Advancing Quality NHS Advancing Quality Alliance

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GPs and commissioners are invited to attend one of several locality meetings being held in January to discuss the role of CCGs in Advancing Quality.

Advancing Quality is a clinically-led quality improvement programme designed to drive up standards in healthcare, reduce variation and reduce avoidable mortality. Historically funded by all North West PCTs, Advancing Quality (AQ) is a well-established programme ‘live’ in every NHS acute and mental health provider trust in the region since 2008.

Operating in specific clinical areas, the AQ quality indicators aim to ensure every patient receives the same high standard of care in every hospital, as required by the NHS Mandate. The indicators form part of the CQUIN framework and provide a benchmark for commissioners to measure quality and understand variation across the region.

And it works. In a paper published in the New England Journal of Medicine, a team of independent health experts and economists led by the University of Manchester concluded AQ was associated with 890 fewer deaths in just the first 18 months alone.

Additional research from the same team has also shown that, for every £1 invested in funding AQ, an estimated £10 is generated in health gains.

As the new health landscape continues to take shape, GPs and commissioners play a vital role in deciding the future direction of AQ including governance arrangements, future funding and deciding which clinical areas the programme should expand into.

We are inviting the following people to attend a meeting arranged within each of the North West clusters:

The meetings take place as follows:

The quality of care in North West hospitals is continuing to improve, according to new figures released by Advancing Quality today.

The fourth annual results from the programme show the region’s NHS trusts achieved improvements of more than 30 per cent in key quality measures designed to drive up standards.

The table below shows the scores for each clinical focus area from year one to year four of the programme. These figures represent the North West region as a whole. The trusts are scored by how consistently they deliver the quality of care measures. The percentage increase is the overall improvement in the North West from year one to year four.

AIM* CABG** Heart failure Hip and knee Pneumonia Stroke Dementia FEP***
Year 1 92.52% 96.78% 62.12% 89.54%  76.31%  N/A N/A N/A
Year 2 97.49% 96.94% 69.95% 92.82%  81.54%  N/A N/A N/A
Year 3 97.76% 98.22% 75.45% 94.58%  85.97%  N/A N/A N/A
Year 4 98.26% 98.02% 81.23% 95.56%  84.33% 86.87% 74.55% 87.85%
Actual increase between Y1-Y5 scores +5.74 +1.24 +19.11 +6.02 +8.02 N/A N/A N/A
% increase from Y1-Y5 +6.20% +1.27% +30.76% +6.71% +10.50% N/A N/A N/A

*AMI: Acute Myocardial Infarction i.e. heart attacks **CABG: Coronary Artery Bypass Graft i.e. heart bypass surgery ***FEP: First Episode Psychosis

The figures follow last week’s publication in the New England Journal of Medicine of an independent evaluation by a team of economists and health experts from the Universities of Manchester, Nottingham, Birmingham and Cambridge who found there has been a “significant” fall in mortality rates since the introduction of Advancing Quality.

The researchers investigated figures for in-hospital deaths within 30 days of admission for patients with pneumonia, AMI and heart failure 18 months before and after the introduction of Advancing Quality. They conclude that avoidable mortality rates fell by six per cent in the North West, the equivalent of 890 deaths.

The aim of the Advancing Quality programme is to improve clinical quality and outcomes for patients by reducing complications, length of hospital stay, mortality and re-admission rates for patients in regularly performed surgery and treatments for heart attackship and knee replacementspneumoniaheart failure and heart bypass surgery.

Following early success of the programme, it was expanded into the care of stroke patients and patients suffering from dementia and first episode psychosis. The first set of these results have also been published today.

Mark Woodhead, Advancing Quality clinical lead for pneumonia, said:

“For adults with pneumonia, we have seen a clear improvement in the standards of care across the North West over four years of Advancing Quality and I look forward to continue working with all the pneumonia teams across the North West to share best practice and build on these excellent achievements.”

Scot Garg, Advancing Quality clinical lead for AMI, added:

“Advancing Quality is a success thanks to the dedication and commitment of all the teams who work together to share examples of best practice across the region. The results for AMI have improved year-on-year with 98% of our patients receiving the Advancing Quality measures, so we can be proud that the care we provide to patients is of the highest standards.”

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Notes to editors:

  1. For further information on Advancing Quality, see www.advancingqualitynw.nhs.uk or contact Lindsay Kirby on 0161 206 8438 or Lindsay.kirby@srft.nhs.uk
  2. Advancing Quality is the flagship programme of AQuA, an NHS membership body dedicated to helping NHS organisations in the North West provide high quality health care services and improved health. For more information, visit the AQuA website.
  3. The results which have seen the smallest improvements, such as CABG and AMI, can be attributed to the first year of Advancing Quality setting a higher baseline so there has not been as much room for improvement as in focus areas such as heart failure and pneumonia.
  4. Advancing Quality has clinical leads in each focus area to act as sounding boards for their area of expertise and work with colleagues across the region to drive compliance to the measures.

