高血压英文ppt精品课件alcohol improvement programme early implementers

Understanding VSC26/NI39 Alcohol Improvement Programme Early Implementers Conference 2 December 2009 Data Workshop Joanna Copping Chris Gibbins Verity Bellamy Understanding VSC26/NI39 Outline of presentation How NI39 is calculated Latest trends in NI39 for England How to calculate NI39 fro your own PCT/LA NI 39 in Nottingham How PCTs can reach their NI39 target- discussion Ready Reckoner version 5 Understanding VSC26/NI39 How alcohol admissions indicator is calculated PSA 25.2, VSC26, NI39 Developed in 2007 Broader measure includes conditions partially attributable to alcohol Based on review of epidemiological literature by NWPHO Produced set of conditions caused by alcohol and corresponding attributable fractions Understanding VSC26/NI39 The measure 13 wholly attributable conditions (attributable fraction of 1) 31 partially attributable conditions (attributable fraction less than 1) Example: cancer of oesophagus Women aged 16-24, AF = 0.23 Understanding VSC26/NI39 Applied to NHS Information Centres data on Hospital Episodes Admission episodes for residents; valid sex and age; classpat = 1,2,5 Any mention of alcohol related diagnosis (not just primary diagnosis) 7.56Total = If more than one in episode, use largest AF eg I10X = 0.34; G409 = 0.61 Count of admissions; not patients (whole admission equivalent) To get rate, use ONS resident population estimates: .uk/statbase/Product.asp?vlnk=15106 Attributable fractions for the non-data minded! 2 NI39 admissions = Ethanol poisoning2 X Epilepsy4 X Hypertension10 X Breast cancer25 X Understanding VSC26/NI39 Improving access and understanding DH releases of data: Q1 2009/10 Final 2008/09 Subsequent quarters about five months after end of quarter NWPHO sub-analyses 2007/08: December 2008/09: January Confidence intervals - scoping HES ARA variable Currently undergoing user acceptance testing ARA tool Feed admission level data in (from HES or SUS). Calculates attributable fractions and standardised rates. Available on Alcohol Learning Centre: .uk/Topics/Latest/Resource/?cid=5369 Ready Reckoner Assist PCTs to select interventions to reduce alcohol admissions. 4 high impact changes. Also on ALC: .uk/Topics/Browse/Commissioning/Data/?parent=5113 hypertension (41%), cardiac arrhythmias (20%) and falls (12%) being highest Zero bed days We also looked at zero bed days (admissions not passing through midnight). The top 10 are shown below. Hypertension was highest (30.8%) followed by psoriasis (11.4%) How do we reduce our rising rates of alcohol related admissions? Men contribute more to NI39, especially middle aged Most admissions are emergencies (72%) Main conditions that contribute: -Hypertensive disease (25%) and responsible for 20% of cause of increase in NI39 -Mental& behavioural (22%) and responsible for 46% of cause of increase in NI39 -Cardiac arrhythmias (15%) and responsible for 16% of cause of increase in NI39 -Epilepsy (8%) -Alcohol liver disease (7%) Increases over 6 years most obvious in liver diseases Possible interventions- what would you do? Target the men (NB they dont usually seek health care) Most come as emergencies so key opportunity for Emergency Department (IBA) and alcohol liaison team Hypertensive disease- but also asking GPs to improve detection. IBA may reduce incidence but will take time Mental & behavioural (includes intoxication, harmful use, intoxication, withdrawal, DTs, psychosis, amnesia)- improved alcohol treatment services should help Cardiac arrhythmias, epilepsy, liver disease- Alcohol workers in outpatient clinics