An extra 40% of cases of Alcohol-Related Liver Disease (ALRD) were detected when compared with standard approaches for capturing data on emergency admissions.
The North West region of England has one of the country’s highest rates of alcohol-specific deaths. ARLD is the dominant cause. Early inpatient intervention has the potential to save lives, however reports show fewer than half of patients received ‘good care’ and mortality rates are high.
The detection of extra cases of ARLD resulted in improved knowledge of disease burden and better monitoring of inpatient and post-discharge outcomes.
There were four use cases for the alcohol pathway projects:
Development of a new experimental case mix-adjusted mortality measure using analysis from 3,887 admissions for ARLD, through working closely with the Advancing Quality Alliance (AQuA) ARLD Collaborative across seven hospitals. The new measure now informs analytics for service improvement.
Provision of hospitals with data reports for ARLD pathways in the first 90 days following an admission. Focusing on seven hospitals and covering a five year period, a benchmarking dashboard was created to compare activity levels for index admissions for ARLD, tracking pathways from admission through discharge and 90-day events, readmissions, A&E attendances and outpatient visits. The analytics were presented locally as benchmarking reports, comparing hospitals, and shared with hospital teams, gathering feedback to refine the content and methods. The teams were made aware of a 2-3-fold variation between hospitals in the proportion of patients attending an early hospital outpatient review following discharge from index admission with action being taken by the clinical teams to support service improvement.
Bespoke data outputs were developed with local clinicians in line with service priorities. One hospital team had undertaken retrospective case note reviews of all deaths from liver disease in response to an ‘alert’ on national metrics. Granular data confirmed case-mix differences from local trusts for that year. Whilst the hospital was an outlier using simple case-mix adjustment, the Trust team was provided with independent analysis showing that there was no significant signal of excess mortality when adjustments were made for additional clinical severity flags using the risk adjustment models.
Working with Hartree Data Science Centre, cohort identification and segmentation algorithms were transferred from test datasets into Liverpool CCG’s data warehouse containing hospital, primary care and other data for routine service commissioning. This resulted in deployment into live systems containing richer datasets to exploit opportunities for near-real-time analytics to identify factors associated with readmission and to create models.
How the NWC CHC team worked
To improve the quality of care and identification of alcohol-related liver disease, the NWC CHC:
Developed new algorithms and analytical tools to monitor outcomes of unplanned admissions and post-discharge events, identifying variation over time between hospitals and different localities.
Mapped ARLD hotspots and services and linked these to use of emergency and other services generating new insights to help re-design pathways for alcohol patients.
Worked closely with Advancing Quality Alliance (AQuA) to improve the reliability of clinical practice and to reduce variations in care for patients with alcohol-related liver disease.
Moved from previously unavailable analytics to a live and ongoing QI programme, the experimental mortality metrics were added to our site-level benchmarking reports in 2019.
“..we linked, analysed and visualised data in ways that reflect the complexities of alcohol-related conditions and the wide variability in local service provision and organisation across the region – bringing local context to the interrogation of data.” DR KEITH BODGER, CLINICAL LEAD FOR ALCOHOL, NWC CHC