Professor Mark Woodhead is a consultant and honorary senior lecturer in respiratory and general medicine at Central Manchester University Hospitals NHS Foundation Trust.
Dr Scot Garg is a consultant cardiologist at East Lancashire Hospitals NHS Trust.

Researchers evaluating the impact of the Advancing Quality programme in the North West have estimated hundreds of lives were saved within the first 18 months.

In a paper published in the New England Journal of Medicine, a team of economists and health experts from the Universities of Manchester, Nottingham, Birmingham and Cambridge found there has been a significant fall in mortality rates since the introduction of Advancing Quality.

The researchers investigated figures for in-hospital deaths within 30 days of admission for patients with pneumonia, AMI and heart failure 18 months before and after the introduction of Advancing Quality. They conclude that avoidable mortality rates fell by 6% in the North West, the equivalent of 890 deaths.

Lead author Matt Sutton, Professor of Health Economics in The University of Manchester’s Institute for Population Health, said:

“We examined a unique initiative in which a bonus system from the US was adopted only in North West of England. We found that while research has shown the US scheme had no effect on patient health, the same scheme in the NHS did and resulted in 890 lives being saved during the 18 month scheme.”


Julia Hickling, AQuA Director, said:

“This is really encouraging news and is testament to the dedication and commitment of clinical teams and NHS staff across the region. The fact that AQ is associated with 890 fewer deaths in just the first 18 months far exceeds even the most ambitious expectations we held for the programme and further demonstrates AQ’s value as a method for commissioning for outcomes.”

Advancing Quality was introduced in all North West hospitals providing emergency care in 2008 to improve standards and reduce variation. It is based on the Healthcare Quality Incentive Demonstrator project which was operated by Premier Incorporated in the United States. In late 2010, Clarity Informatics was contracted by AQ to continue the operation of data and other support services. Along with pneumonia, heart failure and AMI, it is also live in coronary artery bypass graft surgery, hip and knee replacement surgery, stroke, dementia and first episode psychosis.The programme is based on a set of quality standards which clinicians agree define and measure good clinical practice and should be delivered to every patient to ensure they receive the highest standard of care. Hospitals collect and submit data on these quality standards, which range from recording that the right antibiotics are given at the right time through to patients receiving written discharge instructions on how to prevent relapses.

Each NHS trust has an AQ team who work locally to drive improvements. AQuA hosts Advancing Quality collaborative and shared learning events throughout the year to give the teams the opportunity to come together to share examples of best practice and learn about the latest developments in the programme and the focus areas.

The results are publicly reported once a year via the Advancing Quality website and the latest results for Year 4 of the programme (April 2011 to March 2012) will be published Wednesday 14th November 2012.

The full New England Journal of Medicine article is available to subscribers via www.nejm.org

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Notes to editors:

  1. For further information on Advancing Quality, see www.advancingqualitynw.nhs.uk or contact Lindsay Kirby on 0161 206 8438 or Lindsay.kirby@srft.nhs.uk
  2. Advancing Quality is the flagship programme of AQuA, an NHS membership body dedicated to helping NHS organisations in the North West provide high quality health care services and improved health. See the AQuA website for more information.
  3. Clarity Informatics is an internationally-renowned centre of excellence in the application of evidence-based health informatics. For further information, please contact Rebecca Brown of Clarity Informatics on 0845 113 1000 or Suzie Creighton of Castlegate on 0772 999 3721 or suzie@castlegatecommunications.co.uk

The Y4 results of the Advancing Quality programme are scheduled to be publicly reported for the first time this November.

The results, which will be uploaded to the Advancing Quality website, will also include the results for the new measures introduced in stroke, dementia and first episode psychosis care pathways over the last 18 months.

The original ethos of AQ programme, which was introduced in all hospitals across North West England in 2008, includes a commitment to transparency so members of the public can see how their local NHS acute or mental health trust is performing across some of the most common clinical conditions which affect the region’s population.

If you would like to be notified when the Y4 results are live on the Advancing Quality website, please email us.

An updated version of the AQuA Work Programme, which sets out it’s priorities over the next 12 months, has been published for the summer.

The programme, which can be accessed via the AQuA website, outlines how the AQuA (Advancing Quality Alliance) approach relates to the five domains of the NHS Outcomes Framework: Preventing premature deaths; Enhancing quality of life; Episodes of ill health or injury; A positive experience; Safe and harm free.

Advancing Quality is the flagship programme of AQuA, an NHS membership health improvement body which aims to promote best quality care across the North West.

Thank you to everyone who visited the Advancing Quality exhibition stand at this year’s NHS Confederation in Manchester. It was a fantastic opportunity to meet so many people who wanted to find out more about Advancing Quality and the impact it is having on health services in the North West of England.

