 2,318 0 0 240,600 481,200 South Staffordshire PCT 605,435 8,726 1,112 1.8 2,511 0 0 279,200 558,400 North Staffordshire PCT 208,582 3,846 414 2.0 2,222 0 0 92,000 184,000 Solihull Care Trust 220,953 3,400 463 2.1 2,281 0 0 105,600 211,200 Dudley PCT 312,366 4,631 692 2.2 2,238 20 45,398 154,900 309,800 Wolverhampton City PCT 256,543 3,848 575 2.2 2,329 23 54,315 133,900 267,800 South Birmingham PCT 386,532 6,122 918 2.4 2,461 87 213,578 225,900 451,800 Coventry Teaching PCT 349,333 5,420 846 2.4 2,346 95 222,401 198,500 397,000 Sandwell PCT 322,378 5,612 883 2.7 2,277 190 432,151 201,100 402,200 Walsall Teaching PCT 266,448 4,773 731 2.7 2,488 158 393,223 181,900 363,800 Birmingham East and North PCT 424,787 6,059 1,270 3.0 2,350 357 837,982 298,500 597,000 Stoke On Trent PCT 276,018 5,512 915 3.3 2,183 321 701,557 199,700 399,400 Making the Case for Change in Coventry Metrics Patient Feedback Pathway Analysis 10
Patient & Carer Feedback Access to a central specialist service with good parking Better information about what COPD is & what treatment to expect Better information on managing COPD, especially exacerbations (who to call and when) Patient & Carer Feedback Carers wanted more information about COPD & how to help the patient More information about services that are available to support them and how to access them Ongoing support after completing pulmonary rehabilitation programme Consistent care 11
Pathway Analysis  High admissions & rising year on year  Many admitted patients not on respiratory ward nor S/B specialist  Only 46% followed up post discharge  QOF prevalence below expected levels  Significant variation in Primary Care spirometry QA  Less than 20% patients on HOS had specialist assessment  No clear pathway to suport EOLC for COPD 12
13
Risk Stratification Self Management Integrated Care Pulmonary Rescue packs Rehabilitation Quality Spirometry Case Finding 14
Staff Training Medicines Management Post Discharge Review Telehealth End of Life Oxygen 15
Risk Stratification Self Management Pulmonary Rescue packs Rehabilitation Staff Training Medicines of Life End Management Quality Case Finding Spirometry Post Discharge Review Telehealth Integrated Care Oxygen Whole System Approach 16
Long Term Conditions Long Term Conditions Level 3 High Complexity Case Management Level 2 High Risk Disease & Care Management Level 1 70-80% LTC Population Self Care/ Support Management 17
Long Term Conditions Level 3 High Complexity Case Management Primary Care Level 2 High Risk Disease & Care Management Level 1 70-80% LTC Population Self Care/ Support Management Long Term Conditions Role of COPD Team Level 3 Shared care High Complexity Case Management Primary Care Specialist Level 2 High Risk Opinion Disease & Care Management Support & Level 1 Education 70-80% LTC Population Self Care/ Support Management 18
Long Term Conditions Primary Care COPD Diabetes Neurological Heart Failure conditions Long Term Conditions Social Care Primary Care COPD Diabetes Neurological Heart Failure conditions 19
From Vision to Reality From Vision to Reality Local engagement/ownership of CCG KoL Empowering local champions Relationship building at practice level (GP, Nurses, practice Managers) Flexible commissioning with risk sharing Clear & progressive goal(s) setting incorporating regular patient feedback Clear governance across integrated pathways 20
Progress • Community team established • COPD high on the agenda • Widespread sign up to the model of care • 75% of practices use POINTS • Reduction in admissions • 90% outpatient activity now in community • High levels patient satisfaction • All patients offered post discharge follow up Quality Up skilling Primary Care Adherence to NICE Guidance & Quality Standards Alignment with COPD Outcomes Framework Minimising unnecessary variations Patient satisfaction End of Life Care 21
Patient Feedback 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100% The appointment me was convenient for me. I had confidence in the nurse/therapist who visited me. I was involved in the decisions about my care Strongly Disagree and treatment. I understood what the nurse/therapist said to Disagree me. Agree I feel knowledgeable and in control of my symptoms. Strongly Agree I was instructed on the use of my medica ons N/A in a way I could understand. No Answer I was given advice about other services and support that is available to me. I was treated with respect and dignity. Overall I was sa sfied with the standard of treatment I received. Overall I was sa sfied with the venue. Innovation Working Smarter Network Integration Care closer to home Empowering patients Education/ SPACE manual Using data Tele health 22
Productivity Admissions avoidance Moving out patient care to community Efficient use of resources Medicines management Home oxygen COPD Admissions 1200 1000 800 2006-07 2007-08 600 2008-09 400 2009-10 2010-11 200 2011-12 0 Coventry Teaching Warwickshire PCT PCT 23
COPD Admissions by CCG 500 400 COPD Admissions 300 2010/11 200 2011/12 100 0 Godiva Inspires Prevention Primary: Smoking cessation, education Secondary: Early detection, smoking cessation, self management, pulmonary rehabilitation, rescue packs, oxygen alert cards 24
Savings & Investment £600,000 £400,000 £200,000 £- £(200,000) £ £(400,000) £(600,000) £(800,000) £(1,000,000) £(1,200,000) 2011/12 2102/13 2013/14 Savings (including growth) £(308,597) £(635,565) £(989,747) Additional Investment £353,000 £353,000 £353,000 Net Costs/savings £44,403 £(282,565) £(636,747) 25
Karen Jackson Paul Davies Practice Tracy King physiologist Practice Manager nurse Finance COPD Rhea Fielding Manager UHCW Chris Mullins nurse Jerry Head UHL Dan Horne of Munday Mark Galloway Breathe Easy pulmonary rehabilitation Tim Berry Head of medicines management Coventry Professor PCT GP & LTC lead Sally Consultant palliative care Godiva CCG Singh IM&T Fiona Shally Andrew Michelle Hardy Park John Thompson Directorate Manager Dymphna Medlock Lead Nurse UHCW Community CEO UHCW Contract Manager COPD nurse COPD Team PCT Jo Peter Shakespeare O’Brien Jeremy Bacon Stephen Mark Jones Jones Estates Manager GP & LTC lead CEO Arden Head of Respiratory BLF Inspires CCG Cluster Physiology UHCW PCT Roy Sarah Phipps Lee Sharrard Thompson Head of information Angela Wall Associate general Finance Community UHCW Claudia Roginski manager UHCW Manager PCT matron CWPT Business rcp.nhslocal.nhs www.inhale.nhs.uk 26
0 5 10 15 20 25 1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 151 161 171 181 191 201 211 221 231 241 251 261 271 281 291 301 311 321 331 341 351 361 371 381 391 401 411 421 431 441 451 461 471 Hospital Coventry 2010/11 481 491 501 COPD Admissions to University 511 521 531 541 551 561 571 581 591 601 27

