1 st November 2017 EMBER Meeting Lucy Sitton Kent East Midlands Academic Health Science Network Between the health care we have and the care we could have lies not just a gap but a ID: 778108
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Slide1
Spreading & Adopting Innovation
1st November 2017EMBER Meeting Lucy Sitton-Kent, East Midlands Academic Health Science Network
Slide2“Between the health care we have and the care we could
have, lies not just a gap, but a chasm”Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001:1
Slide3Adoption & S
pread of mobile phones
Slide4We have come a long way!
Slide5There’s still some work to do!
5Median time (minutes) from arrival at hospital to brain imaging for stroke patients by CCG
Slide6The ultimate variation?
Life expectancy in the UK
Slide7How fast do clinical procedures reach patients
?Clinical Procedure Landmark Trial
Rate of
Use study
Rate of Use %
Annual
increase
in Rate of Use %
Flu
Vaccination
1968
1997
55
1.9
Thrombolytic
therapy
1971
1989
20
1.1
Pneumococcal vaccination 1977199735.61.8Diabetic eye exam1981199738.42.4Beta Blockers after MI1982199761.94.1Mammography 1982199770.44.7Diabetic footcare19831998204.0Cholesterol screening 19841995655.9Fecal occult blood test 19861993172.4
Average annual rate of adoption = 3.2 %
Balas, E. A., & Boren, S. A. (2000).
Yearbook of Medical Informatics: Managing Clinical Knowledge for Health Care Improvement.
Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH.
Slide8“Our ambition must be for an NHS defined by its commitment to innovation demonstrated both in its support for research and its
success in the rapid adoption and diffusion of the best transformative, most innovative ideas, products, services and clinical practice”Sir David Nicholson,Innovation, Health and Wealth, 2011
Slide9Improving outcome’s, reducing variation and driving down cost through innovation!
Slide10Slide11Slide12Lost in translation?
Slide13The “6 C’s” of Adoption
and SpreadContent & Context are critical,Objective clinical, technical and economic evaluation,Demonstration of improved clinical outcomes, better patient experience and reduced costs,Delivers on the strategic direction of the organisation. Champions are vital at national, regional, local and very local levels,Publishing a well referenced academic paper is not enough to change behaviour,Adoption & Spread requires people to meet people.
Slide14The “6 C’s” of Adoption
and SpreadClarity & simplicity,Clear messaging that makes Adoption & Spread a “no brainer”,The process of implementation has to be straight forward even though it might not be easy,Support in making the change is essential – clinical evidence, health economics, implementation guidance, procurement documentation, “executive” summary, FAQs, “help line”.Adoption & Spread is a Contact sport!Publishing a well referenced academic paper is not enough to change behaviour,Adoption & Spread requires people to meet people. Co-production is a powerful accelerant,Patients and carers need to be engaged early and often, Development teams need to work collaboratively throughout the process from “cradle to grave”,Pull is better than push, pull and push is even better.
Slide15Is there a right level of funding for A&S?
A&S compared to R&D
Slide16Spreading Innovation with Impact
Slide17Preventable harms from medicines in general practice
Prescribing errors1 in 20 items with an error – 1 in 550 with a serious errorOver 1 billion items dispensed = >1.8 million serious prescribing errorsPreventable medication-related admissions to hospitalThese account for around 1 in 25 hospital admissions4 classes of drug account for over 50% of these admissions: anti-platelets diuretics NSAIDs anticoagulants
Slide18The PINCER Trial
A cluster randomised trial comparing the effectiveness of a Pharmacist-led IT-based iNtervention with simple feedback in reducing rates of Clinically important ERrors in medicines management in general practicesThe Lancet, 2012;379:1310 – 1319 doi:10.1016/S0140-6736(11)61817-5
Slide19PINCER findings
At 6-months follow-up patients in the PINCER group were 42% less likely to have been prescribed a nonselective NSAID if they had a history of peptic ulcer without gastroprotection27% less likely to be given a beta blocker if they had asthmaAlmost 50 % less likely to be prescribed an ACE inhibitor or loop diuretic without appropriate monitoringUsing GP computer systems to identify patients at risk, combined with a pharmacist intervention, can substantially reduce medication errorsThere was evidence that the intervention was cost-effective The intervention could be rolled out across NHS at low cost to reduce medication errors
Slide20ChatHealth: Innovation into practice
A safe and secure text messaging service that puts secondary school pupils in touch with a school nurse, via their mobile phoneDeveloped by Leicestershire Partnership NHS Trust, and was a winner of a 2015 NHS Challenge PrizeKey benefits: highly cost effective, is more convenient for the user (no need to wait for a school nurse visit) and uses technology that young people are familiar and comfortable with
Slide21ChatHealth: what’s the impact?
EMAHSN impact dimensionActual impactAssist the adoption and spread of innovation into practicePre-EMAHSN support: 65,000 users. Following EMAHSN support = 1,000,000 users nationally (Q4 2016)Create wealth, stimulate economic growth or generate income
Trust income generation
from l
icence fees:
£225,000 during 15/16
In
16/17 ChatHealth made an operating surplus.
Influence or change commissioning
By
Q1 2017,
26 NHS Trusts within England
had adopted this innovation
Change that benefited the economy
4 full time jobs
created
What’s next?
Plans to extend its reach beyond schools to health visitors, mental and sexual health services
Slide22AF Advance
Innovation – Novel technology and pathways to ensure rapid screening and detection.Improvement – reducing variation across CCGs, optimising anti-coagulation and enabling the delivery of best practice care.Education – develop clinical ambassador roles within each CCG and provide up-skilling training to enable clinical ambassadors to take a leadership role in driving through improvements in AF diagnosis and management.
Slide23Thank you for listening
Any questions?
Slide24EMAHSN:
Transforming the health of 4.6m East Midlands people and stimulating wealth creation lucy.sitton-kent@nottingham.ac.uk www.emahsn.org.uk @EM_AHSN