Map of Medicine supporting the QIPP challenge
Map of Medicine is a key tool in helping local health communities safely reduce their costs while improving the quality of healthcare delivery, goals central to the Department of Health's QIPP (Quality, Innovation, Productivity, Prevention) agenda. The Map can help to achieve the aims of QIPP by enabling the establishing of new services and facilitating communication across traditional boundaries to share best practice and productivity improvements.
Care pathways are increasingly seen as playing a key role in improving the quality of care. A recent Cochrane review has concluded that clinical care pathways are associated with reduced in-hospital complications and improved documentation. The majority of the 27 studies analysed reported a decreased length of stay and reduction in hospital costs when clinical pathways were used.
Map of Medicine care maps have been shown to improve patient outcomes, reduce delivery costs, and aid efficient service reconfiguration. They draw from a quality-assured evidence base, incorporating front-line clinical experience from Royal Colleges and clinical societies, and an awareness of policy demands. The maps can be customised by commissioners looking to devise new and improved pathways in their communities. Local care maps are viewable by any Map of Medicine user, promoting the spread of innovation throughout the NHS.
Presenting evidence-based, practice-informed best practice options allows clinicians to choose what is right for their patients. This results in high-quality individualised treatment and reduces unjustified variations in care. Map of Medicine care maps consider the complete patient journey across care sectors, leading to an improved patient experience.
Using the Map of Medicine can ensure that the goal of improving healthcare delivery is not sidelined by the need to cut costs.
NHS Wirral localised the Map of Medicine map on age-related macular degeneration (AMD), the UK's leading cause of blindness to:
Reduce waiting time for treatment from ten weeks to ten days
Achieved annual savings of approximately £200,000
Map of Medicine helps local health communities innovate locally and then share this innovation between groups across the NHS. As local care maps are visible across teams, care settings, and organisations, all efficiency and productivity developments are widely communicated. Communities can draw from and contribute to a general fund of knowledge and innovation. They are able to see how those facing similar challenges related to the QIPP objectives have successfully transformed their healthcare delivery. This information can then be used to inform their own service reconfiguration.
Innovation is crucial in order to improve the quality of healthcare with limited resources. Pathways are a patient-centred aid to designing services to achieve this goal. The adaptable nature of the Map of Medicine allows communities to define and put into practice local solutions to their particular challenges in healthcare delivery.
NHS Western Cheshire used their Cellulitis map on the Map of Medicine to communicate new procedures for intravenous antibiotic treatment in the community. They:
- Halved average monthly hospital admissions (from 40 to 20 patients)
- Generated minimum savings of £2,000 per patient
Map of Medicine care maps promote cost-effective quality improvements, offering the ideal starting point for service redesign. This enables healthcare communities to enhance their standard of care in a cost-saving environment. Using the Map of Medicine to embed the QIPP improvements in everyday processes helps preserve established benefits and enables ongoing service development.
The maps take a holistic rather than fragmented approach, displaying a patient's journey across both generalist and specialist care settings. This helps communities plan for an overall treatment strategy, ensuring appropriate allocation of resources whilst also achieving continuity of care.
‘Productivity considerations for service design’ give evidence-based recommendations on how to improve productivity while retaining or improving quality.
South Devon Local Health Community used the Map of Medicine to redesign knee pain services, developing a specialist physiotherapy service based in primary care. They:
- Projected savings in first year of at least £60,000
- Avoided over 400 unnecessary consultant appointments
- Achieved 70% reduction in referrals to secondary care, but increased appropriate referrals
Map of Medicine has a strong focus on preventing complications and common health problems. Early diagnosis and comprehensive follow-up for secondary prevention is central to all topics addressed. Specific maps also seek to achieve primary prevention through targeting risk and promoting healthy lifestyles, for example; smoking cessation, alcohol withdrawal, obesity, cardiovascular disease risk management and venous thromboembolism (VTE) risk assessment and prophylaxis.
Local healthcare communities, working as multidisciplinary teams, develop these maps further to address local needs. By expanding the Map of Medicine alcohol withdrawal map, Western Cheshire embedded alcohol screening advice in A&E and community sexual health services.
One of NHS Newham's safety-focused objectives in developing the anticoagulation map was to prevent patients from developing complications. Newham:
- Implemented point of care testing service in primary care for stable patients
- Received positive response to the new service from 96% of patient respondents
- Projected savings of £300,000 for 2009/10, and £500,000 for 2010/11