Pranathi Ramachandra Caring for dementia patients Plaques and tangles Primary care Neurology AampE Older peoples m ental health Medicine for elderly Social care Problems Too many silos of service provision ID: 228646
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Slide1
Joined up care and research in dementia: Braiding the strands
Pranathi RamachandraSlide2
Caring for dementia patients
Plaques and tangles?
Primary care
Neurology
A&E
Older people’s
m
ental health
Medicine for
elderly
Social careSlide3
Problems
Too many silos of service provision
Errors of commission - Duplication of services
Errors of omission - ‘slips through the net’
Parallel information systemsOutdated information storage and retrieval No information about magnitude of needSlide4
Trying to make sense
Audit of OPMHS memory assessment service 2009
7 teams
March to September 2009
650 new referrals17 patients of dementia pathway???!!!! – IT report after 6 weeks3 months of plodding through paper files – 450 referrals for memory problems, 187 new onsetSlide5
Project aims
ICD-10 coding of all new referrals to OPMHS
Record codes electronically
Retrieve reports periodically
Encourage research participationRipple effect across the trustContribute data to local dementia registerSlide6
Partners
CLAHRC
OPMHS
IPHCPFT IT
CUHFTDeNDRoNSlide7
Process
For CPFT coding
IT
OPMHS colleagues
Admin staffFor dementia registerNeurologyDMEGPsDHDeNDRoN
3rd sectorBRCSLAMSlide8
Multiple avatars
CLAHRC fellow
CLAHRC old age theme psychiatrist
Liaison older people’s psychiatrist
Memory clinic psychiatrist
OPMHS research with DeNDRoNCPFT IT clinical safety officerGeneral nosey parker, jack of all trades, maverick, ‘dosser’Slide9
Acts of God and natural disasters
Services stretched thin
2 clinical sessions and 8 research sessions in September 2011
7 clinical sessions, 1 CLAHRC session and 1 IT session todaySlide10
However…
ICD Coding becomes norm in
O
PMHS
Ripple effect – liaison psychiatry and specialist TRD clinic start codingCoding to be mandatory across trustDementia on the map, there to stayDH working group endorses dementia register is priority project
SLAM IT partner with CPFT to use CRIS for researchMove for national dementia informatics projectSlide11Slide12Slide13Slide14
Results
1341 new referrals
7 teams
100% coding
645 dementia 484 AD184 MCI114 delirium
1 international multi-site trial of monoclonal amyloid antibody in prodromal AD1 non-commercial multi site national study in LOSLP 1 RNIB study in visual deficits in dementia1 PhD project on end of life decisions in dementiaSlide15
We’re not perfect
O
ccurrence at home 12
O
ccurrence at other place 1Hepatic failure, unspecified 1Circumscribed brain atrophy 2
Anankastic personality disorder 2Personality disorder, unspecified 1Unspecified mood disorder 1Mental retardation with statement, minimal or no impairment 1Developmental disorder of scholastic skills, unspecified 1Adjustment disorder with predominant disturbance of other emotions 1Problems in relationship with spouse or partner 1Slide16
The fellowship
Terrific experience
Thinking space and time
Excellent cohort
Great quality and variety of subjects and teachersALS sessions are amazingGreat organisation
and catering Special thanks to Christine, Lea, Angela and DianeFar too short!