SPICE What's it all about

1
SPICE What's it all about?

• Dr Stephen Lynch
• RCGP Regional Quality Initiative adviser N.E
  Scotland.

2
SPICE

• Objectives of the programme
• Criteria development
• Data Collection and feedback
• New GP GMS Contract
• Successes
• Challenges

3
SPICE - PC

• Scottish
• Programme for
• Improving
• Clinical
• Effectiveness-PC ( in primary care).

4
Principal Aim

• To assist primary care clinicians in the
  provision of effective care and to encourage
  quality improvement in the primary care setting

5
Specific Objectives

• To develop criteria for quality of care
• To facilitate the use of these criteria within
  primary care
• To collect and feedback data

6
The stakeholders within the programme

• RCGP - Scottish Council
• SGPC
• Directors of PGME
• University Depts of GP
• PCTs
• Institute of Healthcare Management

7

• Scottish practice nurses association
• Health councils
• Management Executive
• CRAG

8
Joined up working

• GPASS
• PCCIU
• (CSBS)

9
The criteria working groups

• Representative nominated by the LMC
• Representative nominated by the LHCCs
• Representative nominated by RCGP Faculty
• GP with a special interest in the clinical area
• Hospital Specialist in the clinical area
• Representative of the Regional Director PGME
• Nursing representative
• Patient representative

10
Completed clinical areas 2000 -2002

• The management of diabetes
• Secondary prevention of CHD
• Hypertension detection and management
• Monitoring of Warfarin therapy

11

• Management of leg ulcers
• Asthma
• Pernicious Anaemia
• Heart Failure
• Epilepsy
• Hypothyroidism
• Stroke

12
2002 2003 clinical areas

• Back Pain
• Smoking cessation
• Oral Contraception (COC,POP and emergency)
• Hormone replacement therapy
• Rheumatoid arthritis
• Management of Chlamydia infection
• Postnatal depression

13
How it works

• Specific disease management screens within
  consulting room IT systems
• On screen prompts to record data
• automatic upload for national collation
• comparative data fed back to practices, LHCCs

14
Data entry and collection

• Fully computerised - care management screens
  (GPASS)
• CDSS
• Templates in other IT systems
• Data collected by standardised read codes (SCIMP
  codes )

15
On screen reminders
16
Benchmarking

• Feedback to practices and LHCCs of comparative
  data
• Future targets can be set by the practices

17
New GP contract - 2003

• Organisational criteria
• Clinical criteria

18
Contract Clinical Criteria

• SPICEpc Lite
• Vast majority of criteria are in SPICEpc already

19
Contract areas in SPICEpc

• Diabetes
• Coronary Heart Disease
• Left Ventricular dysfunction
• Hypertension
• Stroke
• Asthma
• Thyroid disease
• Epilepsy

20
New contract areas

• COPD
• Cancer
• Severe and enduring mental health

21
Action

• Criteria sets produced for all areas
• Contract specific criteria highlighted
• Production of appropriate Care Management Screens
  
• CDSS screens

22
(No Transcript)
23
(No Transcript)
24
SPICE Reports

• Will include contract targets
• Practice feedback will enable practices to direct
  efforts

25
An example - diabetes

• Number/ of type 2 diabetics
• of practice diabetic population with HbA1c in
  last 15 months
• of practice diabetic population with HbA1c
  lt7.5
• of practice diabetic population with eye and
  foot checks in the last 15 months

26
(No Transcript)
27
(No Transcript)
28
Outcomes

• 210 practices took part in Autumn 2003 feedback
• Patient database of 1,200,000
• gt 1000 hits per month on CEP website

29
The successes

• Developing criteria sets
• The data collection system
• Making SPICE criteria contract compliant
• The network of quality advisers
• Raising awareness of quality issues in primary
  care

30
The challenges

• Information management
• Selling the project to GPs and getting them to
  use it in practice.
• Initial data indicated large gaps in data
  collection at practice level
• Closer working relationship with SIGN.
• Demonstrating an effect on health care

31
Useful web site

• www.cepcc.org/spice
• www.cepcc.org/scimp