More Related Content

PDF
Rao SV_2 201110
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Managing exacerbations in chronic obstructive pulmonary disease (COPD): A sec...
byNHS Improvement
 
PPT
Ec gs for medical student
byMohammed Alsheikh
 
PPT
ECG PART 9
byRamzan Ali
 
PDF
Self-care for COPD patients
byInnovation Agency
 
PDF
2011-10-21 ASIP Santé Conférence Télémédecine "Présentation de COPD Briefcase"
byASIP Santé
 
PPT
Copd imp د. جيهان
byfaculty of nursing Tanta University
 
PPTX
Bilgrami, Irma — Reading the Vent Like an ECG
bySMACC Conference
 
Rao SV_2 201110
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Managing exacerbations in chronic obstructive pulmonary disease (COPD): A sec...
byNHS Improvement
 
Ec gs for medical student
byMohammed Alsheikh
 
ECG PART 9
byRamzan Ali
 
Self-care for COPD patients
byInnovation Agency
 
2011-10-21 ASIP Santé Conférence Télémédecine "Présentation de COPD Briefcase"
byASIP Santé
 
Copd imp د. جيهان
byfaculty of nursing Tanta University
 
Bilgrami, Irma — Reading the Vent Like an ECG
bySMACC Conference
 

More from NHS Improvement

PDF
PEN Awards Webinar Series 3 of 6
byNHS Improvement
 
PDF
Directory of Diagnostic Services for Commissioning Organisations
byNHS Improvement
 
PDF
Top tips to overcome the challenge of commissioning diagnostic services
byNHS Improvement
 
PDF
Managing multi-morbidity in practice… what lessons can be learnt from the car...
byNHS Improvement
 
