NICE Quality Standards and the Commissioning Outcomes
Framework: A work in progress
Fergus Macbeth,
Director of Centre for Clinical Practice, NICE [email protected]
NHS Outcomes Framework
• The delivery of the outcomes in the NHS Outcomes
Framework will be supported by a suite of NICE Quality Standards.
• A suite of supporting Quality Standards developed by NICE setting out the structures and processes of care that the evidence suggests would be most likely to deliver
improved outcomes for the overall domain as well as the specific improvement areas within the domain.
• The NHS Commissioning Board will work with clinicians, patients and the public at every level of the system to develop the NHS Outcomes Framework into a more comprehensive set of indicators, reflecting the quality standards developed by NICE.
What are quality standards?
• Quality statements and measures – Quality statements
– Descriptive statements (10-15) of the critical infra- structural and clinical requirements for high-quality care as well as the desirable/expected outcomes – Key points on care pathway
– The statements are aspirational (they describe excellence) but achievable
– Each statement should usually have no more than two components
What are quality standards?
• Quality measures
– Structure, process (and outcome) measures – ‘High-level quality indicators
• use at local level as audit criteria
• inform subsequent national quality indicator development
– ‘Measurement stakeholders’ involved
• NHS Information Centre
• HQUIP
• Condition specific groups - NCAT, NDIS
Overview of quality standards process
Topic
Evidence Source
NICE or other NHS evidence accredited source Guidance Recommendations
Quality Statements
Quality Measures
Requires
Generates
Distilled into
Produce
Current work programme
2009-2010 – Pilot Phase 2010-2011 – Transition Phase
Stroke COPD
Dementia CKD (Adults)
VTE – Prevention Diabetes (Adults) Specialist Neonatal Care Depression (Adults)
End of Life Care (Adults) Glaucoma
Heart Failure Breast Cancer
Alcohol Dependence Patient Experience
Current work programme
2011-12 topic referrals
Antenatal Care Headache/migraine Osteoarthritis
Asthma Head injury Ovarian Cancer
Bipolar disorder in adults AND in
children
Hepatitis B Postnatal Care
Colorectal Cancer Hip fracture Pressure Ulcers Diabetes in children Intrapartum Care Prostate Cancer
Drug use disorders IV Fluid Therapy Pulmonary Embolism Epilepsy in adults Lung Cancer Safer Prescribing
Epilepsy in children Management of MI Schizophrenia Falls in a care
setting
Meningitis in children under 16
Stable angina
Gastro-oesophageal reflux disease
(GORD)
Nutrition in hospitals Ulcerative Colitis
Quality standards and COF
• NICE is now developing indicators from existing NICE quality standard measures for potential inclusion within the COF
• Draft indicator development is being built into quality standards process
• Working closely with the NHS Information Centre
COF Advisory Committee
• Chair: Danny Keenan
• 15 members: GPs, secondary care consultants,
commissioners, public health specialists, information analysts…
• First meetings in September 2011
• Will meet twice a year to consider and agree candidate indicators
Key points in COF process
Indicator field testing (piloting)
Recommends COF indicators COF Advisory Committee - Prioritisation of draft COF
indicators
Development of draft COF indicators
NICE Quality Standard
NICE NHS IC
NHS
Commissioning Board
COF Advisory Committee
- Approval of final COF indicators
COF Indicator development process (1)
• NICE quality systems team develops the COF indicators
– For each NICE quality standard
• Step 1 from quality standard to quality indicator
• Formal consensus methods
• Panel members recruited from NICE Quality Standard Topic Expert Group
• Post-consensus process – indicators with high face and content validity
• COF Advisory Committee
– Prioritises which draft COF indicators should go forward for testing and consultation
COF Indicator development process (2)
• Step 2 Testing (piloting)
– Led by NHS Information Centre – To assess:
• feasibility, acceptability and implementation
• reliability
• validity
• unintended consequences
• Step 2 Consultation – Led by NICE
– All registered stakeholders, including patients and professional groups
COF Indicator development process (3)
• Step 3 - Validation
– COF Advisory Committee reviews development documents including cost effectiveness and cost impact analysis and makes recommendations on final COF indicator set.
– The set of COF indicators is reviewed by NHS Commissioning Board and it makes
recommendations on which are to be used in the NHS.
COF indicators
• Routinely measureable and meaningful at the level of CCG populations.
• Specific enough to reflect activity that can, in large part, be directly influenced by the commissioning activity of CCGs.
• Sensitive enough to enable the NHS Commissioning Board to distinguish good and poor performing CCGs.
COF indicators from other sources
• DH, NHSIC and NICE reviewing areas not currently covered by published quality standards.
• Potential indicators from other sources put through a shortened testing process by NHSIC.
• Results brought back to COF Advisory Committee summer 2012.
Sources of potential of indicators
• NICE guidance, including quality standards
• NHS Outcomes Framework
• Other quality-assured guidance sources via NHS Evidence
• NHS Commissioning Board commissioning guides
• National Indicator Set
Conclusions
• NICE has started to develop draft COF indicators.
• Rooted in NICE Quality Standards and evidence-based guidance.
• But how will they work in the new system?
