Using NICE guidance advice and standards: Information challenges

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• Using NICE guidance advice and standards
  Information challenges

• Val Moore, Implementation Programme Director
• Nick Baillie, Associate Director Indicators

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The role of information in implementation

• Context
• Understanding role of information in
  implementation
• Stimulate change
• Evaluating change
• Sustaining change
• Technological progress
• Demand for accountability
• Today - Using information in implementation
• Technologies
• Clinical guidelines and other NICE guidance
• Standards indicators

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Board reports on uptake information
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Medicines and technologies focus
Date Types of NICE guidance Evaluation method
2000 NICE technology appraisals (TAs) cost utility evaluation method, mostly of medicines Cost utility
2010 Diagnostic evaluations Cost utility
2010 Medical device evaluations cost benefit Cost benefit
2012 New medicines information and evidence summaries review
2013 Highly specialised medicines Process tbc
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Medicines and technologies focus
Cost, volume, recommended population, other
options, variation and variation over time
Date Types of NICE guidance Evaluation method
2000 NICE technology appraisals (TAs) cost utility evaluation method, mostly of medicines Cost utility
2010 Diagnostic evaluations Cost utility
2010 Medical device evaluations cost benefit Cost benefit
2012 New medicines information and evidence summaries review
2013 Highly specialised medicines Process tbc
Place in pathway
Sales data
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Experimental statistics on variation

• Section 1 - observed and expected use data from
  13 of 25 treatment groups suitable for analysis
• Section 2 - further groups where a valid
  interpretation couldnt be made

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Innovation, Health WealthNICE compliance
regime
Innovation scorecard
NICE Implementation Collaborative
Formularies

• Scorecard to provide a high level view of an NHS
  organisations use of technology appraisals
  (medicines and technologies) at Trust and CCG
  level data
• Medicines featured within the annual Use of NICE
  appraised medicines report are a source
• First one published in January 2013
• FAQs .

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Innovation, Health WealthNICE compliance
regime (2)
Innovation scorecard
Formularies
NICE Implementation Collaborative
NIC

• NICE Implementation Collaborative aims to
• support and promote the timely and consistent
  implementation NICE TAs and adoption of all other
  forms of NICE guidance
• drive the uptake of innovation, understand the
  barriers and help overcome them
• oversee 4 pilots (newer anticoagulants,
  denusomab, BNP testing, insulin pumps)
• report on the assessment of the implementation
  issues, and action at national level to improve
  uptake. Opportunity of Academic Health Science
  Centres to inform and act.

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Other types of guidance
Date Types of NICE guidance Evaluation method
2002 Clinical guidelines Cost utility
2005 Public health interventions and programme guidance Cost utility
2013 Service guidance Process tbc
2003 Interventional procedures Safety and efficacy no cost effectiveness assessment
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Other types of guidance
Baseline assessment, local clinical audit,
national audit, risk management
(NHSLA), Regulation
Date Types of NICE guidance Evaluation method
2002 Clinical guidelines Cost utility
2005 Public health interventions and programme guidance Cost utility
2013 Service guidance Process tbc
2003 Interventional procedures Just safety and efficacy (no cost effectiveness assessment)
Local JSNA, policies , audit, national
measurement obesity, physical activity,
Clinical coding, registries, audit for consent
and outcomes
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Using NICE audit tools to improve patient care

• Thinking delirium in Herts and Beds critical
  care units
• An audit based on the NICE clinical audit tool
  for the Delirium guidance
• Baseline audit in June 2012

Standard Result
If indicators of delirium are identified, an assessment based on CAM ICU has been carried out in the previous 24 hours. 71
If a positive score is recorded, action is taken. 50
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• Action plans included
• the use of NICE implementation tools
• local education
• consultant champions
• assessment score in nursing team handover sheets
• hosting a regional delirium conference.
• Re-audit in January 2013
• Further improvement work and audit is planned.
• For further details see www.nice.org.uk/sharedlear
  ning

Standard used 2012 2013
If indicators of delirium are identified, an assessment based on CAM ICU has been carried out in the last 24 hours. 71 80
If a positive score is recorded, action is taken. 50 72
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Guidance and quality standards
A comprehensive set of recommendations for a
particular condition or service area
Sentinel markers A prioritised set of concise,
measureable statements designed to drive quality
improvements across a pathway of care.
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NICE quality standards

• NICE quality standards are a concise set of
  statements designed to drive and measure priority
  quality improvements within a particular area of
  care
• Library of 180 topics across clinical, public
  health and social care
• Each statement has associated measures
• National data collections and local measures

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What are NICE quality standards?

