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1、NICEs role in establishing guidelines and Quality standardsDr Franoise Cluzeau,Associate Director,NICE InternationalDr Ryan Li,Adviser,NICE InternationalOverviewNICE,its role,structure,funding&governanceGuidelines&Quality Standards process and methodsEnhancing guidance implementation and pay for per
2、formanceHow does the work of NICE improve care quality?Learning from other countriesNICE.what is it?The National Institute for Health&Care Excellence(NICE)is the independent organisation responsible for providing national guidance and advice to improve health and social careNICE as an organisation R
3、ange&products medicines,treatments,procedures,diagnostics&devices clinical guidelines&pathwaysQuality Standards,performance metrics and a range of information services for those providing commissioning and managing services across the spectrum of health and social care.Shared Learning AwardsCentres&
4、support servicesImplementationEvidence ResourcesCommunicationNICE InternationalBusiness,Planning&resourcesFunding&expenditureNational Institute for Health and Care Excellence Annual Report and Accounts 2013/14FundingExpenditureNICE GUIDELINES AND QUALITY STANDARDS10Why NICE clinical guidelines and q
5、uality standards?Variation in care and health outcomes across the country “postcode lottery”“Different organisations set different standards,using different methods and evidence not clear which standards must be followed and which are optional”Sir Liam Donaldson,previous Chief Medical OfficerNICE gi
6、ven responsibility to develop guidance:To promote cost-effective use of NHS resourcesBased on best available evidence and participatory process11What are NICE guidelines and quality standards?A prioritised,concise set of statements(usually 6-8)with associated measurable indicators,chosen and adapted
7、 from the Clinical Guideline recommendationsA comprehensive set of recommendations for a particular disease or conditionExample:Quality standard for stroke developed from NICE guideline15Indications for immediate brain imaging:Indications for thrombolysis or early anticoagulation treatment On antico
8、agulant treatmentKnown bleeding tendencyDepressed level of consciousness(Glasgow Coma Score 13)Unexplained progressive or fluctuating symptomsPapilloedema,neck stiffness or feverSevere headache at onset of stroke symptoms.NICE guideline development brings together many different stakeholders NICEDef
9、ine process and methodsQuality assure NCCs workManage stakeholder consultation and disseminationAccountable for the final guidelineNational Collaborating CentresConvene GDGs Provide technical input to facilitate GDGDraft the guidelineGuideline development groups(GDG)Review evidence base and make rec
10、ommendations Respond to consultation commentsThe Guideline Development Group(GDG)is crucial to each guidelineMulti-disciplinary committee consisting ofChair:usually highly experienced and respected clinical leaderClinical and academic expertsPatients,carers and lay membersNCC technical teamGDG membe
11、rs bring their own expertise from different perspectives,but do not represent particular organisationsAll members have equal statusKey role of the GDG is to make judgements based on the evidenceNICEDECISIONSOther socialvalues:ethics,equity,rightsLegal and policy constraintsPracticalities of implemen
12、tationExtent of uncertainty&Irreversibility of decisionCost-effectivenessEffectivenessDeveloping guidelines some challenges.ScopeWhat to include/exclude?TimelinessTaking into account cost-effectivenessSelecting topics for economic modellingWhen to rely on published dataKeeping guidelines up to dateH
13、elping compliance/implementationBaseline assessment/audit tools Cost impact toolsOnline educational toolsLocal practice improvementFinancial incentivesDo they work?What is the impact of NICE guidance Shared Learning AwardsBaseline assessment toolUsed to evaluate current practice and plan activity to
14、 meet NICE recommendations Can serve to audit practiceAlways used in conjunction with the guidelines they relate toLocal Practice improvement case studies_shared learningAntibiotic prescribing for coughs reduced from 54.5%to 37.7%over 3 months Antibiotic prescribing for URTI reduced from 32.6%to 19.
15、7%over 3 months In January alone,67 patients avoided unnecessary prescription of antibiotics(over 700 fewer prescriptions in 1 year)LessonsBuy-in of staff from across the practicereinforcing the message to clinicians Involving reception staff from the early stages as first contact with patients on t
16、he phone.Pay for Performance in Primary Care Quality Outcomes Framework(QOF)Introduced in 2004 voluntary annual incentive scheme that rewards family doctors in the UK for improving care.GPs get achievement points for:-Managing common diseases(asthma/diabetes)-Implementing preventative measures(blood
17、 pressure checks)-Targeting hard to reach/at risk groups(vaccinations and screening)There are 75 indicators across 25 disease areasNICE develops indicators,based on NICE guidelines/Quality StandardsDoes QOF improve outcomes?Recording?definitelyProcess?mostly yesIntermediate/proxy outcomes?yes for so
18、me but not for othersClinical outcomes?unclearStrong evidence of initially improved health outcomes for a limited number of conditions but subsequently fell to the pre-existing trend;“limited impact on improving health outcomes due to its focus on process-based indicators.”(Langdown et al.2014,J Pub
19、 Health)Some evidence that the poorest performing practices have improved the most with narrowing of inequalities in care(Gillam et al.2012,Annals Fam Med)An estimated 25,000 people die from DVT each year.Ministers said trusts that fail to act on the guidelines are likely to face financial penalties
20、.Hospitals that fail to screen at least 90%of their patients will be penalised by withholding payments.From 1 April 2010,a hospital could stand to lose 0.3%of its income through the new Department of Health commissioning for quality and innovation framework.Preventing VTEsNICE International is NICEs
21、 non-profit programme since 2008Supporting foreign governments to make better policy decisions for better healthoTechnical support:HTA,guidelines and quality standardsoAdvice on process and governance:transparency,public and stakeholder involvementPractical support projects(clinical pathways,quality
22、 standards)with country partners,including:China,India,VietnamVietnam:QS for Stroke developed over 14 month,country-owned processMOH policymakers and clinicians across Vietnam engaged in deliberative processSelected relevant recommendations to address high-priority clinical areasDeveloped quality st
23、atements and measures,appropriate to Vietnamese contextFinal product approved by Vice Minister33QS:a model of national/international partnership?Effective partnershipConvened policymakers and stroke clinicians for the first time with direct policy impactStronger institutionsMoH incorporated QS in Ho
24、spital Quality CriteriaPilot QS implementation funded through World Bank projectBetter decisionsFocus on low cost,high impact interventions:prevention,joint working across disciplines,early diagnosis and rehabilitationFull implementation could lead to improved care for 115,000 patients,and net savings of US$2.8m per year34