Transcript Document
NATIONAL CARDIAC REHABILITATION PROJECT PEER SUPPORT MEETING National update on CR 8th December 2011 Prof. Patrick Doherty NCL for CR (NHS Improvement) The session will cover • NICE service commissioning guidance – CMG39 CMG40 • NHS outcomes • 30-Day post discharge readmissions tariff • Early CR as a key focus for 2012 NICE CR service commissioning guide: CMG39 and CMG40 (Nov 2011) • Aligned with DH CR commissioning pack 2010 • Informed by NICE CG 48, 94 & 108 • Identifying in-scope and eligible patients • comprehensive patient assessment pre and post CR • tailored management plans based on patient needs and BACPR core components • offering choice that includes hospital, community and home-based programmes • providing a quality assured service with audit (NICE example NACR) NHS framework domains 2012/13 • CR is aligned with the new NHS structure and priorities: – Reduces premature death in a highly cost effective way (Domain one) – Proven in the delivery of significant outcomes for patients with long term conditions (Domain two) – Is an emerging solution to the problem of unplanned readmissions (Domain three) – Complements patient experience through a comprehensive co-morbidity inclusive approach (Domain four). Update on readmissions! • Recent work by the DH, NICE, NHS Improvement and the NACR has estimated the cost for CR. as £477(staff cost only) • There is also an estimated £120 (plus or minus local variation) for associated costs such as equipment, assessment materials, phone calls, intervention costs and audit costs. • Collectively these calculations bring the overall minimum cost to about £600 per patient. • Finally the DH is also pushing hard to deliver CR as a solution to unplanned readmissions which will hopefully result in a Post Discharge Tariff in 2012. Early CR focus • NACR data (NACR 2011) highlights that patients are waiting on average 25 days for first the CR assessment and 56 days for tailored interventions to commence. • Patients continue to report that they are waiting too long and lose motivation for rehab as wait times increase. • This situation flies in the face of logic and needs to be tackled urgently by CR providers • • The DH and PbR are developing approaches to tackle 30- day readmissions and are keen to support CR as an interventions with a post discharge tariff attached. • There is emerging evidence indicating that CR commenced early is safe to do, is linked with improved uptake and adherence, is associated with improved care and can reduce the likelihood of unplanned hospital readmissions. • • • Greg Lam, Rick Snow, Lynn Shaffer, Michelle La Londe, Kathy Spencer, Teresa Caulin-Glaser. THE EFFECT OF A COMPREHENSIVE CARDIAC REHABILITATION PROGRAM ON 60-DAY HOSPITAL READMISSIONS AFTER acute MI JACC April 5, 2011, Volume 57, Issue 14, Heran BS, et al (2011) Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001800. DOI: 10.1002/14651858.CD001800.pub2 Haykowsky M., et al (2011). A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling. Trials p. 12:92. Parker K., et al (2011). An Early Cardiac Access Clinic Significantly Improves Cardiac Rehabilitation Participation and Completion Rates in Low-Risk ST-Elevation Myocardial Infarction Patients. Can J Cardiol. 2011 Sep;27(5):619-27. Epub 2011 Apr 7. For more detail please visit: 1. NHS Improvement: www.improvement.nhs.uk/heart/cardiacrehabilitation 2. British Heart Foundation Cardiac Care and Education Research Group www.cardiacrehabilitation.org.uk 3. British Association for Cardiovascular Prevention and Rehabilitation (BACPR) www.bcs.com 4. Department of Health: Publications policy and guidance http://www.dh.gov.uk/en/Publicationsandstatistics/Publica tions/PublicationsPolicyAndGuidance/Browsable/DH_117 500 5. Connecting for Health www.connectingforhealth.nhs.uk/clinicalcoding Questions most welcome. Thank you!