Breakout 5: Better care – role of data at the frontline of the COVID-19 response Chairs: • Simon Ball, Executive Medical Director, University Hospitals Birmingham, NHS Trust & Research Director, HDR UK Midlands • Alastair Denniston, Director, INSIGHT – The Health Data Research Hub for Eye Health Panellists: • Liz Sapey, Director, PIONEER – The Health Data Research Hub for Acute Care & Managing Director of NHR Clinical Research Facility Birmingham • Ben Goldacre, Director, The DataLab • Sue Mason, Professor of Emergency Medicine, University of Sheffield This session will start at 13:50 BST. Please use the Q&A function to ask questions to speakers. You are welcome to comment using the chat function, but we cannot guarantee this will be monitored.
Data in the time of COVID: Using health data to inform health processes in real time Better Care Professor Elizabeth Sapey E.Sapey@bham.ac.uk
Challenges for patients • Lack of clarity of patient pathways HOME • Results not shared • Lack of joined up thinking across RAPID PHARMACY RESPONSE ENHANCED providers COMMUNITY ADULT/CHILD CARE • PRIMARY CARE Diagnostic delay +/- CARE ESCALATION • Health inequalities • MINOR INJURIES UNIT Poor health outcomes ACUTE HOSPITAL ACUTELY UNWELL RESIDENTIAL PLACEMENT ADULT/CHILD Challenges for researchers HOME 111/ 999 AMBULANCE CALL ASSESSMENT • Unclear what data are there • ADULT/CHILD Unknown quality ACUTE CARE: ANY UNPLANNED HEALTHCARE CONTACT. MULTIPLE ACCESS POINTS ACROSS PROVIDERS • Poor accessibility • Minimal linked data • Slow to access • Further curation needed
• Individually link data across acute health care providers • Primary care, • Out of hours, • Ambulance, • Secondary Care, • Community Care • • Start with an acute care contact, then curate Population 6M • data from onset to outcome 18 acute hospital trusts • One ambulance trust • Episode/ Disease agnostic and multi-morbid • Six mental health trusts inclusive • Four community trusts • • Ageless (including children and adolescents) 1 Local Comprehensive Research Network (LCRN) • 975 GP practices and 700 dental practices • Patients at the heart of executive decision • Every day, around 100,000 people are treated making • Healthcare is delivered by 126,000 staff
The health delivery challenge of COVID • Novel virus • Clinical compass “off” • Heterogeneity in presentation/ course/ outcomes • Lack of clarity about who is “hot” and “cold” • No community testing • Slow turn around of swab results • No proven treatments or treatment pathways • Urgent need to reconfigure NHS hospitals to account for care needs of patients while protecting staff • Urgent need to collect high quality data to inform patient pathways
Capturing accurate COVID-specific data in EHR
Identifying positive patients as diagnosed
Capturing new practices in EHR
Ensuring biomarkers collection using bundles
Changing decision support tools
Planning service provision across PICS EHR sites
Informing HCPs across PICS EHR sites
20/HRA/1689 University Hospitals Birmingham Turing Analytics NHS FT/ PIONEER Data harmonisation External data DECOVID Results requestor disseminated Microsoft Azure Data Trust Committee and Questions in/ Results returned Public/Patient involvement Scientific Steering Committee Clinical insight and oversight Send non-pseudonymized clinical Send pseudonymized clinical data Review outputs data Sanity Check Data provider without Clinical/ Research University College London Public and Charity capacity to pseudonymise Community Hospitals NHS FT
Learnings • Amazing what you can achieve when you have to • COVID-19 accelerated Hub journey • Rapid use of accurate health data has supported clinical decision making and hospital management on a daily basis • Respond to clinical challenges • Map pandemic, staffing and service needs on local level • Continuing need to improve digital maturity of NHS to share benefits
Thank you E.Sapey@bham.ac.uk
Breakout 5: Better care – role of data at the frontline of the COVID-19 response • Ben Goldacre, Director, The DataLab Please use the Q&A function to ask questions to speakers. You are welcome to comment using the chat function, but we cannot guarantee this will be monitored.
