Reporting on outcomes
Project leads were supported in setting performance indicators and evaluating their work. The outcome data below report on five component projects. The final project reports a are in no sense “victory narratives”. They identify challenges and what has not worked well as well as recording progress. For many projects the results cannot be attributed to any one intervention; many activities have had an impact. Hence project leads were asked to comment on how participation in Quality:MK made a difference.
1 Brief interventions in alcohol pilot
“The ability to involve the GP within the TAF group through the availability of funding ... made a significant contribution to the development of the pilot LES. Quality: MK has changed mind sets, with the main winner being public and patient involvement .. right from the beginning... we have talked about it for years but probably never got this embedded in our thinking. Coming in second would be the requirement for good evidence underpinning the service. Third and much more problematic... as I think it is difficult to find interested GPs (even with a little funding). ..“I ..found the requirement for ... reporting difficult especially where this project was so impacted on by external factors, such as the surprise introduction of a national DES at the same time as the new LES was planned..."
- Total number of referrals Feb 09/Feb 10: 150
- 96% had more than one appointment and reduced alcohol consumption by 20% or more.
- Of these 33% reduced alcohol consumption to within sensible recommended alcohol limits (with a score of 0 to 8 on the Full AUDIT assessment), as set by the government guidelines
- 63% reduced their alcohol consumption by more than 20% and to an increased risk level (with a score of 9 to 15 on the Full AUDIT assessment), as set by the guidelines
- 4% showed no significant change
- 79% (n=119) also referred on to other agencies for further assistance
- Read the evaluation final report here.
2 The complex patient medication management project
“funding was secured for 2 years from Quality: MK ........Benefits of participation ... also included ... Primary Care Trust stakeholders, who provided support and frameworks to complete project data and documentation which contributed to the project’s success ... Quality: MK enabled wider promotion of the work locally which has led to changes in practice in other surgeries and PCT staff ....”
- 40 patients in the study; positive measurable outcomes were achieved in all reviews
- £24,500 saved in prescribing costs over one year period, and costs to provide the multi-disciplinary reviews cost £3000.
- OOH presentations reduced from 95 to 2; hospital admissions reduced from 34 to 2
- All patients had changes made to medication
- The same multidisciplinary review framework used successfully in two other surgeries.
- PCT decided to fund a fulltime pharmacist to work with other health care professionals to review all patients in nursing homes.
- Community matrons changed their referral criteria as a result of the project’s outcomes
- Due to staff changes, lessons learnt will not be integrated in the pilot surgery as planned.
- Read the evaluation final report here.
3 Diabetes pathway
“The overarching themes and joint project group with regular updates required added rigour and a supportive framework to the project. Learning from other projects and the finding that some areas of concern particularly around roll-out and contracting were shared with others. Already the lessons learned from this project have proven invaluable for other long term conditions care pathways such as Stroke and COPD. ... We are considering how we might apply for an innovation fund to take forward complex patients’ medicine management (from another Quality:MK project) for COPD patients”
- QOF diabetes monitoring indicators have improved on average since 2007/8 for testing for microalbuminurea (by 1.7%) and retinal screening recorded (by 1.1%)
- Recording of HbA1c has remained constant at its high level of 96.8%
- All of the QOF diabetes management indicators have improved for patients
- Reduction in exception reporting;
- Hospital Ketoacidosis admissions have fallen from 1 admission for every 100 registered patients 2007/8, to 1 admission for every 150 registered patients 2009/10, despite the increase in the number of people registered with diabetes. Cost savings to be calculated.
- Over 1000 patiints have received an annual review with care planning since April 2009 in the first three practices of the pilot studies
- The number of practices initiating insulin has increased from 5 to 14.
- Intermediate service to provide direct clinical care outside hospital yet to be procured
- Read the evaluation final report here.
4 Smoking cessation
“The smoking services in Milton Keynes have become more three dimensional in the delivery of the service and the flexibility of approach to partnership working. The involvement with Quality:MK enabled a closer look at working practices and an understanding of how the work is perceived by outside agencies.”
- Number of 4 week quitters:
- 07/08 Target 1425; actual achieved 1337;
- 08/09 Target 1610 and actual achieved 1597;
- 09/10 Target 1700 and actual achieved 2678 (58% over target)
- Quit rate per 100,000 population: 09/10 Target 620 and actual achieved 970 (56% over target). This is the highest across South Central Region.
- Read the evaluation final report here.
5 Weight management
“the Quality:MK project has given the project focus, initially by identifying that weight management needed to have some focus. It has also enriched the involvement of health professionals in the project by figure heading the work. The various support mechanisms provided through the principles of the QMK project has enabled the project to progress in an effective manner.... The links formed with our patient representative will be extremely useful in the development of future services, getting a patient’s perspective throughout the development stage. Also, the use of the librarian and the wealth of knowledge and evidence base that is currently available.”
- An increase of 70 referrals to new weight management services,2008/09 to 2009/10 (up 47%) “evidences the effect of this project”
- The levels of obese children in Reception as measured by the national child measurement programme decreased from 13.9% in 2007/08 down to 9.4% in 2008/09. These levels are now in line with the national average, and much lower for year 6.
- Many activities will have had an impact on this and the differences will have been made in the early years which have been a focus for work over the last year.
- Read the evaluation final report here
- Watch the film here: Quality MK : Motiv8 childrens weight management programme
6 Qualitative evaluation
An independent qualitative evaluation of Quality:MK, commissioned from Solutions for Public Health, was published in June 2010.
- Functional, Public and Patient Engagement , i.e. involving service users and representatives, appears well established in the PCT. ... More recently the Patient Participation Groups (PPG’s) have been forming in practices. ... The depth of engagement (described as the quality of engagement by the LINks group) remains to be developed at both practice and commissioning level.
- Of the three principles, that of ‘evidence‐based’ appears to be the most firmly embedded... evidence was sought and used in all the component projects supported by the growth over the three years from ‘journal club’ ... to the current IMPACTE groups.... .. evidence has become central to pathway review and redesign. ... MoM is not embedded in day to day clinical practice but has been adopted as tool to support commissioning
- The third principle, Primary care led, has demonstrated a number and range of improvements … ‘Task and Finish’ groups have involved clinicians in various ways including … contributing to reviews and redesign, piloting new approaches... The majority of stakeholders felt that considerable progress had been made towards greater involvement. At the same time several of the component projects highlighted the challenges they had faced e.g. the Alcohol project found it was not always possible to stimulate interest from GP practices serving a deprived population
- Overall, there was evidence that the principles of Quality:MK have become ‘a reasonably well established norm’.
Read the full final evaluation report here.
Comments (0)
You don't have permission to comment on this page.