Quality of care for adolescents and young adults
There is an urgent need to develop new health care models to improve the quality of care for adolescents and young adults. With the rapid expansion of knowledge and technology and a health care system that performs below acceptable levels for ensuring patient safety and needs, a gap has developed between recommendations and practice.
The Department of Health and Social Care (DoHSC) have published standards for adolescent and young adult (AYA) health, however evidence from the Care Quality Commission (CQC) suggests these are rarely met in practice. The standards recognise that AYA have separate medical, psychological, social and developmental needs to children and adults, and that services should be structured to reflect this. They also recognise that AYA health outcomes are different to other age groups, particularly in those with long term health conditions, who have poorer outcomes and lower levels of educational attainment.
Quantifying adherence to quality indicators can serve as a measure of the quality of care and provide a measurable target for quality improvement, although there is no accepted standard for quality of care that combines the perspectives of all stakeholders. This proposal is about integrating routinely collected health care data into routine care as a mechanism for improving AYA health care quality.
To co-design, implement, and evaluate a Learning Health System (LHS) for AYA, that uses routinely collected demographic and healthcare data to report an AYA vulnerability score to clinicians in real time. The score would allow clinicians pre-emptively to identify AYA at risk and personalise interventions that might prevent hospital admission.
- To use OpenSafely, a large national primary care dataset of encounters, linked to emergency department visits and hospital admissions, to identify factors which predict admission for AYA.
- To co-develop electronic audit tools and dashboards within GP systems that report these factors to the clinical team in real-time. This will involve iterative cycles of development of a prototype reporting dashboard; repeatedly assessed for acceptability and use with frontline health-workers through co-development workshops.
- To implement, validate and pilot test and adapt the LHS (audit tools/dashboards) systems in 5 GP practices, in collaboration with EHR system providers, to test the IT specifications, utility and acceptability of the system with front line workers and change the system in line with user feedback.
- To track hospital admissions for AYA before and after implementation of the LHS and compare with control GP practices in the locality.
OpenSafely is an open source, highly secure informatics platform storing primary care data on 24 million people in England, linked to hospital admission and emergency department attendances. Data is pseudonymised and held within a secure datacentre accessible only through a proxy. As the data are linked to sustainability and transformation plan (STP) regions, it will be possible to analyse outcomes in the context of regional socioeconomic factors using linked datasets.
Adolescents, young people, healthcare quality, learning health systems