Keeping CR on the agenda

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Keeping CR on the agenda Bob Lewin Professor of
Rehabilitation RJPL1_at_york.ac.uk
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Some terms Minimum dataset (MDS) the
information that is collected by everyone in
the audit can be built into any database system
eg. Tomcat. CCAD Central Cardiac Audit
Datasets the collection of UK audits for
CARDIAC specialties - MI, Surgery, Stents, ICDs,
Arrhythmia nursing (coming soon) and Cardiac
Rehabilitation - The NACR Database Lotus notes
database that is used to send the data up to CCAD
who store the information Benchmarking
comparing your results with other
programmes Process Benchmarking comparing how
the outcomes of CR are effected by the different
processes the patient has experienced Audit
reporting what is achieved by each programme,
where needs are not being met (locality, gender,
ethnicity, social class etc)
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• Principles of the NACR
• no unfair league tables improvement scores
  not raw outcomes
• record resources (staff) available to each
  programme to make fair comparisons as show how
  results depend on resources
• include local indices of deprivation and other
  health indices to ensure fair comparisons
• benchmarking confidential to each programme
• developed by CR for CR its going to be as good
  as YOU make it

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Minimum Dataset Literature search, international
consultation, possible questionnaires tried out
by a panel of 100 patients and clinician from 10
CR programmes focus groups to select best
measures, dissemination to experts, professional
bodies and the clinical community for comment.
Download papers, dataset, definitions and the
questionnaires from www.cardiacrehabilitation.org.
uk/datasets
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BHF/BACR/CCAD Lotus Database
Built in buttons for commonly requested reports
All your data can be exported to Excel at any
time for your own purposes Many users can unite
secondary and community care
Template letters or design your own
Lots of free text comments boxes for you to
record notes add as much information as you
want.
30 spare fields for you to enter any other data
you want or need to collect e.g. repeat
exercise tests, dietary assessment, etc.
Lists anxious and depressed patients
automatically etc etc etc
And it is free courtesy of the BHF
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Annual Audit Reports to DH, HCC, BHF, Public,
Patients
BHF York
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We need every CR programme to join Planed to
recruit 45 per quarter so that recruitment is
complete end 2007 projected figure by end of 2nd
quarter 2006 was 130 actual no. with software
committed to take part is 210 Number linked
electronically 101
April - Dec 2005 April - Dec 2005 April - Dec 2005 Year 2. 2006 Year 2. 2006 Year 2. 2006 Year 2. 2006 Year 3. 2007 Year 3. 2007 Year 3. 2007 Year 3. 2007 Year 4 2008 Year 4 2008 Year 4 2008 Year 4 2008
Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Total
Newly enrolled 15 25 45 45 45 45 45 40 40 35
Target Actual Linked 15 40 85 130 210 100 175 220 265 305 345 380 380
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Annual / online / paper survey with Alton
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Annual / online / paper survey
HCC will use this data to assess trusts IF you
complete the paper survey and join the NACR
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Youre never alone with the NACR!
BHF York
CCAD HELPLINE
CARDIAC NETWORK Lee, Margaret
BHF REGIONAL CRCs
Smart group - nacr-users_at_smartgroups.com
You
Other Users
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People
BHF York (all part-time) Project Manager
Corinna Petre Data Manager / analysis - Simon
Coulton Data Quality officer Jo Orchard
Secretarial / Admin Roz Thompson Statistician
to be appointed BHF regional Cardiac
Rehabilitation Coordinators Shirley Hall, Dianne
Card, Steph Dilnot, Step Lillie, Elaine Tanner
Cardiac Network Lee Panter, Margaret Leid
CCAD Help Desk at CCAD for your IT people
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Organisations involved BHF - champion, financial
sponsor BACR part of core requirement for a CR
programme? DH Heart Team Roger Boyle has put
resource in Cardiac Networks Lee,
Margaret Health Social Care Information
Systems - mother organisation for CCAD, HES and
other NHS and social datasets HCC will use our
data to assess trusts IF you complete the paper
survey and join the NACR
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• The audit will provide you with
• automatic reporting of NSF targets many other
  reports about your programme
• evidence about what you achieve as a health
  gain for your local population
• evidence to inform local planners as to the
  adequacy of CR provision in your patch
• an understanding of how well funded you are
  compared to the national norms
• the ability to compare what your programme
  achieves with the national averages on a range
  of outcomes national benchmarking

