A Primary Care Trust Perspective NHS North Lancashire

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A Primary Care Trust PerspectiveNHS North
Lancashire
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Dr Jim Gardner Medical Director PEC Chair
NHS North Lancashire
Jim.gardner_at_northlancs.nhs.uk
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PCT Perspective

• Corporate Objectives
• Commission health care
• Improve health outcomes
• Reduce health inequalities
• Achieve financial balance
• Patient Safety First
• Whole-systems thinking
• Not experts in VTE

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VTE Improvement Cycle
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Sources of data

• Primary Care
• PRIMIS
• QoF
• Secondary Care
• Regional Data Warehouse (SUS)
• CHKS
• Hospitals own pathology/haematology

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Primary Care Prevalence from PRIMIS searches
Total number of patients diagnosed with either
DVT or PE as a of a total GP population of
298,371 (5 practices data was not included due to
discrepancies in the data collection)
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Primary Care Patients on Warfarinfrom PRIMIS
search
Total number of patients prescribed Warfarin (in
last 3/12) from the total GP population of
298,371 (5 practices data was not
included due to discrepancies in the data
collection)
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Annual Hospital Incidence from SUS data.
Data from Cumbria Lancashire Commissioning
Intelligence Support (CaLCIS) North Lancashire
Residents (population 340,000).
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Benchmarked Analysis of Venous Thromboembolism
2006-2008 data
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Venous Thromboembolism primary or
secondary position
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Venous Thromboembolism Length of Stay by
type 2008 only
NHS North Lancashire - Population 340,000.
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Venous Thromboembolism mortality rates 2008
only
NHS North Lancashire Population 340,000
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VTE Improvement Cycle
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Commissioning for Quality

• What is quality?
• Safety, efficacy, personalisation, outcome
• Advancing Quality carrots v sticks
• Risk Assessment for all hospital admissions
  embedded in contracts
• Financial support to providers
• PCT Project Manger for VTE to monitor and support
• Audits / Root Cause Analyses/ Trajectories

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Refining DVT diagnosis in primary care

• gt140,000 referrals for ?DVT/year in UK
• 80 90 do NOT have DVT
• Need to refine tests in primary care
• Clinical Decision Process including
  near-patient-testing
• Safely Ruling out Deep Venous Thrombosis in
  Primary Care. Buller et al. Ann intern Med.
  2009 150229-235
• One PBC consortium implementing.

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VTE Mind Map from PCT Perspective
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Project Plan

• Understand the data and the issues
• Raise awareness
• Set standards in contracts
• Support improvement initiatives
• Measure outcomes
• Link VTE to other initiatives
• Manage the project through a Lead
• Share learning

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Questions

• In our PCT area, our two acute hospital trusts
  have different heparin regimes at discharge. This
  causes confusion for our community staff.
• In the interests of safety, should we (as a PCT)
  seek to standardise heparin protocols across our
  health economy?
• Should we, as an exemplar community, look to
  standardise heparin protocols across England?