Improving patient safety with INRstar analytics
Leicester CCG has used INRstar analytics to improve patient safety and commissioning efficiency
Leicester City Clinical Commissioning Group (CCG) has worked in partnership with INRstar, to develop an award winning* analytics tool to improve patient outcomes and improve commissioning efficiencies to support the Quality, Innovation, Productivity and Prevention (QIPP) programme.
Thanks to analytics Leicester City CCG can now easily demonstrate:
- Over 1,300 new warfarin patients requiring anticoagulation treatment added to the INRstar system to monitor TTR and regular patient monitoring which all reduce the risk of stroke
- 78% reduction in the number of patients with an overdue warfarin monitoring
- 95% of patients with a TTR >50%
- No INR readings >8 for over 9 months
- Database for DOAC patients to support quality reviews and reduce the risk of stroke
- Medicines management audits showing improved quality of prescribing
- Practices requiring additional clinical support from GP mentors
The Analytics real-time intelligence tool has been developed to support a wider population based approach to patient safety and prevention within the Cardio Vascular Disease (CVD) programme. It supports clinical leads, practices and commissioners to work together to improve the safety of the use of warfarin and support the agenda to reduce the risk of strokes in the population.
INRstar analytics supports clinicians through clinical analysis of time in therapeutic range (TTR) trends and National Patient Safety Agency (NPSA) audits and identifies patients who have missed INR tests which could put them at higher risk of stroke. The primary care anticoagulation service is delivered from 52 GP practices on behalf of all practices within Leicester City and provides an initiation, monitoring and management service for patients’ prescribed anticoagulation (warfarin and DOAC) therapy. The deployment of INRstar analytics means that providers and commissioners are now able to monitor and measure activity and quality metrics for patient safety and clinical outcomes in real-time, with a single push of a button. This information enables the providers to reduce clinical variation, and supports the commissioning intention to improve patient outcomes by reducing emergency stroke admissions.
*Winner of the 2015 Ehealth Insider (EHI) awards “Excellence in Business Healthcare Analytics” category.
Many commissioners, including Leicester City CCG, spend days gathering and analysing activity, and quality and clinical audit data from different locations. INRstar analytics was designed with clinicians and commissioners at Leicester City CCG, to give users instant, up-to-date business intelligence data on anticoagulation services across multiple locations using INRstar. Introducing analytics has meant that the CCG is now presented with real time clinical and activity intelligence dashboards including a national comparison, which has been an innovation to support commissioning outcomes.
Leicester City CCG commissions a successful anticoagulation service provided by 52 practices for a 380k population and had implemented INRstar across the City in 2012 as part of an integrated primary care approach to atrial fibrillation (AF) detection and management. Monitoring and managing AF, DVT and PE patients forms a key part of the CCG’s stroke prevention programme and since having developed the analytics tool with INRstar, the CCG can demonstrate:
- 50% reduction of the risk of stroke
- More than doubled the number of patients with AF who have been prescribed, monitored and anticoagulated
- Number of patients with an INR>8 is significantly lower (zero patients in the last 9 months) than when the patients were being treated in an outpatient setting
- SystmOne records updated through the interoperability function with INRstar
- Medicines management audits improve quality of prescribing
- Hot spots of practices that need additional clinical support from the GP mentors
The development of INRstar analytics has been a true partnership between the NHS and a commercial partner. Working with INRstar, there was a real focus on user experience and smart visualisation of data in order to create charts that ‘tell the story’ behind the data. The CCG team and INRstar spent a lot of time working out how to display a lot of complex data in a way that was easy to visualise and that would support CCGs and clinicians in running their services. The CCG Programme Manager uses the charts and graphics as part of the discussions with GP mentors and practices to improve service delivery and, from a patient quality perspective, overdue appointments and TTR trends.
The deployment of INRstar analytics is providing excellent analytics for the CCG’s anticoagulation service and has been integrated into the routine business intelligence system in the monitoring of the community based contracts. The analytics tool downloads a dataset into a reportable format which is presented monthly to the CVD Programme Board, the CCG Finance and Performance Committee, and quarterly to the CCG Quality and Clinical Governance Committee.
Users can extract measureable data and incorporate it into their GP mentor support packages, as well as quality and performance dashboards. The formatting is easy to interpret and enables the CCG to immediately identify practices requiring support. The data also enables the team to tailor the support required to individual practices.
The service manages over 2,450 patients and the data demonstrating overdue appointments is presented on a monthly basis to individual providers. The tool has enabled the Programme Manager to work in partnership with practices to reduce the number of patients at risk of not being monitored from 200 to under 25 patients. This is a significant step towards reducing the risk of stroke and partnership working between commissioner and provider to improve patient safety.
The project has transformed the way in which the programme management team work with the practices and present quality and activity performance within the CCG and primary care. The analytics tool developed with INRstar, integrated with the data analytics generated from SystmOne searches, has enabled the CCG to see dramatic results through the CVD programme.
Improved TTR results
The solution has enabled commissioners to work in partnership with providers to evaluate vital quality and performance metrics to demonstrate the clinical outcomes for patients and successful delivery model.
INRstar complies fully with Caldicott 2 guidelines, meaning that approved users can view aggregated and appropriately anonymised data. Users are required to get permission from the service in order to access data. Significant effort went into the overnight processing of many millions of records – which is not easy, and calculating TTR from millions of test results is a massive achievement, while national benchmarking (across 1,900 further INRstar anticoagulation services) enables the CCG to compare services nationally.
Delivering real time improvements and better patient care
The CCG has successfully implemented a number of inter-dependent developments to improve the clinical outcomes for people with cardiovascular disease-related conditions which have been embedded within primary care since April 2013. These include new pathways for atrial fibrillation and warfarin management. These programmes have delivered improved clinical outcomes to support the agenda to tackle the disease further, to transform the health and healthcare programmes for patients. The development of the analytics tool with INRstar has enabled the CCG to go beyond monitoring provider performance, enabling commissioners and 52 providers to work together to deliver real time improvements and better patient care.
Continuing professional development and learning opportunities
In addition to the business analytics dashboards, the analytics tool provides information that GP mentors have been able to identify as learning themes and develop it into the quarterly anticoagulation training events for primary care clinicians. INRstar fully supports these professional development events and presents sessions to delegates on INRstar functionality, business analytics tool and reporting.