PDF
Improving the quality and safety of home oxygen services: The case for spread
byNHS Improvement
 
PDF
Making the case for cardiac rehabilitation: modelling potential impact on re...
byNHS Improvement
 
PDF
Breakout 4.5 Preventing Oxygen Toxicity: a whole system approach - Prof Tony ...
byNHS Improvement
 
PDF
Breakout 4.4 End of Life Care in Respiratory Disease ~ What we did in Solihul...
byNHS Improvement
 
PDF
Breakout 4.3 Building a caring future - Liz Norman
byNHS Improvement
 
PDF
Breakout 4.3 How to manage… exacerbations of COPD, asthma and… in hospital - ...
byNHS Improvement
 
PDF
Breakout 4.2 Optimise not maximise for better value COPD and asthma care - No...
byNHS Improvement
 
PDF
Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and a...
byNHS Improvement
 
PDF
Breakout 4.1 Finding the missing millions - David Halpin
byNHS Improvement
 
PDF
Breakout 3.5 ‘Dying for a fag’ The hypoxic patient actively smoking – case st...
byNHS Improvement
 
PDF
Breakout 3.4 Asthma and psychological problems - Mike Thomas
byNHS Improvement
 
PDF
Breakout 3.4 How to support the psychological needs of patients with COPD - K...
byNHS Improvement
 
PDF
Breakout 3.3 Achieving Excellence Across Primary & Secondary Care - Sarah Kea...
byNHS Improvement
 
PDF
Breakout 3.3 Pro-active management - Stephen Gaduzo
byNHS Improvement
 
PDF
Breakout 3.2 Managing Multimorbidity in Practice - Dr Kevin Gruffydd-Jones
byNHS Improvement
 
PDF
Breakout 3.1 How to…… Diagnose earlier and accurately: spirometry and history...
byNHS Improvement
 
PEN Awards Webinar Series 3 of 6
byNHS Improvement
 
Directory of Diagnostic Services for Commissioning Organisations
byNHS Improvement
 
Top tips to overcome the challenge of commissioning diagnostic services
byNHS Improvement
 
Managing multi-morbidity in practice… what lessons can be learnt from the car...
byNHS Improvement
 
Improving the quality and safety of home oxygen services: The case for spread
byNHS Improvement
 
Making the case for cardiac rehabilitation: modelling potential impact on re...
byNHS Improvement
 
Breakout 4.5 Preventing Oxygen Toxicity: a whole system approach - Prof Tony ...
byNHS Improvement
 
Breakout 4.4 End of Life Care in Respiratory Disease ~ What we did in Solihul...
byNHS Improvement
 
Breakout 4.3 Building a caring future - Liz Norman
byNHS Improvement
 
Breakout 4.3 How to manage… exacerbations of COPD, asthma and… in hospital - ...
byNHS Improvement
 
Breakout 4.2 Optimise not maximise for better value COPD and asthma care - No...
byNHS Improvement
 
Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and a...
byNHS Improvement
 
Breakout 4.1 Finding the missing millions - David Halpin
byNHS Improvement
 
Breakout 3.5 ‘Dying for a fag’ The hypoxic patient actively smoking – case st...
byNHS Improvement
 
Breakout 3.4 Asthma and psychological problems - Mike Thomas
byNHS Improvement
 
Breakout 3.4 How to support the psychological needs of patients with COPD - K...
byNHS Improvement
 
Breakout 3.3 Achieving Excellence Across Primary & Secondary Care - Sarah Kea...
byNHS Improvement
 
Breakout 3.3 Pro-active management - Stephen Gaduzo
byNHS Improvement
 
Breakout 3.2 Managing Multimorbidity in Practice - Dr Kevin Gruffydd-Jones
byNHS Improvement
 
Breakout 3.1 How to…… Diagnose earlier and accurately: spirometry and history...
byNHS Improvement
 

Recently uploaded

PPTX
Dacryocystitis .pptx
byDrSayantaniSharma
 
PPTX
Biochemistry
byDr. Sankalp Bhargava
 
PPTX
Virginia_Henderson_theory_group_B_2.pptx
byMedical PPT
 
PPTX
Bill Faloon Age Reversal Update Nov 2025
bymaximuspeto
 
PDF
Key Tasks Third Party Claims Administrators Perform for Insurers
byDataGenix
 
PDF
Medicinal Plants: Uses, Benefits and Mechanisms of Action
byazamsaleembilgrami
 
