National IBD Audit Pre-Pilot

Alan Moore

Description

ƒƒ¾ƒƒƒ¾ƒ¾ƒƒ National Audit to Assess and Improve Services for People with Inflammatory Bowel Disease Project Summary The UK National IBD Audit aims to improve the quality and safety of care for IBD patients throughout the UK, by involving professional groups and patients in a national audit of individual patient care and of service resources and organisation in all hospitals The project is based on a collaborative working partnership between the British Society of Gastroenterology, the Association of Coloproctology of Great Britain and Ireland, the National Association of Colitis and Crohn’s Disease and the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit. The project is funded by a grant from the Health Foundation and is a four-year, nation-wide, full cycle comparative audit with initial audit, subsequent dissemination and change implementation followed by re-audit. The audit aims to: Assess the current structure and organisation of care for IBD Assess the processes and outcomes of care delivery (inpatient and outpatient) in IBD Enable Trusts to compare their performance against national standards Identify resource and organisational factors that may account for observed variations in outcome Facilitate, develop and institute an intervention strategy to improve quality of care. Repeat the audit to prove that change has occurred Establish a series of measures that healthcare services can ...

Informations

• Publié par: Nething
• Nombre de lectures: 24
• Langue: English

Extrait

National Audit to Assess and Improve Services for People with Inflammatory Bowel Disease Project Summary ¾The UK National IBD Audit aims to improve the quality and safety of care for IBD patients throughout the UK, by involving professional groups and patients in a national audit of individual patient care and of service resources and organisation in all hospitals ¾The project is based on a collaborative working partnership between the British Society of Gastroenterology, the Association of Coloproctology of Great Britain and Ireland, the National Association of Colitis and Crohn’s Disease and the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit. ¾The project is funded by a grant from the Health Foundation and is a fouryear, nationwide, full cycle comparative audit with initial audit, subsequent dissemination and change implementation followed by reaudit. The audit aims to: ƒAssess the current structure and organisation of care for IBD ƒAssess the processes and outcomes of care delivery (inpatient and outpatient) in IBD ƒEnable Trusts to compare their performance against national standards ƒIdentify resource and organisational factors that may account for observed variations in outcome ƒFacilitate, develop and institute an intervention strategy to improve quality of care. ƒRepeat the audit to prove that change has occurred ƒEstablish a series of measures that healthcare services can use beyond the study to compare quality of IBD services ƒDevelop a sustainability programme to maintain quality of care. Data definition, collection, analysis, reporting strategy and intervention The project has 5 stages over a 4year period. Much of the work is sequential, so some details in the later years may be changed in light of the early findings. At each stage of the project, the audit will include piloting of new variables and dual data collection to ensure good data quality and repeatability. Thus the conclusions should be reliable to use as a major driver for improvement. Stage 1 – Pilot Stage (May – June 2006) The elements of organisation and clinical care to be measured will be defined. The key “organisational” indicators for assessing the IBD service are to be defined from: a.The recently published BSG guidelines and statement on service provision b.Experience from previous CEEU national audits The clinical indicators for the process and outcome of care for people with IBD are to be defined from the published guidelines augmented by consensus methods.Principles learnt from earlier studies of limiting variables to those that need to be known, and of ensuring tight and unambiguous definitions have been followed. The defined questions are to be piloted to test their reliability and reproducibility. A webbased data collection tool will be designed to simplify the process. Feedback will also provide critical appraisal on the webbased audit tool, functionality of the site and usefulness of the associated help booklets. At this stage only the pilot sites will be in contact with the project but advance planning and publicity will alert other hospitals to prepare for the national audit.

Stage 2 National Audit of Clinical Care (20062007) A lead clinician for IBD services, a lead colorectal surgeon and audit lead in all relevant acute Trusts will be identified, contacted and recruited.Trust Chief Executives will be alerted to the study. ƒInclusion criteria: st An audit of the site organisation of IBD services as at 1June 2006 Retrospective casenote audit of 40 consecutive patients (20 Crohn’s and 20 st Ulcerative Colitis) working backwards from 1June 2006.Case identification will be based on the discharge diagnosis as this defines the standards the clinical team would expect to be assessed against. Data collection will be retrospective 3 months after the admission to allow for limited outcome data to be collected. th st Data collection for the main audit will run from 4September 2006 to 1December 2006. ƒData collection method:Data will be entered via a web based tool ƒData analysis:Statistical analyses will compare each Trust separately against the National Guidelines and also against a benchmark derived from the performance of other Trusts across the country.Subgroup analysis will be restricted to the national (and regional if numbers permit) dataset and will examine the two diagnoses separately and possibly sub groups receiving, or not receiving, surgery. ƒData feedback: Individual hospital results will be fed back (within 3 months of data completion) to the clinical teams at each site with comparisons to national norms. This information will also be sent to Chief Executives.More limited summary data on the first round of audit will be made available to the SHAs and PCTs. Stage 3 – Intervention (20072008) Multidisciplinary regional meetings will stimulate local discussion of the data and begin the search for local solutions to identified problems.This approach is known to work but the project would like to accelerate the pace of change. Two thirds (selected at random) of hospitals will be asked to prepare a local action plan. The clinical team, in conjunction with local management, should complete the plan.They should comprise 5 key action points per site (and more if wished), with the aim of the study to evaluate the 5 principle points per site.In half of those who have produced action plans (i.e. one third of all participants), the project management team will follow up by seeking updates on progress towards the agreed local targets. This will give three equal groups (simple feedback, feedback plus an action plan, and feedback plus a moderated action plan) whose relative progress can be evaluated in terms of reported changes introduced in organisational structures and the actual changes in processes and outcomes of care achieved in the repeat audit study. Stage 4  Reaudit (20082009) Both the organisational audit and clinical care audits will be repeated.Changes in service delivery will be identified. Changesin the process and outcome of care will be noted, along with changes in the utilisation of services.In particular the changes that trusts have instituted will be recorded to compare and assess the relative efficacy of the intensity of the intervention above.The project would hope to see change in each of these dimensions. Stage 5  Feedback of results and future planning (2009) Results will be fed back to Trusts and because there should now be more confidence in the reliability of the data, much fuller reports will also be produced for Strategic Health Authorities, PCTs and the Healthcare Commission.Local action plans will again be encouraged.Discussions with all parties will establish how the project should continue.

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