Friday, 16 November 2012

Liverpool Care Pathway – Statistics, Statistics, Statistics

The CQUIN payments have been reported in these pages for a long time - 


The Department of Health (DOH) uses a Commissioning for Quality and Innovation (CQUIN) payment framework which enables commissioners to reward excellence by linking a proportion of providers’ income to the achievement of local quality improvement goals: 
"It makes a small proportion of provider income (0.5% of contract value in 2009/10) conditional on achievement of locally agreed goals around quality improvement and innovation. It is intended that goals should be stretching but realistic."
CQUIN has set targets for 2011/2012 with regard to the End of Life program.
The forward plan is to increase the number of patients identified to be on the end of life care pathway and from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.
To ensure they receive their provider income in fulll, Trusts have to comply with or exceed these goals. Some, like Royal Brompton, have upped the plan expectations:
1) 95% of patients identified as end of life (last 48 hours of life for expected deaths) are offered an EOL care planning discussion
2) 80% of patients offered a discussion should have an advanced care plan
3) 98% of patients who have an advanced care plan should have a record of the decision to resuscitate stated clearly in the notes
4) 50% of patients who die in hospital (expected deaths) should die on a Liverpool care pathway 
It is the DOH which is the driving force behind rolling out LCP across the NHS!
The MailOnline reports here on one of the quality schemes highlighted in the CQUIN guidance - the Advancing Quality programme in the North West region. -

MailOnline - news, sport, celebrity, science and health stories

The hospitals given a cash bonus if FEWER patients die 

  • UK trial led to 900 lives being saved over 18 months
  • Fewer deaths from hip replacements and conditions such as pneumonia 

A controversial scheme to give hospitals a bonus if fewer patients die has led to nearly 900 lives being saved over 18 months.

Twenty four NHS hospitals in the north west took part in the Advancing Quality programme where they are given cash incentives to cut mortality rates for conditions like heart attacks.

A total of £4.8 million over 18 months was available to share between those hospitals who showed the most improvement in their death rates.

Is there a conflict between one 'controversial scheme' to prevent death and another 'controversial scheme' to promote death, via the Liverpool care pathway?

May both be cleverly managed and manipulated to gain funding?

Here is NHS local -

NHS local
High mortality rates can be "re-coded" by describing patients' conditions as terminal, Inquiry told

Published Wed, 2011-06-15 11:34; updated 8 weeks ago.

High numbers of hospital deaths can be "re-coded" to make the figure appear less worrying by describing patients as "being expected to die", the Mid Staffordshire Inquiry was told.

Roger Taylor, co-founder and director of research and public affairs of Dr Foster Intelligence, a provider of health and social care information, said an NHS trust's common response on being shown to have a high "hospital standardised mortality ratio" (HSMR) is, "I think this is probably to do with the way we're coding the data".

This is "a relatively comforting explanation for why you have a high HSMR. And it is the most commonly cited reason," said Mr Taylor, is also responsible for Dr Foster publications, including the annual Hospital Guide.

He was giving evidence to the Public Inquiry into "appalling" patient care and high death rates at Stafford Hospital  between 2005 and early 2009.

"We've seen some examples where people have re-coded data and reduced an HSMR," said Mr Taylor. "The only caution I would give about that is some of those re-codings are fairly extreme and involve, for example, coding very large numbers of deaths as being palliative care. And so my concern there would be, well, I'm not 100 per cent certain that the newly coded data is more accurate thanthe original coded data.

"And what I haven't seen is somebody produce an account of a high HSMR that says, 'This was a coding issue, this is was why it was wrong and this is why the HSMR should be lower than it is'."

Mr Taylor continued: "You can get very high rates of palliative care coding where essentially very large numbers of patients who die are coded as being palliative care, i.e. the hospital says, 'We were expecting them to die, so they have a very high risk and their death makes less difference to the HSMR'. Because of that, we now publish the coding rates, and on our tools you can see the graph showing you the rate of palliative care coding at your hospital. So you can see the degree to which your HSMR has been reduced, simply because you have chosen to define most of your patients as being expected to die.

"And there comes a point where the responsibility for the stuff, you know, is with the hospital, but we think again it is important to be transparent. I mean, we can't say it's not true because we're not running the hospital, but it does strike us as at times implausible."

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