PPTX
A Detailed Description of Raktagulma wrt PTSR
byDr Chandrika Kulkarni
 
PPTX
Gastrointestinal Disorders.pptx congenital malformation in GI TRACT
byshivadwivedi9
 
PDF
CCSN Webinar Chemotherapy induced peripheral neuropathy CIPN_Clean.pdf
byCanadian Cancer Survivor Network
 
PPT
Anaethesia for cardiothoracic surgery.ppt
byummuumaradanzumi
 
PPTX
HELLP SYNDROME-RARE COMPLICATION OF PREGNANCY
byVishnumaya Anand
 
PDF
Mechanisms of Drug Action (PH 1.8) - Complete Pharmacology Flowcharts
byShivankan Kakkar
 
PPTX
goniometer and range of motion lecture pptx
byraedalobaidi
 
PDF
Marburg Viral Disease (MVD) an outbreak at Jinka, Ethiopia 2025
byAbdelaKedir3
 
PDF
Gastrointestinal Absorption of Drugs: From Transport Pathways to Formulation ...
byBaasir Umair Khattak
 
PPTX
Typhoid - Communicable Diseases, causative agents, Clinical presentations a...
byAyesha Fatima
 
PDF
Dr.Pothireddy Surendranath Reddy explains Robotics in Orthopaedic Surgery.pdf
bybvsubbareddy1
 
PPTX
anatomyandphysiologyoftheeye-140730012447-phpapp02.pptx
bygitarilewiskarani
 
PDF
Top 5 Places to Buy Aged LinkedIn Accounts and Should ....pdf
byche3h5jojp4zk2gkv4s
 
PPTX
Levothyroxine-Dosing-Principles-and-Clinical-Application.pptx
byamarnath970868
 
Dacryocystitis .pptx
byDrSayantaniSharma
 
Biochemistry
byDr. Sankalp Bhargava
 
Virginia_Henderson_theory_group_B_2.pptx
byMedical PPT
 
Bill Faloon Age Reversal Update Nov 2025
bymaximuspeto
 
Key Tasks Third Party Claims Administrators Perform for Insurers
byDataGenix
 
Medicinal Plants: Uses, Benefits and Mechanisms of Action
byazamsaleembilgrami
 
A Detailed Description of Raktagulma wrt PTSR
byDr Chandrika Kulkarni
 
Gastrointestinal Disorders.pptx congenital malformation in GI TRACT
byshivadwivedi9
 
CCSN Webinar Chemotherapy induced peripheral neuropathy CIPN_Clean.pdf
byCanadian Cancer Survivor Network
 
Anaethesia for cardiothoracic surgery.ppt
byummuumaradanzumi
 
HELLP SYNDROME-RARE COMPLICATION OF PREGNANCY
byVishnumaya Anand
 
Mechanisms of Drug Action (PH 1.8) - Complete Pharmacology Flowcharts
byShivankan Kakkar
 
goniometer and range of motion lecture pptx
byraedalobaidi
 
Marburg Viral Disease (MVD) an outbreak at Jinka, Ethiopia 2025
byAbdelaKedir3
 
Gastrointestinal Absorption of Drugs: From Transport Pathways to Formulation ...
byBaasir Umair Khattak
 
Typhoid - Communicable Diseases, causative agents, Clinical presentations a...
byAyesha Fatima
 
Dr.Pothireddy Surendranath Reddy explains Robotics in Orthopaedic Surgery.pdf
bybvsubbareddy1
 
anatomyandphysiologyoftheeye-140730012447-phpapp02.pptx
bygitarilewiskarani
 
Top 5 Places to Buy Aged LinkedIn Accounts and Should ....pdf
byche3h5jojp4zk2gkv4s
 