• They do not restate essential standards or
  regulatory requirements. Where there is overlap,
  statements should be mutually supportive and
  complementary.

NICE quality standards
Proportion of services
Standard of services
Unsafe
Substandard
Adequate
Good
Excellent
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Quality standards referrals

• Library of 180 quality standards (QS)
• including 3 public health focused topics
• Smoking Cessation (Nov 12)
• Physical Activity (Oct 13)
• Alcohol (Dec 13)
• Pilot programme social care QS
• Supporting people to live well with dementia
• Health wellbeing of LACYP
• Full programme went live in April 2013
• Mental wellbeing of older people in care homes
  (Feb 13)
• Autism (Mar 13)

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How can quality standards be used?

• NICE quality standards help demonstrate delivery
  of high quality care through measureable
  statements and indicators, to be used in a
  variety of ways in England including

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NICE Quality Statement 1 People with diabetes
and/or their carers receive a structured
educational programme that ful?ls the nationally
agreed criteria from the time of diagnosis, with
annual review and access to ongoing education

• 74 of PCTs have contracts with services to
  provide NICE compliant education for people with
  newly diagnosed Type 1 diabetes and 85 have
  contracts to provide NICE compliant education for
  people with newly diagnosed Type 2 diabetes, but
  only 66 review whether all people newly
  diagnosed are o?ered structured education.
• For patients under their care, two-thirds
  (66) of specialist providers o?er NICE compliant
  structured education to all people newly
  diagnosed with Type 1 diabetes and 84 o?er
  ongoing education. In addition, 70 provide
  structured education for people using insulin
  pump therapy.
• 72 of paediatric specialist teams o?er
  structured education to all newly diagnosed
  children and young people and 75 adjust the
  education to the development stage of the
  child/young person. However, only 52 have a
  written schedule of education from diagnosis
  onwards, with 59 monitoring uptake of education.
  
• Source DiabetesE www.innove.co.uk

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Information challenges

• How can we ensure quality measures are adopted
  within national collections?
• How can we minimise the burden of data collection
  where no national measures?
• Additional challenges within the quality standard
  development process

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Indicators

• NICE develops evidence based indicators from
  quality standards, NICE guidance and accredited
  guidance
• Rigorous development methods including testing,
  public consultation and consideration by
  committee

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Quality and Outcomes Framework (QOF)

• Introduced in 2004, the QOF is an incentive
  scheme for GP practices in the UK, rewarding them
  for how well they care for patients
• The QOF contains groups of indicators, against
  which practices score points according to their
  level of achievement
• The QOF gives an indication of the overall
  achievement of a practice through a points system
• NICE publish a menu and final indicators
  negotiated by BMA and DH (NHS England in future)

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Clinical Commissioning Group Outcomes Indicator
Set (CCG OIS)

• Supports CCGs and health and wellbeing partners
  in improving health outcomes by
• providing comparative information on the quality
  of health services commissioned by CCGs and the
  associated health outcomes
• supporting transparency and accountability by
  making this information available to patients and
  the public
• Includes some proxy indicators of outcomes that
  are good predictors of improvement
• intermediate outcome indicators
• processes that are shown to have a strong link to
  outcomes
• range of areas, for which they score points.

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Clinical Commissioning Group Outcomes Indicator
Set (CCG OIS)

• August 2012 NICE menu of indicators published
• August 2012 September 2012 NHS Commissioning
  Board (NHS England) engagement events
• December 2012 NHS Commissioning Board (NHS
  England) published first CCG OIS

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Information challenges

• QOF is an example of how improvements in
  informatics can be driven by quality agenda
• CCG OIS how can we ensuring data is available to
  ensure indicators can be constructed by
  commissioning group?

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Future uptake sources

• New data sets
• Cancer Outcomes and Services Dataset
• General Practice Extraction Service
• Other
• Commissioning for quality and innovation (CQUIN)
  payment framework
• Quality, Innovation, Productivity and Prevention
  (QIPP) comparators

• Outcomes frameworks
• QOF
• CCG OIS
• NASCIS
• HQIP Social Care national audit
• Innovation, Health and Wealth
• NICE Implementation Collaborative
• Innovation scorecard

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Summary

• NICE guidance at the heart of many improvement
  activities
• Information is vital to stimulate, evaluate and
  sustain change
• Challenges in data collection, attribution and
  reporting
• Examples exist of the use of indicators and
  routine data for quality improvement