Using routine data to understand pandemic impacts across the health and care system - potential for informing future service delivery responses Suzanne Mason, Professor of Emergency Medicine, University of Sheffield (Ass. Director HDRUK Better Care Partnership North) Jo Knight (Lancaster University), Nancy Preston (Lancaster University), Camila Caiado (Durham University), Barbara Hanratty (Newcastle University), Graham King (Newcastle University Hospitals), Ian Dove (County Durham & Darlington NHSFT). 25/06/2020
The Care Home Challenge • Care homes & residents adversely affected by COVID-19 • More than doubling in excess deaths (April 2020) • Guidance published March 2020 from DHSC, NHSI, PHE but early guidance lacking • SAGE reported deficits in evidence (May 2020) regarding routes of infection and infection control strategies
Outbreaks of suspected & laboratory confirmed COVID-19 in care homes (PHE) Care Home Outbreaks - 5th June 2020
Outbreaks in nursing homes within England (PHE) 100% 90% COVID outbreaks (PHE data): 80% 70% All care homes: 46% 60% Residential: 35% 50% Nursing: 66% 40% 30% Dementia care homes: 53% 20% Residential: 42% 10% Nursing: 69% 0% <5 5-19 20-49 50-99 100+ Size of care home - number of beds % of nursing homes with an outbreak by size % of all nursing home outbreaks Source: bed size - https://www.cqc.org.uk/sites/default/files/HSCA_Active_Locations_01_June_2020.xlsx outbreaks - HPZone from PHE Health Protection from 10 March to 1 June
In-hospital survival of care home residents (Roberts, Caiado et al, In submission) Survival significantly worse compared to those admitted from own home. Median survival in care home group was 12 days (95% CI 8 – 24)
Learning Care Homes Linking data: • Care Home: Digital App (SBAR, NEWS2, referral action) • Primary Care record • Emergency Department • Hospital Admission • Diagnosis • Discharge – date, place • Death • Covid status • Ambulance service data Evaluate the impact of introducing structured digital referrals from care homes to community on clinical outcomes for residents, hospital attendance / admission, health service costs, acceptability & utility to health care workers
Analysing NEWS Score implementation in care homes (Barker, Hanratty et al, doi: 10.1093/ageing/afz130) • Implementation to identify acute illness • N=46 care homes (2424 adults) • 30 month analysis NEWS scores • Mixed methods evaluation • Interviews care home staff: • Improved NHS communication, ↑confidence, speedier response to illness • Engagement challenging – competing priorities, training 25/06/2020 23
Relationship between NEWS scores & COVID deaths (Stow, Hanratty et al, In submission) • Care home NEWS scores linked to demographics, ONS all cause mortality • N=480 care homes (6464 residents) • Rise in NEWS predicted increase in COVID incidence • Restricting to O2 / RR / Temperature measurement adequately predicted COVID incidence 2 weeks ahead • Useful as health surveillance tool for populations e.g. care homes 25/06/2020 24
Future Research: Impact of covid-19 pandemic on care home pathways, outcomes, safety of care Outstanding questions about management of residents becoming unwell during COVID: • Undertake temporal analysis of changes in transfers to secondary care from care homes (and vice versa) before and during pandemic • Describe patterns of COVID / non-COVID disease and deaths in relation to transfer in and out of secondary care settings before and during pandemic • Explore decision making related to care of residents in the care homes during pandemic • Mixed methods: Linked dataset; care home / community care staff interviews
Thank you s.mason@sheffield.ac.uk @ProfSueMason
Breakout 5: Better care – role of data at the frontline of the COVID-19 response Chairs: • Simon Ball, Executive Medical Director, University Hospitals Birmingham, NHS Trust & Research Director, HDR UK Midlands • Alastair Denniston, Director, INSIGHT – The Health Data Research Hub for Eye Health Panellists: • Liz Sapey, Director, PIONEER – The Health Data Research Hub for Acute Care & Managing Director of NHR Clinical Research Facility Birmingham • Ben Goldacre, Director, The DataLab • Sue Mason, Professor of Emergency Medicine, University of Sheffield
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