Levothyroxine-Dosing-Principles-and-Clinical-Application.pptx
byamarnath970868
 

Breakout 1.3 Improving COPD Care in the West Midlands - Colin Gelder

  • 1.
    Improving COPD Carein the West Mildands Colin Gelder Clinical Lead Respiratory Midlands Region, NHS Midlands & East 1
  • 2.
  • 3.
  • 4.
  • 5.
    West Midlands Non-Elective COPD Admissions 3.5 2009/10 Admissions per 100,000 population 3.0 >2 fold variation 2.5 2.0 1.5 1.0 0.5 0.0 West Midlands COPD Non-Elective Admissions COPD admissions per 1000 population COPD admissions per 1000 registered pts Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 2.1 2.3 2.2 146 155 140 - - - - - - SHA 2.0 2.2 2.2 147 154 143 - - - - - - Herefordshire PCT 1.5 1.5 1.4 117 109 98 1 1 1 23 16 22 Heart Of Birmingham Teaching PCT 1.6 1.6 1.5 229 237 215 4 2 2 31 23 27 Warwickshire PCT 1.6 1.6 1.6 133 126 119 5 3 3 35 30 36 Shropshire County PCT 1.7 1.8 1.7 110 118 108 6 5 4 45 44 42 Telford and Wrekin PCT 2.0 2.3 1.8 127 134 101 9 9 5 74 79 49 Worcestershire PCT 1.5 1.9 1.8 122 147 130 3 6 6 30 54 52 South Staffordshire PCT 1.5 1.7 1.8 109 121 127 2 4 7 24 36 55 North Staffordshire PCT 2.1 2.1 2.0 128 122 108 10 8 8 82 73 70 Solihull Care Trust 2.0 2.4 2.1 139 164 136 8 12 9 73 89 77 Dudley PCT 2.1 2.4 2.2 160 169 149 11 11 10 83 87 86 Wolverhampton City PCT 2.1 2.3 2.2 156 162 149 12 10 11 84 84 88 South Birmingham PCT 2.3 2.6 2.4 151 167 150 13 13 12 94 100 96 Coventry Teaching PCT 1.9 2.1 2.4 135 142 156 7 7 13 71 72 98 Sandwell PCT 2.8 3.0 2.7 170 176 157 14 14 14 119 117 115 Walsall Teaching PCT 3.0 3.0 2.7 194 181 153 17 16 15 129 119 116 Birmingham East and North PCT 2.9 3.1 3.0 212 226 210 15 17 16 122 123 124 Stoke On Trent PCT 3.0 3.0 3.3 163 162 166 16 15 17 125 118 133 5
  • 6.
    Coventry PCT COPDAdmissions West Midlands non-elective COPD hospitalisation costs COPD tariff per 1000 population COPD tariff per 1000 registered pts Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 4.2 4.6 5.1 297 314 329 - - - - - - SHA 4.1 4.6 5.1 297 315 336 - - - - - - Heart Of Birmingham Teaching PCT 3.4 3.3 3.5 495 500 491 6 2 1 43 23 25 Herefordshire PCT 3.1 3.1 3.5 241 227 238 3 1 2 27 15 26 Shropshire County PCT 3.3 3.4 3.8 212 220 239 5 3 3 36 27 31 Warwickshire PCT 3.3 3.6 4.1 272 271 297 4 6 4 35 39 41 Worcestershire PCT 2.8 3.5 4.2 219 268 301 1 5 5 13 38 45 Telford and Wrekin PCT 3.9 4.6 4.2 244 271 238 7 9 6 61 76 46 North Staffordshire PCT 4.4 4.0 4.4 263 231 239 11 7 7 87 58 55 South Staffordshire PCT 2.9 3.5 4.6 212 245 320 2 4 8 18 32 66 Solihull Care Trust 4.1 5.1 4.8 286 349 311 10 12 9 77 100 72 Dudley PCT 4.0 4.3 5.0 298 303 334 8 8 10 68 67 73 Wolverhampton City PCT 4.6 4.8 5.2 334 331 348 12 11 11 93 84 83 Coventry Teaching PCT 4.0 4.6 5.7 279 308 366 9 10 12 73 79 100 South Birmingham PCT 4.9 5.7 5.8 328 367 369 13 13 13 104 109 106 Sandwell PCT 5.5 5.7 6.2 332 332 358 15 14 14 116 111 110 Walsall Teaching PCT 6.5 6.8 6.8 426 407 381 17 16 15 133 131 119 Birmingham East and North PCT 6.2 6.9 7.0 452 501 493 16 17 16 129 132 124 Stoke On Trent PCT 5.5 6.0 7.2 304 320 362 14 15 17 115 116 127 6
  • 7.
