Indicators and Outcomes Framework - relevance to patients and ...

Indicators and Outcomes Framework - relevance to patients and ...

Indicators and Outcomes Framework relevance to patients and commissioners Parul Desai NHS England, London : 7 June 2016 PORTFOLIO OF INDICATORS FOR EYE HEALTH AND CARE Purpose Review & monitor population eye health, care and well being ( national & local level) Embed an eye health perspective in the use & interpretation of mainstream Outcome Frameworks (NHS-OF; PHOF; ASCOF) Make better use of existing sources avoid duplication and additional burden for data collection Contains Broad Population and Eye Specific Indicators Evidence (or policy) based Developed by the VISION 2020 UK Ophthalmic Public Health Committee Broad consensus achieved across Eye Health Sector Endorsed by the Clinical Council for Eye Health Commissioning http://www.vision2020uk.org.uk/search-results/?phrase=portfolio+of+indicators&adv=1&type=11 PORTFOLIO OF INDICATORS FOR EYE HEALTH AND CARE Broad Population Indicators To demonstrate overall change at population level in areas relevant to prevention of sight loss, eye health improvement and living with sight impairment. Are currently measurable, reportable and in the public domain Indicators taken from the PH, ASC and NHS Outcomes Frameworks are health and care indicators at population level that: will include people with & without varying levels msight impairment & sight loss represent modifiable risk factors for systemic disease associated with sight impairment include services & care provided for people with sight impairment & sight loss highlight sight impairment / sight loss as a contributory comorbidity PORTFOLIO OF INDICATORS FOR EYE HEALTH AND CARE

Eye Specific Indicators Cover the main causes of sight impairment in the UK, all age groups, all sectors Domains include : prevention, accessibility, availability, safety & effectiveness, of services Some are not supported by national data collection ALL are measurable and suitable for local review & action Applications: Include in contract /service specifications for review through local clinical audit Facilitate monitoring of access & availability of services Encourages scrutiny of data & its quality address a gap Ensure whole pathways considered in service specifications : clinical, support & care services Many available now (locally or in the public domain nationally) Broad Portfolio Indicators: RFs / determinants* population eye health REGION North West North East York &Humber West Midlands East Midlands East England South East South West London England 2.12 2014. 2.13 2014. 2.14 2014. % Adults Proportion Prevalence of overweight or physically smoking obese active adults 18 yrs. & over. 66.1 68.6

67.1 66.6 66.7 65.6 63.4 64.2 58.4 64.6 better than England same as England 54.2 53.6 56.1 55.5 57.6 57.8 59 59.4 57.8 57 19.9 19.9 20.1 16.9 18.8 17.9 16.6 16.9 17 18 2.17 2014-15. 2.21vii 2012-13 2.24 2014-5. % QoF recorded Access to

Injuries Diabetes registd DR screening due to Falls with GP- 17yrs+ programme * # 6.7 6.7 6.6 7.3 6.8 6.1 5.7 6.1 6.1 6.4 78.8 77.3 79.2 78.9 77.6 82.8 80.5 83.4 77 79.1 ! 2465 2167 2041 2130 2057 1956 2086 1962 2253

2125 * PHOF http://www.phoutcomes.info/ Portfolio of Indicators for Eye Health and Care Broad Portfolio Indicators: RFs / determinants* population eye health Local Variations : identify populations at particular risk to their eye health inform (eye) needs assessments inform local (eye) health priorities Alignment with broader health priorities for chronic disease prevention and management Relevance to Patients : eye needs assessed with their overall health needs Relevance to Commissioners: added value to broader prevention and health risk assessment person approach Relevance to the Population: modification of risks to eye health eye health improvement programmes . whole Portfolio Indicators : Diabetes Region North Midlands & East South London England Standard Portfolio Indicators - Diabetes Broad

Eye Specific % Children and Young % Uptake of Screening People 12-18 years % referred R3A assessed Offer >=12 yrs age (range) diagnosed as Diabetic within 4 weeks (range) that are screened 83.2 (76.3 to 91.8) 80.3 (45.7 to 92.2) * 84.3 (78.9 to 92.6) 76.0 (41.7 to 92.6) * 81.4 (72.3 to 91.9) 72.2 (27.8 to 98.4) * 81.9 (72.0 to 88.4) 76.3 (55.2 to 92.3) * 82.9 (72.0 to 92.6) 76.7 (27.8 to 98.4) 64.9** 70.0 to 80.0 80% Source: Annual DESP KPI 2014-15 https://www.gov.uk/government/publications/nhs-screening-programmes-kpi-reports-2014-to-2015 ** National Paediatric Diabetes Audit 2014-15 Notable variations Standards for urgent referral not met patient safety and risk issue CYP not routinely reported but potential patient and safety issue.

Relevance affirmed by NPDA 2014-15 ** Portfolio Indicators: Sight Impairment / Loss Portfolio Indicator Relevance to Patients Relevance to Commissioners BROAD Certification Sight Impairment (causes & new additions to prevalent pool) Recognition of sight impairment and need for support Inform planning and provision of social services Registered Blind & Partial Sight Assessment and provision of (known to the system prevalent pool) support in the community EYE SPECIFIC Audit of CVI and causes (practice & patient uptake) Ensuring access to emotional Support independence and and rehabilitation services social inclusion ECLO Service Commissioned Living with sight loss, independence and inclusion Low Vision Service Commissioned Support independence and

social inclusion Portfolio Eye Specific Indicators: Primary & Community Care % of NHS Sight Test in Eligible Population by Area Team in England, 2014-15 0-15 yrs % NHS Sight Tests 30 28 60 25 22 21 20 >=60 yrs % NHS Sight 70 Tests: 20 16 17 49 50

20 44 43 17 42 42 40 35 15 33 31 30 10 20 5 10 0 AN D EN GL

LO ND OF Maximum H Minimum SO UT & S ON ... GL EN EA ST GL EN H NO RT England: 26,764 NHS sight tests per 100,000 population 0-15 yr

Regional M ID LA ND Maximum OF Minimum En gl Regional AN D an d 0 England: 44,981 NHS sight tests per 100,000 population>=60 Portfolio Eye Specific Indicators: Primary & Community Care - Glaucoma Source : Atlas of Optical Variation. Reproduced with permission from LOCSU Portfolio Eye Specific Indicators: Hospital Eye Service Clinical Outcome : local audit

high volume, high cost service new interventions for chronic disease VA outcomes of anti-VEGF Rx for AMD, DMO, or RVO after the loading dose at 1 year after starting Rx Relevance to patients : maintain current sight Relevance to commissioners: evidence of effective intervention to meet clinical need Patient Safety : local audit % rebooking of non-attendance hospital appointments that occur within 25% of planned interval RCOphth quality standard Relevance to patients avoid harm from disease progression Relevance to commissioners KPI for safety and monitoring capacity issues Summary The Portfolio A pragmatic tool The right information, right time at local and national level - what is going on/how we are doing to : Stimulate pro-active discussions between clinicians, providers and commissioners Underpin contract specification Facilitate getting evidence into practice Relevant clinically, to the health service and patients INFORM APPROPRIATE ACTION

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