In this CHKS* Advisory Board blog, we look at mortality benchmarking during the COVID-19 pandemic and the implications for quality improvement. Advisory Board members are experienced and well-respected leaders from across the health and care sector. Most board members felt that as well as understanding the treatment and mortality of COVID-19 in an acute hospital setting now, delivering effective care for long COVID will require a coordinated and consistent effort for many years to come.
From the outset of the COVID-19 pandemic activity dramatically changed within all hospitals, although this happened at different times and at different speeds. NHS Digital released new coding guidance for COVID-19 quickly, but since it was a novel disease, it was not included in any risk modelling. There were no historical cases to review, and pre-existing case mix mortality measures could not be used.
The implications for mortality benchmarking are significant. The way forward is to incorporate new methods for comparing in-hospital mortality rates specifically for patients with confirmed COVID-19. These new approaches will allow hospitals to compare their actual deaths with an expected figure given the case mix (age and sex) of their own COVID-19 cases. However, these models must also consider the differences in survival rates between the first and second waves.
In addition, long COVID-19 is developing as comorbidity, which presents a unique challenge to the health service.
Members of the CHKS Advisory Board were all in agreement that long COVID-19 will have an impact on health and care for years to come. They pointed out the different approaches that are being taken in primary care, secondary care, and community care. In secondary a care for example, one board member highlighted the long COVID clinics that are now being set up. The board felt such initiatives were welcome, but that a whole system approach is needed because it is providers outside hospitals that are likely to see the greatest impact.
The issue of capacity in the community sector was raised as an area of concern. Throughout the pandemic, the acute sector has been able to ease demand on capacity by pushing back on elective care, but the community care sector is not in the same position.
The work of one community trust was brought to the attention of the board. This board has made long COVID-19 its top priority. One of the initiatives under discussion is to revisit virtual wards, where patients are assigned to a virtual ward outside the acute setting where their condition is managed by a range of health and care professionals. This would allow patients to be discharged from hospital sooner on the basis that they would still be monitored by staff with specialist skills and experience.
Accurate data and insight will be critical to our response as we will need to understand the likely impact on primary and community care, to find out who is at greater risk and what interventions are needed. Ideally, a new dataset needs to be developed that captures long COVID-19 diagnosis and treatment data in mental health care, community care and within GP practices. This is a health complication that requires detailed review to understand diagnoses and improve data capture.
Board members also agreed that this whole system approach should be one that compares what we are seeing here with data from other countries in Europe. Learning from international experience will be an important success factor in our ability to meet the long COVID-19 challenge.
The CHKS Advisory Board members are as follows:
Bob Alexander, Interim Chair, Imperial College Healthcare NHS Trust and Independent Chair at Sussex Health & Care Partnership
Dr Amit Bhargava, Senior GP Partner Southgate Medical Group
Maria Kane, Chief Executive, North Bristol NHS Trust
Jim Mackey, Chief Executive, Northumbria Healthcare NHS Trust
Martin Rennison, Director of Commercial Contracting, Spire Healthcare Group Plc
Andrew Ridley, Chief Executive, Central London Community Healthcare NHS Trust
Charles Waddicor, Chair of F&I Committee and Chair of New Models of Care Committee, Barnet Enfield and Haringey Mental Health NHS Trust
Professor Andrew Walton, Group Executive Director, Connect Health and Strategic Council Member at Independent Healthcare Partners Network
Dr Cathy Winfield, Director, NHS England
*CHKS part of Capita Healthcare Decisions are the healthcare intelligence experts at Capita plc.