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Improving outcomes for people with COPD by developing networks of general practices: evaluation of a quality improvement project in east London.

Hull S, Mathur R, Lloyd-Owen S, Round T, Robson J - NPJ Prim Care Respir Med (2014)

Bottom Line: Between 2010 and 2013 completed care plans increased from 53 to 86.5%, pulmonary rehabilitation referrals rose from 45 to 70% and rates of flu immunisation from 81 to 83%, exceeding London and England figures.Hospital admissions decreased in Tower Hamlets from a historic high base.Key behaviour change included the following: collaborative working between practices driven by high-quality information to support performance review; shared financial incentives; and engagement between primary and secondary care clinicians.

View Article: PubMed Central - PubMed

Affiliation: Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK.

ABSTRACT

Background: Structured care for people with chronic obstructive pulmonary disease (COPD) can improve outcomes. Delivering care in a deprived ethnically diverse area can prove challenging.

Aims: Evaluation of a system change to enhance COPD care delivery in a primary care setting between 2010 and 2013 using observational data.

Methods: All 36 practices in one inner London primary care trust were grouped geographically into eight networks of 4-5 practices, each supported by a network manager, clerical staff and an educational budget. A multidisciplinary group, including a respiratory specialist and the community respiratory team, developed a 'care package' for COPD management, with financial incentives based on network achievements of clinical targets and supported case management and education. Monthly electronic dashboards enabled networks to track and improve performance.

Results: The size of network COPD registers increased by 10% in the first year. Between 2010 and 2013 completed care plans increased from 53 to 86.5%, pulmonary rehabilitation referrals rose from 45 to 70% and rates of flu immunisation from 81 to 83%, exceeding London and England figures. Hospital admissions decreased in Tower Hamlets from a historic high base.

Conclusions: Investment of financial, organisational and educational resource into general practice networks was associated with clinically important improvements in COPD care in socially deprived, ethnically diverse communities. Key behaviour change included the following: collaborative working between practices driven by high-quality information to support performance review; shared financial incentives; and engagement between primary and secondary care clinicians.

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Related in: MedlinePlus

Flow chart to show summary of network intervention. CRT, community respiratory team; GP, general practitioner; HCA, health-care assistant; MDT, multidisciplinary team; PCT, primary care trust.
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fig1: Flow chart to show summary of network intervention. CRT, community respiratory team; GP, general practitioner; HCA, health-care assistant; MDT, multidisciplinary team; PCT, primary care trust.

Mentions: A further investment was in information technology (IT) required to provide real-time tracking of the KPIs for each of the care packages. As part of the set-up costs, each of the eight networks had funding for a network manager and recall coordinator to work across all care packages. All networks had training in organisational change and development. Network funding to deliver the COPD care package (approximately £300,000 across all networks per annum) was provided as 70% upfront running costs based on COPD register size and severity, and 30% at the end of the year for achieving the care package targets collectively as a network (this was reduced proportionately according to the distance from the target for some networks). Each network had autonomy on the use and distribution of funds to achieve the KPI targets. Most developed a COPD team to provide local leadership and build practice engagement. Specialist support from the community respiratory team provided spirometry training to practices, community-based pulmonary rehabilitation and a hospital admission avoidance service. This involved a same-day home assessment and review service by respiratory nurse specialists. Provision of this additional expert home support (including prescription of nebulisers and medication as required) was designed to improve patient and GP confidence in managing more patients outside the hospital. The components of the network intervention are summarised in Figure 1.


Improving outcomes for people with COPD by developing networks of general practices: evaluation of a quality improvement project in east London.

Hull S, Mathur R, Lloyd-Owen S, Round T, Robson J - NPJ Prim Care Respir Med (2014)

Flow chart to show summary of network intervention. CRT, community respiratory team; GP, general practitioner; HCA, health-care assistant; MDT, multidisciplinary team; PCT, primary care trust.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373497&req=5

fig1: Flow chart to show summary of network intervention. CRT, community respiratory team; GP, general practitioner; HCA, health-care assistant; MDT, multidisciplinary team; PCT, primary care trust.
Mentions: A further investment was in information technology (IT) required to provide real-time tracking of the KPIs for each of the care packages. As part of the set-up costs, each of the eight networks had funding for a network manager and recall coordinator to work across all care packages. All networks had training in organisational change and development. Network funding to deliver the COPD care package (approximately £300,000 across all networks per annum) was provided as 70% upfront running costs based on COPD register size and severity, and 30% at the end of the year for achieving the care package targets collectively as a network (this was reduced proportionately according to the distance from the target for some networks). Each network had autonomy on the use and distribution of funds to achieve the KPI targets. Most developed a COPD team to provide local leadership and build practice engagement. Specialist support from the community respiratory team provided spirometry training to practices, community-based pulmonary rehabilitation and a hospital admission avoidance service. This involved a same-day home assessment and review service by respiratory nurse specialists. Provision of this additional expert home support (including prescription of nebulisers and medication as required) was designed to improve patient and GP confidence in managing more patients outside the hospital. The components of the network intervention are summarised in Figure 1.

Bottom Line: Between 2010 and 2013 completed care plans increased from 53 to 86.5%, pulmonary rehabilitation referrals rose from 45 to 70% and rates of flu immunisation from 81 to 83%, exceeding London and England figures.Hospital admissions decreased in Tower Hamlets from a historic high base.Key behaviour change included the following: collaborative working between practices driven by high-quality information to support performance review; shared financial incentives; and engagement between primary and secondary care clinicians.

View Article: PubMed Central - PubMed

Affiliation: Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK.

ABSTRACT

Background: Structured care for people with chronic obstructive pulmonary disease (COPD) can improve outcomes. Delivering care in a deprived ethnically diverse area can prove challenging.

Aims: Evaluation of a system change to enhance COPD care delivery in a primary care setting between 2010 and 2013 using observational data.

Methods: All 36 practices in one inner London primary care trust were grouped geographically into eight networks of 4-5 practices, each supported by a network manager, clerical staff and an educational budget. A multidisciplinary group, including a respiratory specialist and the community respiratory team, developed a 'care package' for COPD management, with financial incentives based on network achievements of clinical targets and supported case management and education. Monthly electronic dashboards enabled networks to track and improve performance.

Results: The size of network COPD registers increased by 10% in the first year. Between 2010 and 2013 completed care plans increased from 53 to 86.5%, pulmonary rehabilitation referrals rose from 45 to 70% and rates of flu immunisation from 81 to 83%, exceeding London and England figures. Hospital admissions decreased in Tower Hamlets from a historic high base.

Conclusions: Investment of financial, organisational and educational resource into general practice networks was associated with clinically important improvements in COPD care in socially deprived, ethnically diverse communities. Key behaviour change included the following: collaborative working between practices driven by high-quality information to support performance review; shared financial incentives; and engagement between primary and secondary care clinicians.

Show MeSH
Related in: MedlinePlus