Breakout 5: Better care role of data at the frontline of the - - PowerPoint PPT Presentation

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Breakout 5: Better care role of data at the frontline of the - - PowerPoint PPT Presentation

Apr 26, 2023 147 likes •438 views

Breakout 5: Better care role of data at the frontline of the COVID-19 response Chairs: Simon Ball, Executive Medical Director, University Hospitals Birmingham, NHS Trust & Research Director, HDR UK Midlands Alastair Denniston,

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Breakout 5: Better care – role of data at the frontline of the COVID-19 response

Chairs:

  • Simon Ball, Executive Medical Director, University Hospitals Birmingham, NHS Trust & Research

Director, HDR UK Midlands

  • Alastair Denniston, Director, INSIGHT – The Health Data Research Hub for Eye Health

Panellists:

  • Liz Sapey, Director, PIONEER – The Health Data Research Hub for Acute Care & Managing Director
  • f NHR Clinical Research Facility Birmingham
  • Ben Goldacre, Director, The DataLab
  • Sue Mason, Professor of Emergency Medicine, University of Sheffield

This session will start at 13:50 BST. Please use the Q&A function to ask questions to speakers. You are welcome to comment using the chat function, but we cannot guarantee this will be monitored.

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Data in the time of COVID: Using health data to inform health processes in real time Better Care

Professor Elizabeth Sapey E.Sapey@bham.ac.uk

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PHARMACY PRIMARY CARE

MINOR INJURIES UNIT

ACUTE HOSPITAL

ACUTELY UNWELL ADULT/CHILD

HOME

ADULT/CHILD

HOME +/- CARE ESCALATION

ADULT/CHILD

RESIDENTIAL PLACEMENT 111/ 999 CALL AMBULANCE ASSESSMENT

ACUTE CARE:

ANY UNPLANNED HEALTHCARE CONTACT. MULTIPLE ACCESS POINTS ACROSS PROVIDERS RAPID RESPONSE ENHANCED COMMUNITY CARE

Challenges for patients

  • Lack of clarity of patient pathways
  • Results not shared
  • Lack of joined up thinking across

providers

  • Diagnostic delay
  • Health inequalities
  • Poor health outcomes

Challenges for researchers

  • Unclear what data are there
  • Unknown quality
  • Poor accessibility
  • Minimal linked data
  • Slow to access
  • Further curation needed
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  • Individually link data across acute health care

providers

  • Primary care,
  • Out of hours,
  • Ambulance,
  • Secondary Care,
  • Community Care
  • Start with an acute care contact, then curate

data from onset to outcome

  • Episode/ Disease agnostic and multi-morbid

inclusive

  • Ageless (including children and adolescents)
  • Patients at the heart of executive decision

making

  • Population 6M
  • 18 acute hospital trusts
  • One ambulance trust
  • Six mental health trusts
  • Four community trusts
  • 1 Local Comprehensive Research Network (LCRN)
  • 975 GP practices and 700 dental practices
  • Every day, around 100,000 people are treated
  • Healthcare is delivered by 126,000 staff
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SLIDE 5

The health delivery challenge of COVID

  • Novel virus
  • Clinical compass “off”
  • Heterogeneity in presentation/ course/ outcomes
  • Lack of clarity about who is “hot” and “cold”
  • No community testing
  • Slow turn around of swab results
  • No proven treatments or treatment pathways
  • Urgent need to reconfigure NHS hospitals to account for care needs of patients

while protecting staff

  • Urgent need to collect high quality data to inform patient pathways
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Capturing accurate COVID-specific data in EHR

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Identifying positive patients as diagnosed

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Capturing new practices in EHR

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Ensuring biomarkers collection using bundles

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Changing decision support tools

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Planning service provision across PICS EHR sites

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Informing HCPs across PICS EHR sites

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University Hospitals Birmingham NHS FT/ PIONEER Microsoft Azure University College London Hospitals NHS FT Data provider without capacity to pseudonymise

Send pseudonymized clinical data Send non-pseudonymized clinical data

Data harmonisation

Clinical/ Research Community Scientific Steering Committee Clinical insight and oversight Review outputs Sanity Check Public and Charity Data Trust Committee and Public/Patient involvement

Questions in/ Results returned

DECOVID Results disseminated

External data requestor

Turing Analytics

20/HRA/1689

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Learnings

  • Amazing what you can achieve when you have to
  • COVID-19 accelerated Hub journey
  • Rapid use of accurate health data has supported clinical

decision making and hospital management on a daily basis

  • Respond to clinical challenges
  • Map pandemic, staffing and service needs on local level
  • Continuing need to improve digital maturity of NHS to share

benefits

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Thank you

E.Sapey@bham.ac.uk

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Breakout 5: Better care – role of data at the frontline of the COVID-19 response

  • Ben Goldacre, Director, The DataLab

Please use the Q&A function to ask questions to speakers. You are welcome to comment using the chat function, but we cannot guarantee this will be monitored.