    West Midlands non-electiveCOPD hospitalisation length of stay COPD Length of stay Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 N a ti o n a l 8 .3 8 .0 7 .7 - - - - - - SHA 8.4 8.2 7.9 - - - - - - Solihull Care Trust 8.2 8.5 6.7 7 11 1 62 98 23 North Staffordshire PCT 8.7 7.2 6.8 10 4 2 101 34 27 Heart Of Birmingham Teaching PCT 8.7 7.8 7.2 11 9 3 102 62 46 Stoke On Trent PCT 7.4 7.1 7.3 5 3 4 30 29 51 Herefordshire PCT 8.4 7.7 7.4 8 7 5 73 58 55 Birmingham East and North PCT 9.5 9.1 7.6 14 13 6 130 130 65 Telford and Wrekin PCT 6.9 7.5 7.7 1 6 7 17 49 74 Dudley PCT 7.3 6.9 7.8 4 2 8 28 26 77 Sandwell PCT 7.2 6.6 7.9 3 1 9 23 21 91 Walsall Teaching PCT 8.6 9.7 8.1 9 17 10 87 142 97 Wolverhampton City PCT 9.3 8.3 8.1 13 10 11 123 93 100 Shropshire County PCT 9.7 9.4 8.2 17 16 12 139 138 102 South Staffordshire PCT 7.5 7.3 8.2 6 5 13 37 38 104 Worcestershire PCT 7.1 7.7 8.2 2 7 14 22 58 105 Coventry Teaching PCT 9.6 9.1 8.3 16 12 15 136 129 109 Warwickshire PCT 9.1 9.2 8.9 12 14 16 117 134 132 South Birmingham PCT 9.6 9.4 9.4 15 15 17 133 136 144 West Midlands non-elective COPD hospitalisation 28-day readmission rate COPD readmissions per spell Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 N a ti o n a l 0 .2 0 0 .2 1 0 .2 2 - - - - - - SHA 0.19 0.21 0.22 - - - - - - Herefordshire PCT 0.18 0.16 0.14 5 1 1 38 4 2 Solihull Care Trust 0.20 0.26 0.18 14 17 2 92 145 17 South Staffordshire PCT 0.18 0.18 0.19 6 5 3 39 18 21 North Staffordshire PCT 0.21 0.19 0.19 17 7 4 107 34 22 Heart Of Birmingham Teaching PCT 0.20 0.21 0.19 10 9 5 80 72 27 Telford and Wrekin PCT 0.20 0.22 0.20 9 11 6 76 80 42 Worcestershire PCT 0.15 0.22 0.20 3 12 7 17 87 47 Wolverhampton City PCT 0.14 0.18 0.21 1 6 8 5 27 54 Walsall Teaching PCT 0.20 0.22 0.21 11 14 9 81 100 55 Dudley PCT 0.15 0.16 0.22 4 2 10 18 7 66 Stoke On Trent PCT 0.20 0.21 0.22 12 10 11 84 78 83 Warwickshire PCT 0.19 0.20 0.23 8 8 12 73 54 86 Shropshire County PCT 0.15 0.16 0.23 2 3 13 12 8 88 Coventry Teaching PCT 0.20 0.17 0.24 13 4 14 91 14 104 Sandwell PCT 0.19 0.22 0.24 7 13 15 62 93 106 Birmingham East and North PCT 0.21 0.23 0.25 16 15 16 106 111 110 South Birmingham PCT 0.21 0.23 0.25 15 16 17 97 112 118 7
  • 8.
    0.0 2.0 4.0 6.0 8.0 10.0 12.0 PCT average 14.0 West Midlands SHA report M86613 M86011 M86630 M86022 M86001 M86026 M86037 M86638 M86020 M86634 M86041 M86019 M86005 M86627 M86013 M86028 M86010 M86008 M86033 M86610 M86012 M86032 M86034 M86016 M86015 M86027 M84012 M86044 M86604 M86014 M86030 M86002 M86039 M86021 M86038 M86605 M86629 M86035 Level Data M86007 M86624 Figure 8.1: COPD non-elective hospitalisations per 1000 population by GP practice M86009 M86040 M86619 M86023 M86018 M86043 M86006 M86622 M86045 M86607 M86612 M86046 M86017 M86004 M86029 M86633 Making the Case for Change M86048 Y00140 M86003 M86603 M86617 Coventry: COPD Admissions Practice M86621 Page | 19 8
  • 9.
    Savings if Non-ElectiveCOPD Admissions Reduced to National Average £1,000,000 £800,000 £600,000 £400,000 £200,000 £- Savings if Non-Elective COPD Admissions Reduced by 20% (QIPP Target) £700,000 £600,000 £500,000 £400,000 £300,000 £200,000 £100,000 £- 9
  • 10.
    PCT Cost SavingPotentials for COPD COPD COPD COPD admissions Cost per Admissions reduced Savings if average Savings if Savings if PCT Population Register admissions per 1000 population spell (£) if average admissions (£) admissions -10% (£) admissions -20% (£) National 54,003,337 829,767 116,130 2.2 2,350 0 0 27,286,400 54,572,800 SHA 5,707,214 86,020 12,299 2.2 2,350 26 61,292 2,890,700 5,781,400 Herefordshire PCT 180,142 2,649 259 1.4 2,436 0 0 63,100 126,200 Heart Of Birmingham Teaching PCT 313,934 2,218 476 1.5 2,288 0 0 108,900 217,800 Warwickshire PCT 546,003 7,527 899 1.6 2,488 0 0 223,700 447,400 Shropshire County PCT 295,342 4,688 504 1.7 2,222 0 0 112,000 224,000 Telford and Wrekin PCT 169,429 2,996 304 1.8 2,342 