Towards a Learning Health System
Problem
The three east London CCGs Tower Hamlets, City and Hackney and Newham are among the most disadvantaged in the UK. In 2016/17 they were the top performing CCGs in England, ranking 1st 2nd or 3rd in 25% of the 60 national Quality and Outcome Framework clinical performance indicators. These achievements have been supported by creating a Clinical Effectiveness Group which provides clinically led support using relatively low cost investment in IT infrastructure and facilitation to support organisational alignment for actionable and ameliorable goals.
Approach
This project aimed to optimise ameliorable improvement in evidence based interventions with maximal impact on individual and population health.The programmes were clinically led with active engagement of CCGs, prescribing teams, public health and hospital and GP providers. We adapted behavioural change methods to inform improvement programmes including aligning organisational goals through stakeholder consensus and dissemination of key actionable performance indicators. Trained facilitators made these indicators ‘actionable’ by enabling provider activity with in-practice IT support using standard data entry templates and decision support. Practice were motivated by demonstrating their near real-time comparative peer performance using graphical displays in 'dashboards'. Financial resources and incentives were also used to support and promote these activities (enhanced services).
Findings
In key indicators for blood pressure and cholesterol control in cardiovascular disease/diabetes, chronic lung disease and other indicators these CCGs are 5 years ahead of the England average and 10 years ahead of other similarly disadvantage areas (each additional 1% representing about 1 year of improvement). These results compare favorably results from internationally leading primary care organisations in the USA.
Consequences
Substantial quality improvement has been achieved with relatively low cost investment in IT infrastructure, facilitation and clinically led support to enable providers, research and development. Better use can be made of existing IT facilities by developing local capacity to develop and use it, combining initiatives across Federations or CCGs where possible.