Webinar Q&A 17 February 2022

When I log on I can still only see Model Hospital (blue) - how can I see the Model Health System view (pink)?
Using the drop-down in the top right of the screen, by your name and organisation name in the header. This short article goes into more detail.

I’m having problems accessing the Model health System.
Please contact us: help@model.nhs.uk

I’ve recently changed organisations and haven’t logged into the Model Health System since in case I get access to data that I shouldn’t. How can I change my requirements?
Please contact us: help@model.nhs.uk

Are there any plans to use the Model Health System to support the national cancer pathways for lung, colorectal, prostate, head and neck and gynae cancer?
There is a Cancer compartment which contains metrics relating to these pathways:

View Cancer (Rightcare) - Model Health System

This is further broken down by sub programme budgeting category. There is a list to the left of the page where you can click on an area of interest. For example, lung cancer:

View Lung - Cancer (Rightcare) - Model Health System

This compartment, and sub-compartment has a range of data across the cancer pathway. Where possible, we have used tumour site data. Otherwise, we have used total cancer data. This data is all at STP and some/most also at CCG level.

Are there any plans for providing the Model Hospital data by site as at present it's provided at Trust level only?
Yes, this work is currently in development. We anticipate it being available to users in April.

What is meant by the quadruple aim?
The quadruple aim of health care, a population health concept, is to: improve the health of the population, the experience of care, the health and wellbeing of the workforce, and reduce the overall costs of care. They extend the triple aim of healthcare by adding the aim of improving the health and wellbeing of the care provider workforce, recognising that a supported and engaged workforce delivers better care and fosters greater patient engagement.

https://www.annfammed.org/content/12/6/573.full

Which pockets of the tools include analysis and insights around Mental Health services?
There is a Mental Health Services lens which can be viewed at Sustainability Transformation Partnership (STP), Integrated Care System (ICS) or Provider level.

What's the difference between System view and Clinical Commissioning Group (CCG) view?
System view is STP/ICS.  For some STPs/ICSs there is just a single CCG in the system but in some there are multiple.

Is the CCG view a build-up of full provider levels within the CCG area or a true CCG commissioned level?
The CCG view is based on the registered population (so true commissioned level). The STP/ICS view is aggregated from CCG or providers depending on the metric.

Does the system activity include activity provided by private providers?
At present this depends on the metric. Generally, population-based metrics will include Independent Sector data, whereas provider-based metrics will not. Adding independent sector data more broadly is currently in development. We anticipate it being available to users in March.

How do we get access to Pathway Improvement Programme data?
There is an option to download data from Model Health System. Within the Interactive Chart, change the toggle above the chart from Chart View to Table View and this will allow you to export the data for the indicator in an Excel file.

Can we see denominator data?
This can generally be viewed via the indented metrics (click the arrow to the left of the indicator name to expand to view).

Can you see other trusts’ metrics? It seems I only have access to my Trust.
You should be able to see all metrics of the trusts in your ICS. When you click on the organisation name (top right) the pop-up window should let you select trusts and the ones in your ICS will be listed.

Does the MHS show patients who did not attend their appointments?
From the browse button, select Care Settings and this information will be under ‘Outpatients’. The section on DNAs is also available from the link:

View Did Not Attend (DNA) - Outpatients - Model Health System

How often is the data refreshed?
This varies from metric to metric. As soon as we have the data we can refresh it. At the bottom of each metric page there is information around where the data has come from and when the next refresh is due.

How are the effectiveness of changes measured? 
Model Health System provides many metrics, updated for different time periods to allow systems to monitor changes. Systems will be able to use these nationally available metrics, coupled with any local information (which could be more specific to the change) to assess the impact of local changes.

How are outcomes measured during pathway development?
Model Health Systems has outcome metrics to support each programme:

·      For musculoskeletal conditions, there are the PROMs (Patient Reported Outcome Measures) for primary hip and knee replacements, which measure patients self-reported health before and after the procedure:

View Clinical outcomes - Pathway Improvement Programme - Model Health System

·      For Eye Care, cataract outcome measures are collected by the National Ophthalmic Database – Audit:

View Outcomes - Pathway Improvement Programme - Model Health System

·      For Cardiac, QOF is a key source of CPIP primary care data. Relevant metrics have been added against key FY 2021/22 CPIP priorities:

View Headline Priority Metrics - Cardiac Pathways - Model Health System

Are there any plans to provide bencmarking data for ICS?
Model health System (MHS) contains system level (STP/ICS) data, which is built up from either the Providers based within the STP/ICS, or from the registered population in the CCGs based within the STP/ICS. The Peer Group for STP/ICSs can be changed between STP/ICSs in the region, or the similar 5 STP/ICS, using the Grey drop down in the top left corner of MHS. These peer benchmarks, and potentially other benchmarks (such as top decile performance of STP/ICSs or clinical targets), will appear within the interactive charts.

Does the platform provide suggested actions for, i) providers to enquire into their performance differences and ii) suggested (tangible) pathway changes? 
Model Health System provides metrics for systems, with possible related metrics being grouped together to provide a more holistic understanding and help users explore and explain performance differences. These can be accompanied by an Opportunities section, which occasionally will have useful links. However, generally MHS itself does not provide suggested actions or changes to pathways for systems.

Good places to look for the additional pathway changes are RightCare, and the Pathway Improvement Programme.

The RightCare information is orientated to making changes and generally includes service/pathway diagnostic and implementation tools (e.g. gap analysis). RightCare prioritises pathway development to areas of significant national opportunity so, whilst perhaps not a full match for a local areas’ opportunities, should cover the significant ones. Their website is:

https://www.england.nhs.uk/rightcare/products/pathways/

RightCare Pathways, Scenarios, toolkits, etc are available for additional care areas, and build on the MHS data sources too. A FuturesNHS site is due to be launched shortly and will look to build a community of practice in addition to support for making change arising from MHS data-identified opportunities, for example, at pathway level.

