An educational programme to improve the quality and productivity of COPD management by ensuring that all of its practices provide a consistent standard of care in line with NICE COPD guidelines. The programme was then monitored and measured by the use of an audit tool to ensure successful outcomes could be implemented across all practices.
This example was originally submitted to demonstrate implementation of NICE guideline CG101. The guideline has now been updated and replaced by NG115. The example has been amended to reflect this and remains consistent with the updated guideline. NG115 should be referred to if seeking to replicate any aspects of this example.
Aims and objectives
Wearside and GSK worked jointly to drive quality and equity of care in the management of COPD:
- This project aims to ensure that all practices within the group are able to provide a consistent level of COPD care in line with NICE COPD guidelines, thus reducing potential inequalities.
- The implementation of this project ensured a thorough understanding of practice and PBC group needs. A bespoke educational programme was then deployed as a part of evidence based care pathway ensuring patients received optimal treatment in most appropriate setting.
- Be appropriately diagnosed earlier.
- To reduce exacerbations of COPD and improve quality of life.
- To receive more localised care closer to home.
- Receive a consistent standard of care across the PBC group.
- Better understanding of the need to manage their condition.
- Improve the patient's experience of the health system and potentially improve patient outcomes.
Up-skilled, motivated healthcare professionals will be:
- Better able to diagnose COPD, reduce exacerbations, manage in line with agreed pathways and reduce hospital related costs.
- Empowered to manage more COPD patients in primary care.
- More able to consistently record important COPD clinical data.
Member practices will be able to enhance patient care by adopting a whole practice approach.
- The development of an agreed best practice patient pathway and treatment protocol.
- The efficient use of existing services across all practices.
- Implementation of a patient screening programme to case find at risk or undiagnosed patients.
Reasons for implementing your project
The British Lung Foundation's 'Invisible Lives' report ranked Sunderland PCT 6th in its table of UK healthcare regions facing the greatest challenge from COPD - and number 1 in the North East. People here are 51% more likely to be admitted to hospital with COPD than the UK average1. The area has a strong industrial heritage, and Sunderland was at one stage the world's biggest shipbuilding town, owing to the wealth generated by Wearside coal and the need to transport it. Locally, Wearside Consortium serves a population of 104,508 people - 37% of Sunderland PCT's population2 - through 21 practices.
Wearside Consortium has a COPD prevalence rate of 2.8%, which equates to 2,916 COPD patients2. COPD presents a significant cost burden to Wearside Consortium, with spend on COPD hospital admissions reaching £1.1m in 2008/093. COPD was clearly a high priority area for the group and was included within the PBC plan as an area where cost efficiencies could be made due to the high level of unplanned admissions. It was also identified skill and capability across the group was varied and would need to be addressed in order to achieve consistent level of patient care.
A baseline assessment was carried out using POINTS (Quintiles audit tool) which highlighted areas for improvement at both a practice and cluster level. Key areas highlighted were: - Diagnosis and recording of spirometry. - Severity coding. - Exacerbation recording. Inconsistency in these areas meant that implementation of NICE guidelines was difficult to assess, potentially leaving patients at risk of sub optimal treatment.
How did you implement the project
- Patient pathway and treatment protocol. The PBC group COPD lead developed a nursing protocol for management of acute COPD exacerbations and a review protocol consistent with NICE guidance. This documentation was used to deliver a consistent standard of care for patients within the PBC group.
- Needs analysis. A needs analysis was developed and carried out at both an individual practice and cluster level to define the training/education/service needs. This included identifying current gaps in the recording of relevant data and coding issues.
- Education. An educational programme was developed; this was bespoke to practice/cluster needs and was and continues to be implemented. The programme up-skilled both healthcare professionals in the delivery of high quality patient care, and equipped patients with more information around their condition, options and treatments.
- Patient audit tools. Patient audit tools (POINTS**) was deployed across the PBC group to enable healthcare professionals to identify at risk and undiagnosed COPD patients more effectively. A standard review template was implemented to ensure consistency in data recording and reduce the risk of inequity of care. Regular audits have been be carried out to track progress against performance indicators in line with NICE.
- Patient review. Implementation of the project across the PBC group has:
- Enhanced ability to provide high quality patient review and care.
- Ensured care is delivered in a consistent way across all practices.
- Monitored progress and tangible benefits of the improvements in quality of care.
- 18% improvement in the quality of patient review, moving from QoF to NICE standards.
- Importantly, the percentage of patients receiving an annual COPD review has increased from 44% to 74%.
- An increase in patient understanding of their condition from 64% to 76%, with 50% of patients reporting that their understanding of what to do if their symptoms get worse had increased as a result of their lung check-up.
- 9/10 patients were satisfied with the level of service given to them during the check-up, and felt the review was thorough.
- A 12% reduction in year-on-year COPD admissions in the period July 2009 to June 2010.
- 42 Healthcare Professionals (a GP and Practice Nurse Respiratory Lead from each practice) have attended three half-day COPD updates, in addition to the training and mentoring delivered through practice-by-practice bespoke action plans.
Key learning points
Most aspects of this project could be replicated in other areas. The key drivers were the consistent use of templates and therefore recording allowing assessment of current situation and the ability to build a bespoke training package to meet these needs. The baseline was crucial to the development of the local PBC plan and enabled the clinical leads to ensure the project was implemented effectively and reviewed regularly. Documented action plans were put in place to ensure changes in practice could be indentified and successes shared across the group to maximise the improvement in patient care. The project was also able to show the adherence to NICE guidance which was crucial to ensure equity in patient care.
This is a Joint Working Project with Glaxosmithkline developed in line with DH/ABPI requirements.