Transcript Document

Complete this sentence by choosing
one of these statements
Cardiac rehabilitation is….
A. …a bit of TLC for patients who’ve had a rough time.
B. ..something patients seem to like that does no harm.
C. ...an exercise programme.
D. …an evidence-based, cost-effective way to save the
lives of cardiac patients, with 36 randomised trials
showing a pooled 26% reduction in cardiac mortality?
So how come?
Since 2000 massive investment in PTCA and Surgery
Angioplasty no improvement in survival
Surgery overall 2% better survival than medical care alone
YET 5 years after the NSF we suspect that 70% of patients do
NOT get CR. If this was surgery there would be a major
scandal.
The official response
“we’d like to help but we can’t afford to do everything right
away, just be patient”
“our turn will come if we just wait” – Animal Farm, G.Orwell
11 June 2004
Firm commitment from the Health Secretary John Reid for
Expert Patients
At a recent Big Conversation event the Health Secretary, John Reid
said
"The government intends to roll out its "expert patient" pilots across
the country. These involve training lay people to support patients
with long-term chronic conditions".
By 2008 everybody with a chronic disease who wants an "expert
patient" (sic) will have one, he promised.
And by the way
CR has not been costed in to ‘payment per treatment’ and
trust finance directors are under increasing pressure to stop
any activity that has no income stream.
Kaiser Permanente and United Healthcare are being asked
to solve the problems of delivery of various underperforming
services. MULTIFIT call-centre based rehab anyone?
In the acres of DoH publicity about the new age of Chronic
Disease Management why have we not seen a single
mention of CR?
Central
Cardiac
Audit
Database
How do others get funding?
By demonstrating shortfalls
National
Pacemaker &
ICD Database
Only health authorities shown in
orange reach the new implant rate
required by N.I.C.E. guidelines.
NEW ARRHYTHMIA CHAPTER OF NSF DUE OUT IN MARCH 2005
It will recommend large increase in funding for ICDs,
coincidence?
What is CCAD?
BRITISH CARDIAC SOCIETY (MINAP) - all MIs
BRITISH CARDIAC INTERVENTION SOCIETY - all PTCA
CARDIOLOGISTS PUTTING IN ICDs all patients with ICDs
PAEDIATRIC SURGEONS AND CARDIOLOGISTS - all children in UK
hospitals undergoing surgery or catheter based intervention for heart
disease.
CARDIAC SURGEONS - Society of Cardiothoracic Surgeons - all adults in
UK hospitals undergoing cardiac surgery.
ELECTROPHYSIOLOGY CARDIOLOGISTS - all ablation patients
“MI, PTCA, Surgery, the whole patient pathway, but.. isn’t
there something missing? …”
Not now.
BACR / BHF - all CARDIAC REHABILITATION PATIENTS
Why is everyone so keen to audit?
To improve their services
To tell the world what they achieve
To demonstrate to managers / DoH, NICE, the Healthcare
Commission where there is a problem of under-investment
To mark out their territory
The national audit of cardiac
rehabilitation
Partners - BACR, BHF, Healthcare Commission. NHS
Information Agency, Heart Team
Online National Benchmarking by CCAD
Overseen by a committee drawn from
Clinician representatives, BACR, BHF, NHS Heart Team, NHS
Information Agency, MINAP / CCAD, patient representative.
Bankrolled by the BHF
Why should we audit?
1 because we provide a life saving intervention that few of
the decision makers in the NHS take seriously.
2 to show purchasers what we have achieved and the
Healthcare Commission what we are NOT achieving and
what we could achieve if we had the tools.
3 Because 70% of patients are not getting CR and many
lives are being needlessly shortened – we need the facts to
fight for better services and put pressure on funders.
4 Because if we can’t get our act together and present a
united front now, when the chance is being offered on a
plate, maybe other people should take over.
How should we audit?
We should choose our own targets - not just aspirin use and
lower BMI - but also - liberation from fear or depression,
improved quality of life, helping patients become active for life
and feeling well.
Otherwise it may appear to be simpler to just have more
primary care ‘chronic disease management teams’ & forget
about CR.
Not by ticking off boxes - e.g.. ‘number discharged with a
written plan’ this tells us nothing - what was the result?
NOT with league tables which are very unfair
1. because of wide case mix patients may not be comparable
2. Because of huge discrepancies in funding and resources
Developed over 6 years Recommended in the NSF Document
Evidence based
Read all about it - http://www.cardiacrehabilitation.org.uk/dataset.htm
What will I get out of it?
Some extra work – no pain no gain!
Free software package developed by the user community to run your
programme
Fantastic annual reports and materials for business cases provided for you
by CCAD and comparing your resources with those of other programmes.
Better knowledge of your own performance relative to that of other
programmes
A set of tools for moving to menu based services.
Job security! Finally being electronically linked to the patient journey and
regarded as an essential part of that journey.
Equality with all other parts of the cardiac service.
What will we all get out of it?
Hundred of 1000s of patients lives prolonged and enriched
better recognition of and funding for CR
Improved understanding of what we need to do to get optimal results in CR
Local and National funding black spots exposed to the Healthcare
Commission, Dept. of Health and general public
Ammunition for BACR, BHF and patient organisations to demand improved
services at the national level
Coming of age of CR as an integral and essential part of the care of every
cardiac patient – electronically linked into the patient pathway – for ever.
Are you going to join? Yes but, no but..
Q. “I don’t have time. I always put my patients needs first”
A. “It takes much less time than you think. But if you take a little time from
patients now it will improve life for thousands of future patients.”
Q. “Patients don’t like questionnaires, questionnaires don’t tell you anything
etc, etc,”
A. “Not true. We need to talk!”
Q. “What if it turns out we aren’t doing very well with the NSF targets?”
A. “That’s the whole point. Providing CR is mandatory show funders where
your weaknesses are and how poor their performance at funding is is
your only hope of improving things. Anyway, your results are
annonymised on the online benchmarking.”
Yes but, no but….
Q. “We already have our own database”,
A. “fine, just link it to this one with a patch.”
Q. “We are collecting different information will we have to stop?”
A. “No, you can collect any information you want BUT we do all have to
collect the same minimum data in the same way”.
Q. “We are well supported locally, get great results and don’t need to prove
anything to anyone”
A. “We desperately need your data to show that it can be done, there are
those who, publicly and loudly, doubt that CR achieves anything.
Unchallenged they may close everyone down”
Yes but, no but….
Q. “I’ve heard this is just a con to get us to do research for nothing?”
A. “This is not a research project, it is a service development, it doesn’t
count for the RAE, some academics at York University have already been
b********d for ‘wasting’ so much time on it.”
Q. “I’ve developed a better minimum dataset why don’t we use that?”
A. “maybe you have, but this one has been developed with and adopted by
all of the key players, it is up and running now and is our only chance to
join the club”.
Q. “What if it doesn’t take off? We’d have wasted a lot of effort”
A. “The only way this can fail is if YOU don’t take part.”
What help will we get?
Masses!
Phone and Email help desk at York – project manager Corrinna Petre.
01904 32 1336, [email protected]. Always first point of contact.
Technical support from the CCAD support line. Talk to your IT people, help
set the system up, problem solve any technical problems. Corinna will put
you through.
On site and phone support from your local BHF Cardiac Rehabilitation
Coordinator, will come and talk to you and your team, show you how to
work the programme, organise local events, etc.
Help with analysis from York, statistician, information scientist.
News letters, online user groups, whatever users want.