Workstream C: Audit – Get involved

‘A pragmatic rolling UK MS audit: What data to collect and how to collect it painlessly’

Jeremy Hobart, Professor of Clinical Neurology and Health Measurement at Plymouth University Peninsula Schools of Medicine and Dentistry is the representative on the national ‘Raising the bar’ steering group and lead for this workstream.

Objectives:

1. To agree on the components, and size, of an achievable pragmatic national rolling MS audit to aid quality improvement;
2. To determine how we can acquire those data with minimum effort and disruption to enable rapid implementation and success;
3. To consider appropriate outputs and mechanisms for leveraging support.

Overview of the workstream

The vision for an audit:

• It should provide some ideas of how to work differently, because work feels quite uncomfortable at the moment.
• It will enable sharing of models of practice,
• Provide a repository of useful tools,
• ultimately see a UK-funded audit hub to underpin everything further.

Sue Thomas shared some learning from the Parkinson’s audit, piloted by the Parkinson’s MasterClass in 2004 for two years, and finally rolled out by Parkinson’s UK in 2008. Some key learning included:

• Getting buy-in across clinicians and therapists, and across elderly care and neurology was important and took time,
• Variation in data was caused by not specifying a minimum sample size and patient surveys being completed in different settings (e.g. clinic or afterwards at home).
• When the audit was taken on by Parkinson’s UK, a lot of administrative support and data analysis was gained, but where ownership left the clinicians, enthusiasm diminished.

Specialist nurses Bernadette Porter and Rachel Morrison both shared the innovative and digitally-based practices they are part of; both of which began with an audit.

• Bernadette detailed NeuroResponse rolled out in parts of London
• Rachel spoke about Morse, an integrated mobile app bringing primary, secondary (and eventually social) care together into one platform, to revolutionise care in the Western Isles of Scotland.

Agree parameters for audit

Immediate audit

100% of healthcare professionals attending the workstream agreed that they were willing to participate in an audit. The agreement was for an initial audit based on existing, easily accessible data (fig 1).

→ Participate in our audit of MS services

→ Instructions to access and import data from Blueteq

There were some concerns raised, which the audit workstream steering group will work to address / support as necessary. These included:

• Blueteq only serves England where this is a UK-wide audit long-term,
• patient involvement needs to be included in the fuller audit, and there are good examples that can be drawn on for the best ways to do this,
• Caveats shared at ‘the Way Forward’ around Blueteq data were noted
• The questionnaire provided was a little too simplistic for some services to feel they could respond easily. In these cases, the audit workstream will work alongside that Centre or team to help gather their data.

Future / longer term:

• The ‘next level’ audit needs to be a fuller, more robust audit based on agreed standards and able to be used for benchmarking. This audit is scheduled in the ‘Raising the bar’ work plan as ready to rollout for July 2020.
• We need to consider existing frameworks or develop new ones…
  • NICE Quality standards
  • MS Brain Health consensus standards - noted the base timeframes for optimal management of people with MS
  • QCMS quality metrics
  • Elective care challenge at the moment for neurology that patients are seen, diagnosed and put onto treatment within 100 days, set by NHS England, and we could raise the profile of MS by bringing MS into that (fig 2).

• Put to the room, a number of people felt that a combination of elements across NICE and the MS Brain Health standards and the quality metrics.
• It was noted that the QCMS was created after a review and discussion of all the existing quality standards available.
• Jeremy demonstrated 3 audits he has done locally based on the Brain Health Standards (fig 3) - and highlighted that these had a large amount of missing data, demonstrating that creating this audit will not be simple.
• Important to include patient-facing questionnaires / discussions to feed into the audit.
• Have an agreed audit for rollout from July 2020.

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Figure 3: Audits based on MS Brain Health carried out in Plymouth (click on the posters to view PDF)

Our goals for the next year: 2019-20

1. Complete the ‘immediate’ audit (fig 1) in the next 3 months
2. Prepare to use the data sources available such as Bluteq (fig 4) and Hospital Episodic Statistics (HES)
   1. HES is accessible through a number of routes including via the Model Hospital and GIRFT.
3. Establish a working / steering group for the workstream and agree the parameters for the future, rolling audit
   1. Review MS brain health consensus standards, and QCMS metrics
4. Release the ‘immediate audit’ report by November 2019 to inform current practice and the development of the full audit.
5. Prepare to roll out the full audit from July 2020 in line with the 3 year plan.

More information

• The three audit posters in fig 3 are all available online and detail:
  • time from first presenting symptoms to first neurologist appt;
  • time from first appointment with GP to diagnosis;
  • time from first discussion of DMT to commencing treatment
• The data workstream highlighted a quick toolkit to access and utilise Blueteq data in a meaningful way – this is relevant to this workstream too – the brief toolkit is in figure 4, and more information about the workstream will be available online soon.
• Brain health promo, Delphi standards poster - Hobart
• Find out about the other workstream’s goals
• Listen to this presentation:

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