Early Intervention and Community Teams QIPP Metrics
Overview of the Metrics Required
Introduction
The Early Intervention and Community Services workstream aims to redesign mental health community services to improve responses to individual mental health needs through early intervention and crisis resolution/home treatment (CR/HT). The workstream has identified a number of areas where significant costs are potentially achievable.
The first relates to extending the capacity of Crisis Resolution/Home Treatment within the region. The anticipated impact of this is twofold. Firstly, the aim is to ensure that all patients are offered support at home before admission to hospital and secondly that all patients in hospital are offered support to facilitate early discharge.
The second area relates to extending the level of Early Intervention to ensure that every patient experiencing a first episode of psychosis receives timely ongoing support from an early intervention (EI) team.
Metrics for the QIPP Workstream for Early Intervention and Community Teams
1 Introduction
In order to be able to monitor and report progress in the Early Intervention and Community Teams QIPP, NHS West Midlands have identified the following items for measurement as necessary for evidence of development towards the aims of:
...redesigning and re-engineering mental health community services to improve their ability to respond to individuals needs through early intervention and to reduce the use of admissions and high intensity high cost services.
Those metrics that can also be used for CQUINS in 2010/11 are noted below.
2.1 Metrics - Commissioners Data
Commissioners should provide data on:
- Expected rates of new EI Patients per year.
- Expected rates of referrals from Acute Inpatient to Crisis Resolution Home Treatment Team per year.
- Commissioned Inpatient Capacity per year.
- Definition of re-admission
2.2 Metrics - Activity Data
The following activity data should be received by each Primary Care Trust on a quarterly basis to support local QIPP monitoring. These quarterly data should be forwarded by each PCT to NHS West Midlands.
2.2.1 Crisis Resolution Home Treatment Teams
- Count of all referrals by source of referral including; mental health hospital, early intervention service, assertive outreach team, community mental health team, Older Adults, CAMHS, Primary Care, sum of all other sources[1].
- Count of CRHT assessments that result in an episode of Home Treatment.
- Count of CRHT assessments that result in the patient being admitted to mental health hospital[2].
2.2.2 Early Intervention Teams
Count of all referrals by source of referral including: community mental health team, crisis resolution home treatment team, assertive outreach team, primary care teams, CAMHS, mental health hospital, sum of all other sources.
- Count of patients on the caseload that are receiving active early intervention support.
- Count of all discharges by discharge destination, including community mental health team, assertive outreach team, primary care teams, CAMHS, sum of all other sources.
- Referrals from EI to Crisis Resolution Home Treatment and Acute Inpatients.
- Lengths of stay data including:
- Minimum length of stay of patient within early intervention service
- Maximum length of stay of patient within early intervention service
- Average length of stay of patient within early intervention service
- Median length of stay of patient within early intervention service
- Count of Early Intervention patients who have duration of untreated psychosis of less than three months[3].
2.2.3 Inpatient Hospital Wards
- Occupancy measured in occupied bed days (both including and excluding leave days)
- Count of admissions by source of referral including crisis resolution home treatment team, early intervention service, assertive outreach team, community mental health team, CAMHS, Primary Care, sum of all other sources[4].
- Mean, median, minimum and maximum length of stay in hospital.
- Sum of all leave days used by inpatients
- Count of all discharges by discharge destination, including crisis resolution home treatment team, early intervention service, assertive outreach team, community mental health team, CAMHS, Primary Care, sum of all other.
- Count of patients who have been re-admitted within 28 days of a previous discharge from the same mental health hospital.
2.2.4 Additional Workforce Metrics
In addition to the above, workforce metrics have been identified by commissioner and provider discussions, in relation to beginning to understand workforce issues around community / domiciliary and hospital based services. The identified metrics for EI, CRHT and Acute Inpatient (not including PICU) are:
- WTE's of dedicated Team / Ward Managers
- WTE's all qualified practitioners except medical staff.
- Sessions per year of medical practitioners
- WTE's care support staff ( e.g. STR workers, Care support workers)
- WTE's admin and clerical staff.
Notes:
[1] The total number of referrals to CRHT from inpatients wards is also one of the numerators for the "CRHT Facilitated Discharge from hospital Response Time" CQUIN
[2] The total number of assessments that result in admission is also the numerator for the "CRHT Gate keeping rate" CQUIN
[3] Analysis of the DUP of EI Patients is a requirement of the Effective EI DUP CQUIN
[4] The total number of admissions is also the denominator for the "CRHT Gate keeping rate" CQUIN
Downloads
Updates to the EI QIPP Workstream
Please note that we are currently adjusting some details that were included in September update to this EI QIPP Workstream. AS soon as we have completed this we will make any details available.
Forecast Tool
This tool has been developed with two PCT's to help estimate growth in maximum Early Intervention caseload size. The parameters for the annual estimated number of new EI patients per year can be entered (as four quarters per year) for the years 2007/08 to 2015 /16 to cover the period of EI teams to date and the future period covered by this QIPP.
Example EIQIPP Caseload Forecast Tool (Excel 2003)
Blank EIQIPP Caseload Forecast Tool (Excel2003)
Tool for Analysis of Activity Data Related to EI QIPP
Explanantory documents:
Description of Metrics for QIPP Workstream for Early Interventions and Community Teams PDF
Excel based tools (written in Excel 2003):
EI QIPP Metrics Excel Tool Example (Excel 2003 file: 1.7 MB)
EI QIPP Metrics Excel Tool - for actual use (Excel 2003 file: 1.7 MB)
Guidance and examples for the Metrics Tool:
How to use the EI QIPP Metrics Tool PDF