The NHS Confederation hosts an annual exhibition and conference to bring together delegates with leaders from across the healthcare system so we were especially proud to be asked to present Advancing Quality as one of the strand sessions entitled Innovation and Incentives: the road to commissioning for quality and improving hospital care.
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AQTeamMembersLesleyKitchenJaneHarperLindsayKirbycompressed

Picture: (From left) Advancing Quality’s Programme Director Lesley Kitchen, Project Manager Jane Harper and Communications Officer Lindsay Kirby at the NHS Confederation 2012.

Notes to Editors:

Advancing Quality was launched in 2008 in all North West hospitals and focuses on heart failure, heart bypass surgery, heart attack, hip and knee replacement surgery, pneumonia, stroke, first episode psychosis and dementia.

Advancing Quality is the flagship programme of AQuA, an NHS membership body dedicated to helping NHS organisations in the North West provide high quality health care services and improved health. For more information on AQuA, visit the AQuA website.

For more information regarding this press release, please contact Lindsay Kirby, Advancing Quality Communications Officer, on 0161 206 8438 or email lindsay.kirby@srft.nhs.uk.

Advancing Quality Alliance (AQuA) has published its work programme for 2012-13 setting out its main priorities over the next 12 months.

The programme, which can be accessed via the AQuA website, outlines how the AQuA approach relates to the five domains of the NHS Outcomes Framework: Preventing premature deaths; Enhancing quality of life; Episodes of ill health or injury; A positive experience; Safe and harm free.

Advancing Quality is the flagship programme of AQuA, an NHS membership health improvement body which aims to promote best quality care across the North West.

AQuA Chief Executive, David Fillingham, said:

“We strongly believe that only be everyone pulling together can we achieve out aim of improving the quality of care delivered to patients and improving the health of local people.”

Patients suffering from five of the North West’s most common conditions are benefiting from improved standards of hospital care, according to the latest results published by Advancing Quality.

Results from the third year of the programme show that the region’s NHS trusts achieved improvements of more than 21 per cent in key quality measures designed to drive up standards.

The aim of Advancing Quality is to improve clinical quality and outcomes for patients by reducing complications, length of hospital stay, mortality and re-admission rates for patients in regularly performed surgery and treatments for heart attackship and knee replacement surgerypneumoniaheart failure and heart bypass surgery.

The table below shows the scores for each clinical focus area in years one to three of the programme. These figures represent the North West region as a whole. The trusts are scored by how consistently they deliver the quality of care measures. The percentage increase is the overall improvement in the North West from year one to year three.

AIM* CABG** Heart failure Hip and knee Pneumonia
Year 1 92.52% 96.78% 62.12% 89.54%  76.32%
Year 2 97.49% 96.94% 69.95% 92.82%  81.54%
Year 3 97.76% 98.22% 75.45% 94.58%  85.97%
Actual increase between Y1-Y3 +5.66% +1.48% +21.45% +5.62%  +13.15%

*AMI: Acute Mycocardial Infarction (i.e. heart attack)
*CABG: Coronary Artery Bypass Graph (i.e. heart bypass surgery)

Advancing Quality is the flagship programme of the Advancing Quality Alliance (AQuA), the North West’s health improvement organisation.

AQuA chief executive, David Fillingham, said: “I am delighted to see that in year three of the Advancing Quality programme the entire region has continued to improve the quality of care delivered to patients. These results pay tribute to the excellent work that is being done by NHS staff. This plays a key role in AQuA’s mission to support improvements in health and the quality of health services in the North West of England.”

The Advancing Quality programme was launched in 2008 and is now live in 32 North West NHS provider trusts. Clinicians have agreed a set of standards for the conditions above which define and measure good clinical practice. Consistent delivery of these interventions is associated with better outcomes for patients. Each measure should be delivered in every patient to ensure they receive the highest standard of care and drive improvements in healthcare across the regiong.

Each trust has an Advancing Quality team who work locally to drive improvements. AQuA hosts Advancing Quality collaborative and shared learning events throughout the year to give the teams the opportunity to come together to share examples of best practice and learn about the latest developments in the programme and the focus area.

Advancing Quality clinical lead for heart failure, Dr Jeff Ball, said: “Advancing Quality is a programme which is driven by clinicians and has been effective with demonstrable improvements in patient care across the North West within a very short time. The programme is about ensuring diagnosis, investigation, treatment and advice are given at the right time, every time for every patient. Published data shows that is is working and we are expecting patient care to continue to improve as the programme progresses.”

The results are publicly reported once a year on the Advancing Quality website so patients can see how well their local trust is performing.

The programme also measures care of stroke patients and patients suffering from dementia and first episode psychosis. Results from these measures will be published later in the year.

A new-look Advancing Quality website has been launched to co-incide with the publication of the programme’s Year Three results.

The website now enables visitors to select their local North West hospital from the ‘Results’ tab where they will then be directed to a page dedicated to the NHS trust which is in charge of that hospital and a summary of its performance over the last three years.

The Year Three results, covering April 2010 to March 2011, will be published online on Wednesday 1st February 2012.

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