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Descriptive overview of patients on the database
Number of patients on the database 25,557
Male 70
Mean age at initiating event 65 yrs
White 91

Mean time from initiating event to referral 14.2 days
Mean time from initiating event to invitation 36.4 days
Mean time from initiating event to start 47.9 days
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Rehab Processes across 4 stages
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NSF targets measured at 12 weeks
NSF Target Week 0 Week 12
50 will be non-smokers 81 90
50 will have BMI lt30kg/m2 73 77
50 will be exercising 30 minutes 5 times per week 22 50
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those who attend Quality of life indicators
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Of those who do attend anxiety and depression
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Analysis
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By 2002 85 of MI and revasc patients will be
offered cardiac rehabilitation After that all
except unstable angina patients should receive
CR. Best guestimate 25-30 of patients getting CR
in 2005-6.
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Problems under treatment inequalities women,
poor, ethnic minorities, depressed, smokers,
elderly, all believed to be under-represented,
postcode lottery failure to invite all indicated
in NSF angina, heart failure, ICD,
arrhythmia dropout varies widely from programme
to programme staffing from single-handed,
part-time, coordinator for 600 patients to a full
multi-disciplinary team. Only 50 of programmes
have an identifiable budget. poor outcomes?-
pragmatic RCT by Robert West
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Can Cardiac rehabilitation survive?
2000/2001 31m for revascularisation 2002/2003
161m. 400 increase Probably 2-5 reduction in
mortality from CABG vs. medical treatment No
increase in funding of CR apart from BHF Lottery
4m
Evidence based Healthcare
not costed in payment per treatment Been
rejected by GPs as a QOF target.
In the new age of self-management and Chronic
Disease Management why have we not seen a single
mention of CR in Government literature?
Using NSF criteria for those expected to benefit,
guesstimated shortfall of 330,000 patients a year
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(No Transcript)
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How do others get funding?
CentralCardiacAuditDatabase
NationalPacemaker ICD Database
Regional variations in ICDimplantation
rate.Only health authorities shown in orange
reach the new implant rate required by N.I.C.E.
guidelines.
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NACRed or wot? The good news is The technology
works and is helping programmes all over the
country organise and communicate
better information sharing between trusts and
across primary/secondary care may be about to
become very simple making the project even more
effective around 50 of UK programmes have
already committed there is solid support from
major stakeholders, BHF, DH, HCC NICE guidance on
MI and secondary prevention strongly supports CR,
indeed treats it as obvious that all patients
including heart failure patients should take part
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Amanda Hutchinson Healthcare Commission I
was involved in a large project about the
National Service Framework and I became
increasingly passionate about the importance of
cardiac rehabilitation. We identified that it
was one of the standards where less progress had
been made despite the enormous commitment of
staff and the effort that was being made to try
and make it work given the historic lack of
priority that cardiac rehabilitation services
have been given. patients were extremely
positive about this as a service and it was
something that was valued by everyone we spoke to
and surveyed. A key finding was that only 16 of
Trusts were able to provide the data we required
... This is why the audit database is so
important, because without the data, it is
extremely difficult to make a case for service
improvement and why the audit is such an exciting
prospect.
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Change the future COULD be the beginning of the
best period yet for CR BUT it could also be the
beginning of the end - replaced by leaflet
bearing lay health trainers in primary care. We
have powerful friends but NO active champions
we are going to have to DO IT OURSELVES working
with charities (BHF), patients, the media and
politicians. Proposal - we should join together
in a sustained 5 year campaign using NACRed to
draw attention to the unmet need. We should
show what we can achieve and how much more we
could achieve if we were all adequately
funded. And we must all do it all together
have a moan, whinge all you want complain about
the extra work - but do it join NACR today and
change the future. WE WILL WIN!