0 0 71,200 142,400 Worcestershire PCT 572,989 7,993 1,038 1.8 2,318 0 0 240,600 481,200 South Staffordshire PCT 605,435 8,726 1,112 1.8 2,511 0 0 279,200 558,400 North Staffordshire PCT 208,582 3,846 414 2.0 2,222 0 0 92,000 184,000 Solihull Care Trust 220,953 3,400 463 2.1 2,281 0 0 105,600 211,200 Dudley PCT 312,366 4,631 692 2.2 2,238 20 45,398 154,900 309,800 Wolverhampton City PCT 256,543 3,848 575 2.2 2,329 23 54,315 133,900 267,800 South Birmingham PCT 386,532 6,122 918 2.4 2,461 87 213,578 225,900 451,800 Coventry Teaching PCT 349,333 5,420 846 2.4 2,346 95 222,401 198,500 397,000 Sandwell PCT 322,378 5,612 883 2.7 2,277 190 432,151 201,100 402,200 Walsall Teaching PCT 266,448 4,773 731 2.7 2,488 158 393,223 181,900 363,800 Birmingham East and North PCT 424,787 6,059 1,270 3.0 2,350 357 837,982 298,500 597,000 Stoke On Trent PCT 276,018 5,512 915 3.3 2,183 321 701,557 199,700 399,400 Making the Case for Change in Coventry Metrics Patient Feedback Pathway Analysis 10
  • 11.
    Patient & CarerFeedback Access to a central specialist service with good parking Better information about what COPD is & what treatment to expect Better information on managing COPD, especially exacerbations (who to call and when) Patient & Carer Feedback Carers wanted more information about COPD & how to help the patient More information about services that are available to support them and how to access them Ongoing support after completing pulmonary rehabilitation programme Consistent care 11
  • 12.
    Pathway Analysis  Highadmissions & rising year on year  Many admitted patients not on respiratory ward nor S/B specialist  Only 46% followed up post discharge  QOF prevalence below expected levels  Significant variation in Primary Care spirometry QA  Less than 20% patients on HOS had specialist assessment  No clear pathway to suport EOLC for COPD 12
  • 13.
  • 14.
    Risk Stratification Self Management Integrated Care Pulmonary Rescue packs Rehabilitation Quality Spirometry Case Finding 14
  • 15.
    Staff Training Medicines Management Post Discharge Review Telehealth End of Life Oxygen 15
  • 16.
    Risk Stratification Self Management Pulmonary Rescue packs Rehabilitation Staff Training Medicines of Life End Management Quality Case Finding Spirometry Post Discharge Review Telehealth Integrated Care Oxygen Whole System Approach 16
  • 17.
    Long Term Conditions LongTerm Conditions Level 3 High Complexity Case Management Level 2 High Risk Disease & Care Management Level 1 70-80% LTC Population Self Care/ Support Management 17
  • 18.
    Long Term Conditions Level 3 High Complexity Case Management Primary Care Level 2 High Risk Disease & Care Management Level 1 70-80% LTC Population Self Care/ Support Management Long Term Conditions Role of COPD Team Level 3 Shared care High Complexity Case Management Primary Care Specialist Level 2 High Risk Opinion Disease & Care Management Support & Level 1 Education 70-80% LTC Population Self Care/ Support Management 18
  • 19.
    Long Term Conditions Primary Care COPD Diabetes Neurological Heart Failure conditions Long Term Conditions Social Care Primary Care COPD Diabetes Neurological Heart Failure conditions 19
  • 20.
    From Vision toReality From Vision to Reality Local engagement/ownership of CCG KoL Empowering local champions Relationship building at practice level (GP, Nurses, practice Managers) Flexible commissioning with risk sharing Clear & progressive goal(s) setting incorporating regular patient feedback Clear governance across integrated pathways 20
