Advancing Quality
Advancing Quality (AQ) is an innovative, pay-for-performance NHS quality improvement programme focused on raising the quality of patient care. Its aim is to give all patients a better experience of health services.
The programme launched in October 2008 in 24 acute trusts across the North West of England in five clinical areas (see below) selected for relevance to the local population:
It incentivises improvement in the quality of patient care in these areas by measuring treatment against three quality indicators, Clinical Process and Outcome Measures, Patient Reported Outcome Measures, Patient Experience.
Data will be assured by the Audit Commission prior to publication in Spring 2010.
Ultimately, it is anticipated Advancing Quality will save money in the NHS by reducing complications and the number of days patients need to spend in hospital.
This will allow hospitals to reinvest their savings in improving facilities and care. Clinicians’ expertise and reputations will also be clearly acknowledged by the scheme. They will be able to expand their skills and knowledge by sharing what works well in their hospitals or clinics - as well as what doesn’t - with colleagues across the region.
To fund the first full year of Advancing Quality, Primary Care Trusts (PCTs) have allocated £10.1m (0.1 per cent of budget) from growth money.
The programme is similar to Hospital Quality Incentive Demonstration (HQID), a pay-for-performance quality programme launched in 2003 in the United States which is now operating in more than 250 hospitals in the US non-profit healthcare sector.
In its first two years, HQID saved the lives of 1,300 heart attack patients, reduced heart bypass surgery death rates and improved patient care against its own benchmarks in participating hospitals.
AQ will be independently evaluated by the University of Manchester Business School, which has been contracted to carry out a five-year evaluation for the Department of Health.
How it works
Advancing Quality aims to provide quality measurements that are clear and easy to understand for NHS staff, patients and the public.
Its initial focus has been to improve the quality of care in five areas of clinical practice, selected for their relevance to a large part of the North West region’s population:
across three areas, each with their own measures (full measures are listed in appendix 1):
- Clinical Process and Outcomes - the quality of clinical care that has been delivered to patients
- Patient Reported Outcome Measures (PROMS) - the improvement of a patient’s quality of life following surgery
- Patient Experience - the patient’s general experience of hospital care
Doctors and nurses are responsible for ensuring the clinical process measures are followed and that data is collected (manually and/or through existing electronic systems) and outcomes monitored. This helps them to identify where improvements can be made in care pathways and processes.
For example, if a patient has a heart attack, doctors and nurses are asked to demonstrate they have given the right drugs at the right time.
Data from the first year of the incentive scheme which runs from 1 October 2008 to 30 September 2009, for clinical outcomes and some PROMs will be publicly reported in spring 2010, when it has been assured by the Audit Commission.
Financial incentives
The best performing hospitals will receive financial rewards, which can then be invested back into patient care:
- Year 1(Oct 2008 - Sept 2009): The top performing two quartiles will receive between two and four per cent top-up on national tariff to the value of up to £3.2 million; there will also be incentives for PROMs and patient experience.
- Year 2(Oct 2009 - Sept 2010): Actual incentive payment is yet to be agreed, but will reward top performance, attainment and most improved for clinical outcomes and patient experience. The AQ PROMs programme has set aside £200,000 for incentives payments within this financial year. £100,000 of the PROMs incentives will be paid out for each completed questionnaire a Trust receives. The remaining £100,000 will then be divided between Trusts based on: the total numbers of pre-operative questionnaires received from an individual Trust multiplied by the recruitment rate weighting divided the total across all Trust.
- Ambulance Reward Scheme: Performance rewarded by a 25 per cent top slice of hospital top performers rewards for the AMI clinical focus area.
Progress to date - June 2009
The first six months - The clinical measures were launched on 1 October 2008, focussing on sharing best practice and knowledge to achieve the very best care standards in every trust.
First quarter data was available in June 2009 and NHS North West is now sharing this with participating organisations, enabling them to compare performance and to start their quality improvement activities.
For trusts that are not performing in line with AQ measures, ongoing support, i.e. mechanisms for knowledge sharing and collaboration with better performing trusts across the region, are available.
In spring 2010, once a full year’s data has been assured by the Audit Commission- accounting for seasonality and the programme embedding itself fully - we will share it with the public.
The first quarter data does not take into account how patients’ lives have improved in the medium and long term e.g. Patient Experience data and Patient Reported Outcomes Measures (PROMS). Patient Experience will assess patients’ general experience of care.
See also
Notes
Appendix One:
Advancing Quality Performance Indicators
Community-acquired pneumonia (CAP)
- Percentage of patients who received an oxygenation assessment within 24 hours prior to or after hospital arrival
- Initial antibiotic selection
- Blood culture collected prior to first antibiotic administration
- Antibiotic timing, percentage of pneumonia patients who received first dose of antibiotics within six hours after hospital arrival
- Smoking cessation advice/counselling
Hip and knee surgery
- Prophylactic antibiotic received within one hour prior to surgical incision
- Prophylactic antibiotic selection for surgical patients
- Prophylactic antibiotics discontinued within 24 hours after surgery end time
- Recommended Venous Thromboembolism prophylaxis ordered
- Appropriate Venous Thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery
- Re-admission within 28 days
Acute myocardial infarction (AMI)
- Aspirin at arrival
- Aspirin prescribed at discharge
- ACE or ARB for LVSD
- Smoking cessation advice/counseling
- Beta blocker at arrival
- Beta blocker prescribed at discharge
- Thrombolytic received within 30 minutes of hospital arrival
- PCI received within 90 minutes of hospital arrival
- Inpatient mortality rate
Coronary artery bypass graft (CABG)
- Aspirin prescribed at discharge
- Prophylactic antibiotic received within one hour prior to surgical incision
- Prophylactic antibiotic selection for surgical patients
- Prophylactic antibiotics discontinued within 48 hours after surgery end time
- Inpatient mortality rate
Heart failure (HF)
- Left Ventricular Systolic (LVS) assessment
- Detailed discharge instructions
- ACEI or ARB for LVSD
- Smoking cessation advice/counselling