Evercare pilots highlight need for better data
- 6 April 2005
The report by UnitedHealth Europe assessing its nine Evercare pilot sites funded by the DH last year uncovered significant issues with data quality and access to IM&T systems and staff. It describes in detail the data issues that arose as the nine PCTs implemented Evercare’s model of case management in which patients at risk of repeated emergency admissions for long term admissions receive intensive support in the community from specially trained advanced primary nurses. In the US, Evercare’s model now covers 71,000 patients and has shown 50 per cent reductions in emergency admissions by nursing home patients. It is being adapted for use in the NHS as part of the DH’s strategy to support people with long-term conditions and reduce emergency admissions by 5 per cent by 2008. Using data to make decisions is one of the five principles of Evercare, but as the report notes: ‘PCTs and NHS leaders acknowledge that using data to drive action is at the beginning stage in the UK.’ One third of the 19 PCT executives interviewed for the study said that ‘difficulty in retrieving the required data’ was the biggest challenge of implementation. The first issue uncovered concerned selection of patients for entering the Evercare caseload. The aim was to enrol patients who had two recent emergency admissions or were thought by their GP to be at high risk of emergency admission. But for 17 per cent of the 1333 patients enrolled, there was no evidence in the database of either criteria having been met. GP systems were found to have significant gaps and discrepancies. There was no data on patients who died, making it impossible to include them in analysis. One of Evercare’s standards includes better management of prescribed drugs but in six PCTs GP systems recorded 18 per cent more prescriptions than nurses recorded manually when visiting patients. The error was likely to lie with the systems, says the report. Ambiguities in coding activity meant it was often impossible to determine who had done what for patients. Likewise, laboratory data were not recorded accurately enough to determine whether tests had been done to monitor for the side effects of high-risk medications. The report details lost data when practices had a data conversion from Torex System 5 to Torex Synergy as well as ambiguous data relating to diagnosis and what GPs did during a consultation. There were also problems in obtaining consistent hospital data. The report says: ‘The PCTs were successful in meeting several data requirements even when they were performing the activity for the first time.’ If PCTs are going to manage and improve care they will need to improve their data quality, says the report, as well as provide meaningful analysis on routine basis. Managers need to value using data in decision making and become confident in doing so. It says: ‘There is still much progress that needs to be made but there is momentum in many of the Evercare programme PCTs to expand their analytic capabilities. Overall the report found that patients liked the Evercare model, GPs found it reduced their workload and nurses found it professionally satisfactory. However, it was not able to provide the hard data on whether it reduces emergency admissions or is cost effective. This reflected admission criteria to the programme as well as the length of time it has been running in the UK, the report says. Richard Smith chief executive of UnitedHealth Europe, said: ‘PCTs are beginning to realise the importance of data and the need for GP systems to be connected to a bigger system. It’s not just about access to data but how you create a culture in which people use data to manage what they do.’
Case management will not get off the ground unless PCTs, acute trusts and GPs improve their data management and quality, a report for the Department of Health has shown.
However, there were also significant successes with PCTs able to submit the data requested in the form requested. All nine PCTs were eventually able to source hospital episode data through the NHS-wide clearing service, allowing some consistency across the pilot projects.