Is the system based on resident or registered populations? or can it do both?
Model health System (MHS) contains system level (STP/ICS) data, which is built up from either the Providers based within the STP/ICS, or from the registered population in the CCGs based within the STP/ICS.

Does this data include children, young people and adults? 
Yes, generally the metrics will include people of all ages. If a metric covers only a specific age group, then this will be stated in the Metadata.

What are the data sources used to capture data along the pathways?
Multiple data sources are used to capture the different care settings along the pathway, and also the different conditions under consideration. For example, the Quality and Outcomes (QoF) is a major source of primary care data, both on prevalence, clinical processes, and outcome measures. Primary care prescribing information comes from the NHS Business Services Authority. Much secondary care data (e.g. on procedures) is obtained from National Commissioning Data Repository (NCDR) – Hospital Admissions Databases, SUS+ SEM (Secondary Uses Services Plus, Standard Extract Mart) or from HES (Hospital Episode Statistics). For musculoskeletal conditions, there are the PROMs (Patient Reported Outcome Measures) for primary hip and knee replacements, which measure patients self-reported health before and after the procedure. And for Eye Care, cataract outcome measures are collected by the National Ophthalmic Database. There are also bespoke collections, such as the recently introduced Theatres data collection.

How does this system collate data?
Multiple data sources are used to capture the different care settings along the pathway, and also the different conditions under consideration. For example, the Quality and Outcomes (QoF) is a major source of primary care data, both on prevalence, clinical processes, and outcome measures. Primary care prescribing information comes from the NHS Business Services Authority. Much secondary care data (e.g. on procedures) is obtained from National Commissioning Data Repository (NCDR) – Hospital Admissions Databases, SUS+ SEM (Secondary Uses Services Plus, Standard Extract Mart) or from HES (Hospital Episode Statistics). For musculoskeletal conditions, there are the PROMs (Patient Reported Outcome Measures) for primary hip and knee replacements, which measure patients self-reported health before and after the procedure. And for Eye Care, cataract outcome measures are collected by the National Ophthalmic Database. There are also bespoke collections, such as the recently introduced Theatres data collection.

How can you get QoF data on Cardio/CVD for previous years?
Currently, Model Health Systems has the QoF data for financial years 2019/20 and 2020/21. NHS Digital publish QoF data annually, with historical data available from:

Quality and Outcomes Framework - NHS Digital

 Do you have any GIRFT cardiac data at trust level?
Yes, some GIRFT metrics are currently included in the 'supplementary metrics' section. These are mirrored from elsewhere on MHS. GIRFT colleagues are currently in the process of updating cardiology and cardiac surgery metrics with a view to adding to MHS shortly. Currently available relevant GIRFT metrics can be found in the secondary/tertiary care section here:

View Supporting Metrics - Pathway Improvement Programme - Model Health System

Is ophthalmology data impacted by outsourcing patients to private providers if not included?
For the GIRFT Questionnaire data that was presented, independent sector (IS) providers do not submit data so will be affected. Including IS providers in the questionnaire has been discussed but has not yet been implemented. For metrics where the data source is the Secondary Uses Service (SUS), IS providers are included in the data. In the metric linked below, the ICS value contains IS activity:

View metric - Average number of pre-operative outpatient appointments attended per patient within a year before a simple cataract procedure - Model Hospital

However, when you drill down to Trust level, the IS values are missing due to technical issues. 

You mention that this data is fed through from the QOF.  Could this be adopted more locally at a CCG/ system level?
QOF currently remains the best source for nationally available primary care data. The advent of CVDPREVENT over the course of 2022 will result in an alternate (and more timely) data source in many instances.

Are you reporting on cancer 2WW and 62 days which is a national issue and relevant right now?
For the total cancer sub compartment, we have 2ww, 31day, 62day data. We present both a financial year figure and a monthly time series which is updated every month, which is available:

View All Cancers - Cancer (Rightcare) - Model Health System

For the financial year figure, we also show the “difference to target” in terms of number of patients. This is an indented metric (click on the purple arrow to the left of the metric to view).

For monthly, we also show the numerator and denominator. This allows the user to see the activity flow. i.e. during Covid the percentage seen within 2 weeks may have been high, but this could have been partially due to a reduction in patients being seen. Therefore, this is included for a complete picture.

We have some waiting times data by specific site (where appropriate). These can be found in their respective sub-compartments. Currently, these are financial year data. We are looking to add rolling quarter data in the near future.

We are also adding trust level data for waiting times indicators.

RE: MSK Does AGI data include procedures delivered in private care?
Yes, the MSK AGI indicators are population-based and so will include NHS commissioned activity, even if it is performed in a private provider. Most systems tend to perform more hip and knee replacement procedures per head (adjusting for age and sex of population) to their less deprived populations. However, often quintile 5 (the least deprived) does not have the very highest rate and this may be partially due to people paying for procedures privately (which would not appear in this data.)

is the hip replacement by deprivation score age standardised?
Yes, the inequalities measures presented are standardised for both age and sex.

How can we get access to the data for all ICS systems? Where we are a national provider but have an ODS for our Head Office in one ICS?
For data access issues, please contact Chris Wilson at: chris.wilson9@nhs.net

What’s the timeline on the prevalence metrics? 
The prevalence data from the Quality and Outcomes Framework (QOF) is published annually by NHS Digital, typically at the end of October, which enables release on Model Health System shortly afterwards.


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