Missed opportunities mapping: computable healthcare quality improvement Benjamin Brown Trainee...
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Transcript of Missed opportunities mapping: computable healthcare quality improvement Benjamin Brown Trainee...
Missed opportunities mapping: computable healthcare quality
improvementBenjamin Brown
Trainee General Practitioner and PhD studentRichard Williams, John Ainsworth, Iain Buchan
Medinfo, Copenhagen, 21st August 2013
@BenjaminCBrown [email protected]
Current practice
Missed Opportunities Mapping
“failure to deliver a quality standard of clinical care that likely contributes to an adverse outcome that may otherwise have been avoided if it had been achieved”
Software
Ainsworth J, and Buchan I. COCPIT: A Tool for Integrated Care Pathway Variance Analysis. Studies in health technology and informatics. 2012: 180: 995–9.
Demo: hypertension and CVDWorld-leading cause of death More deaths <75 years that any other condition UK and NW England performs worse than anywhere in developed world
90% of MI risk attributable to modifiable risk factorsOne of most important is HTN
1/3 adult UK population have HTN - most prevalent risk factor and LTC
Clear guidance abundant2010 UK national health survey: >40% remain ↑BP44% of patients do not receive guideline rx
Therefore, when a hypertensive patient suffers a CVD event it is reasonable to ask:
Was there a missed opportunity for this to have been prevented/postponed?
What was the association with patient demographics, deprivation and co-morbidities?
Demo: methods
• Salford, UK - 3rd highest preventable mortality from CVD• Fully integrated EHR > 232K people, 53 GPs and 1 hospital• All HTN patients suffering CVD events between 2007-12• Whether or not achieved HTN management standards prior
Headline figures
• 3718 patients with CVD events• 1186 (32%) – last BP ≥ 140/90• 1323 (36%) – average BP ≥ 140/90• 382 (10%) – unmeasured two years prior• Estimated cost £3.1M ($4.9M)
Unc
ontr
olle
dDeprivation MultimorbidityGenderEthnicityAge
Unm
easu
red
Uncontrolled
Unmeasured
Uncontrolled
Unmeasured
Conclusions
• A new model for QI• New computational approach• Translatable to multiple clinical scenarios
• Demonstration study• Real-life data to test model• Directly implementable clinical information
• Further work• Generalisability• Clinical significance• Virtuous circle
Thank you for listening
AcknowledgementsDr Matthew Sperrin, Biostatistician
Dr Tim Frank, Academic GPDr Washik Parkar, GP
Dr Steve Little, CardiologistProfessor Simon Capewell, Cardiovascular epidemiologist
Dr Artur Akbarov, Biostatisician
@BenjaminCBrown [email protected]