Welcome 18th March 2009 - King's Thrombosis Centre

A Primary Care Trust Perspective NHS North Lancashire Dr Jim Gardner Medical Director & PEC Chair NHS North Lancashire [email protected]

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

VTE Improvement Cycle Understand Raise awareness Measure Set standards

Sources of data Primary Care PRIMIS QoF Secondary Care Regional Data Warehouse (SUS) CHKS Hospitals own

pathology/haematology Primary Care Prevalence from PRIMIS searches 3000 2500 2000 1500 1000 500

0 1 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) Primary Care Patients on Warfarin from PRIMIS search No of Pts without either DVT or PE prescribed

Warfarin between 01.11.08 - 31.01.09 505 383 No of Pts with DVT and Warfarin No of Pts with PE and

Warfarin 2811 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) Annual Hospital Incidence from SUS data. 1200 1000

800 UHMB BVH LCT Other Total 600 400

200 0 20052006 20062007 20072008 Data from Cumbria & Lancashire Commissioning Intelligence Support

(CaLCIS) North Lancashire Residents (population 340,000). Benchmarked Analysis of Venous Thromboembolism 2006-2008 data Venous Thromboembolism primary or secondary position

Venous Thromboembolism Stay by type 2008 only NHS North Lancashire - Population 340,000. Length of

Venous Thromboembolism mortality rates 2008 only NHS North Lancashire Population 340,000 VTE Improvement Cycle Understand

Measure Raise awareness Set standards 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

Refining DVT diagnosis in primary care >140,000 referrals for ?DVT/year in UK 80 90% do NOT have DVT Need to refine tests in primary care

Clinical Decision Process including nearpatient-testing Safely Ruling out Deep Venous Thrombosis in Primary Care. Buller et al. Ann intern Med. 2009; 150:229-235 One PBC consortium implementing. VTE Mind Map from PCT Perspective 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 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?

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