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25/06/2020

Using routine data to understand pandemic impacts across the health and care system - potential for informing future service delivery responses

Suzanne Mason, Professor of Emergency Medicine, University of Sheffield

(Ass. Director HDRUK Better Care Partnership North)

Jo Knight (Lancaster University), Nancy Preston (Lancaster University), Camila Caiado (Durham University), Barbara Hanratty (Newcastle University), Graham King (Newcastle University Hospitals), Ian Dove (County Durham & Darlington NHSFT).

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The Care Home Challenge

  • Care homes & residents adversely affected by

COVID-19

  • More than doubling in excess deaths (April

2020)

  • Guidance published March 2020 from DHSC,

NHSI, PHE but early guidance lacking

  • SAGE reported deficits in evidence (May 2020)

regarding routes of infection and infection control strategies

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Outbreaks of suspected & laboratory confirmed COVID-19 in care homes (PHE)

Care Home Outbreaks - 5th June 2020

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Outbreaks in nursing homes within England (PHE)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% <5 5-19 20-49 50-99 100+

Size of care home - number of beds

% of nursing homes with an outbreak by size % of all nursing home outbreaks

Source: bed size - https://www.cqc.org.uk/sites/default/files/HSCA_Active_Locations_01_June_2020.xlsx

  • utbreaks - HPZone from PHE Health Protection from 10 March to 1 June

COVID outbreaks (PHE data): All care homes: 46% Residential: 35% Nursing: 66% Dementia care homes: 53% Residential: 42% Nursing: 69%

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In-hospital survival of care home residents

(Roberts, Caiado et al, In submission)

Survival significantly worse compared to those admitted from own home. Median survival in care home group was 12 days (95% CI 8 – 24)

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Learning Care Homes

Evaluate the impact of introducing structured digital referrals from care homes to community on clinical outcomes for residents, hospital attendance / admission, health service costs, acceptability & utility to health care workers

Linking data:

  • Care Home: Digital App (SBAR,

NEWS2, referral action)

  • Primary Care record
  • Emergency Department
  • Hospital Admission
  • Diagnosis
  • Discharge – date, place
  • Death
  • Covid status
  • Ambulance service data
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Analysing NEWS Score implementation in care homes

(Barker, Hanratty et al, doi: 10.1093/ageing/afz130)

  • Implementation to identify acute illness
  • N=46 care homes (2424 adults)
  • 30 month analysis NEWS scores
  • Mixed methods evaluation
  • Interviews care home staff:
  • Improved NHS communication, ↑confidence,

speedier response to illness

  • Engagement challenging – competing priorities,

training

25/06/2020 23

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Relationship between NEWS scores & COVID deaths

(Stow, Hanratty et al, In submission)

  • Care home NEWS scores linked to demographics, ONS all

cause mortality

  • N=480 care homes (6464 residents)
  • Rise in NEWS predicted increase in COVID incidence
  • Restricting to O2 / RR / Temperature measurement

adequately predicted COVID incidence 2 weeks ahead

  • Useful as health surveillance tool for populations e.g.

care homes

25/06/2020 24

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Future Research: Impact of covid-19 pandemic on care home pathways, outcomes, safety of care

Outstanding questions about management of residents becoming unwell during COVID:

  • Undertake temporal analysis of changes in transfers to

secondary care from care homes (and vice versa) before and during pandemic

  • Describe patterns of COVID / non-COVID disease and deaths in

relation to transfer in and out of secondary care settings before and during pandemic

  • Explore decision making related to care of residents in the care

homes during pandemic

  • Mixed methods: Linked dataset; care home / community care

staff interviews

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Thank you

s.mason@sheffield.ac.uk @ProfSueMason

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Breakout 5: Better care – role of data at the frontline of the COVID-19 response Chairs:

  • Simon Ball, Executive Medical Director, University Hospitals Birmingham, NHS Trust & Research

Director, HDR UK Midlands

  • Alastair Denniston, Director, INSIGHT – The Health Data Research Hub for Eye Health

Panellists:

  • Liz Sapey, Director, PIONEER – The Health Data Research Hub for Acute Care & Managing Director
  • f NHR Clinical Research Facility Birmingham
  • Ben Goldacre, Director, The DataLab
  • Sue Mason, Professor of Emergency Medicine, University of Sheffield