NICE | The National Institute for Health and Care Excellence



ADVANCING QUALITY - MONITORING STROKE CARE

Advancing Quality (AQ) is the flagship programme of AQuA, the Advancing Quality Alliance, and aims to give patients a better experience of the NHS by ensuring the highest standards of care are consistently delivered.

Operating in specific clinical areas, including stroke, it has rapidly improved the standard of care delivered in North West hospitals by focusing on adherence to key evidence based clinical interventions, patient experience, and patient and clinical outcomes. 

Although the care given to a stroke patient is tailored to their individual needs, clinicians from across the region have agreed a number of key things should happen, which, if carried out at the same time and in the same way for every patient, will ensure patients are receiving the best possible care when treated for a stroke. These are what AQ refer to as the Clinical Process Measures.

Taking direction from the North West Stroke Alliance - a group of clinicians, commissioners and other stakeholders in the region ensuring implementation of the National Stroke Strategy - an important principle in developing the AQ stroke clinical process measures was that they should compliment pre-existing stroke initiatives and data collections (such as Stroke 90:10, SINAP, the RCP Sentinel Audit, and the Accelerating Stroke Improvement programme.)  

The measures are:

▪ Brain scan within 24 hours of arrival at hospital

▪ Admission to a stroke unit

▪ Aspirin within 24 hours of arrival

▪ Screened for swallowing disorders within 24 hours of arrival

▪ Physiotherapy assessment within 72 hours of arrival

▪ Occupational therapy assessment within 72 hours of arrival

▪ Weight recorded during hospital admission

Each trust has implemented AQ locally to drive improvements. The data for each patient is recorded as part of the normal clinical record and AQ scores how well trusts are delivering against these key qualities of care measures. Each percentage score shows how successfully the doctors, nurses and other clinical staff are delivering to the agreed quality standards for their patients.

Trusts are financially rewarded for improvement using the Commissioning for Quality and Innovation (CQUIN) payment framework. It is the Advancing Quality ethos that such quality payments are directed back to clinical teams for further investment in clinical services.

AQ hosts regular collaborative and shared learning events to give the teams from across the North West the opportunity to come together to share examples of best practice and learn about the latest developments in the programme and stroke care.

Feedback from the last AQ stroke collaborative, 25.01.12:

“As always, a very useful collaborative. It is really useful to learn from other trusts and it is very motivating to liaise with other groups.”

“A huge well done! That was by far one of the best collaboratives I have attended. The atmosphere was great and so were the storyboards, I learnt an awful lot in a short space of time.”

“Following on from Stroke 90:10, the collaborative actively encourages improvements in care/sharing of success. Picked up a few good ideas from the storyboards.”

“The collaborative was beneficial in allowing the team to spend quality time together while the information gained with implement new changes for improvement within the trust.”

(Source: Evaluation forms completed anonymously by collaborative attendees)

RESULTS FOR STROKE

The Advancing Quality results are publicly reported annually, once assured by the Audit Commission. The first set of stroke results are due for public reporting later in the year, but indications from the first nine months show signs of improvement across the North West.

The Composite Quality Score (CQS) is an aggregate score that represents overall quality. It means: did the trust take every opportunity to provide all the measures required? It is calculated by combining the results from each individual measure giving a percentage score where 100 per cent is the best.

CQS for all North West trusts (Oct 2010-June 2011):[pic]

(Please note: both graphs show provisional data which has not yet been validated).

The Appropriate Care Score (ACS) means: did each patient receive all of the clinical process measures i.e. perfect care?

ACS for all North West trusts (Oct 2010-June 2011)

[pic]

The graph below shows the improvement across the North West in some of the AQ clinical

process measures for stroke care in the first nine months (Oct 2010 – June 2011).

[pic]

(Please note: this graph is using provisional data which has not yet been validated).

ADVANCING QUALITY - FURTHER INFORMATION

For further explanations about the Advancing Quality stroke measures, latest results from the five original focus areas, and a list of Frequently Asked Questions, please visit the Advancing Quality website, advancingqualitynw.nhs.uk, for more information.

The overall aims of the Advancing Quality (AQ) programme are:

• To save lives.

• To improve the quality of life for patients.

• To facilitate commissioning for quality in a changing landscape.

• To provide world class health services.

• To incentivise improvements in quality to international levels/standards.

• To achieve value for money.

• To create a system that collaborates.

• To identify opportunities and partnerships that will provide leading edge/innovative solutions to rapid knowledge transfer and improvement.

The programme launched in October 2008 and is now live in 32 North West provider trusts. It originally focused on five clinical areas:

▪ Coronary Artery Bypass Graft (CABG)

▪ Acute Myocardial Infarction (AMI)

▪ Heart Failure

▪ Hip and Knee replacement surgery

▪ Pneumonia

Following the initial success of Advancing Quality (AQ), the programme was extended in two stages:

▪ October 2010 – stroke care

▪ January 2011 – dementia and first episode psychosis.

The programme measures quality across three dimensions:

▪ Clinical Process Measures

(measuring that the best clinical processes are delivered at the same time, in the same way, for every patient)

▪ Patient Reported Outcome Measures (PROMs)

(measuring a patient’s personal view of improvement in their quality of life following treatment or surgery)

▪ Patient Experience Measures (PEMs)

(measuring a patient’s personal view of their own experience in hospital and of the care they received)

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