  • 21.
    Progress • Community team established • COPD high on the agenda • Widespread sign up to the model of care • 75% of practices use POINTS • Reduction in admissions • 90% outpatient activity now in community • High levels patient satisfaction • All patients offered post discharge follow up Quality Up skilling Primary Care Adherence to NICE Guidance & Quality Standards Alignment with COPD Outcomes Framework Minimising unnecessary variations Patient satisfaction End of Life Care 21
  • 22.
    Patient Feedback 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100% The appointment me was convenient for me. I had confidence in the nurse/therapist who visited me. I was involved in the decisions about my care Strongly Disagree and treatment. I understood what the nurse/therapist said to Disagree me. Agree I feel knowledgeable and in control of my symptoms. Strongly Agree I was instructed on the use of my medica ons N/A in a way I could understand. No Answer I was given advice about other services and support that is available to me. I was treated with respect and dignity. Overall I was sa sfied with the standard of treatment I received. Overall I was sa sfied with the venue. Innovation Working Smarter Network Integration Care closer to home Empowering patients Education/ SPACE manual Using data Tele health 22
  • 23.
    Productivity Admissions avoidance Moving outpatient care to community Efficient use of resources Medicines management Home oxygen COPD Admissions 1200 1000 800 2006-07 2007-08 600 2008-09 400 2009-10 2010-11 200 2011-12 0 Coventry Teaching Warwickshire PCT PCT 23
  • 24.
    COPD Admissions byCCG 500 400 COPD Admissions 300 2010/11 200 2011/12 100 0 Godiva Inspires Prevention Primary: Smoking cessation, education Secondary: Early detection, smoking cessation, self management, pulmonary rehabilitation, rescue packs, oxygen alert cards 24
  • 25.
    Savings & Investment £600,000 £400,000 £200,000 £- £(200,000) £ £(400,000) £(600,000) £(800,000) £(1,000,000) £(1,200,000) 2011/12 2102/13 2013/14 Savings (including growth) £(308,597) £(635,565) £(989,747) Additional Investment £353,000 £353,000 £353,000 Net Costs/savings £44,403 £(282,565) £(636,747) 25
  • 26.
    Karen Jackson Paul Davies Practice Tracy King physiologist Practice Manager nurse Finance COPD Rhea Fielding Manager UHCW Chris Mullins nurse Jerry Head UHL Dan Horne of Munday Mark Galloway Breathe Easy pulmonary rehabilitation Tim Berry Head of medicines management Coventry Professor PCT GP & LTC lead Sally Consultant palliative care Godiva CCG Singh IM&T Fiona Shally Andrew Michelle Hardy Park John Thompson Directorate Manager Dymphna Medlock Lead Nurse UHCW Community CEO UHCW Contract Manager COPD nurse COPD Team PCT Jo Peter Shakespeare O’Brien Jeremy Bacon Stephen Mark Jones Jones Estates Manager GP & LTC lead CEO Arden Head of Respiratory BLF Inspires CCG Cluster Physiology UHCW PCT Roy Sarah Phipps Lee Sharrard Thompson Head of information Angela Wall Associate general Finance Community UHCW Claudia Roginski manager UHCW Manager PCT matron CWPT Business rcp.nhslocal.nhs www.inhale.nhs.uk 26
  • 27.
    0 5 10 15 20 25 1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 151 161 171 181 191 201 211 221 231 241 251 261 271 281 291 301 311 321 331 341 351 361 371 381 391 401 411 421 431 441 451 461 471 Hospital Coventry 2010/11 481 491 501 COPD Admissions to University 511 521 531 541 551 561 571 581 591 601 27