The Problem Collaboration

Tony MarsonKeith Bodger

University of Liverpool

Are we the problem?

What are the problems we want to fix?

We want to fix poor patient

outcomes and inefficiency

Unplanned care(Epilepsy, COPD)

Alcohol

Step 1

• Use linked routine health data–Hospital episode statistics–GP prescribing–Investigation results

Iterative change in a ‘learning health system’

Identify problems/ questions

Engage clinical

community

Analyse data

Identify and agree

changes

Implement changes

Are clinicians interested?

Do we have data to

analyse?

Can this be done? is there

budget?

Example from Epilepsy

• Maps on to– North West Coast CLAHRC– Neurology Vanguard

• Early win for CHC

• 4,544 attendances

• Wide variability across

sites

• <50% first seizures

referred to a seizure clinic

• < 50% of ‘known epilepsy’

under active follow up

• Inadequate assessments in

emergency departments

National Audit of Seizure Management in Hospitals

Patients don’t have equitable access to services!

Hospital Episode Statistics

• Dirty data, primary purpose is for reimbursement

• Heavily dependent upon coding• Risk of ‘garbage in – garbage out’• Mainly process rather than outcomes• Need clinical/NHS experience to spot the

obvious• Need complex algorithms to identify cohorts

Neurology appointment after attending ED

These patients were older, more

deprived, had longer stay,

Cheshire and Mersey Pathway

• Implement simple pathway to NHS Trusts affiliated to the Walton Centre

Patient attends ED

Epilepsy / neurology

appt

Patients identified and put on pathway.

Nurse employed to make sure it happens at 3 sites

Appointment within 2 weeks

Individual hospital reports

Individual hospital reports

We can apply the same principles to alcohol and COPD