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Respiratory Benchmarking Packs Yorkshire and the Humber September 2010

Respiratory Benchmarking Packs

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Respiratory Benchmarking Packs. Yorkshire and the Humber September 2010. Respiratory Benchmarking Packs. We have taken two approaches to looking for unwarranted variation in respiratory health care Benchmarking of all PCTs in the SHA against selected indicators - PowerPoint PPT Presentation

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Page 1: Respiratory Benchmarking Packs

Respiratory Benchmarking Packs

Yorkshire and the HumberSeptember 2010

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Respiratory Benchmarking Packs

We have taken two approaches to looking for unwarranted variation in respiratory health care

1.Benchmarking of all PCTs in the SHA against selected indicators

2.Health investment analysis for selected PCTs using programme budgeting tools

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Purpose of Benchmarking Packs

The key purpose of the packs is to help engage local commissioners and clinicians in reducing unwarranted variation

Reducing unwarranted variation will improve outcomes for patients and reduce healthcare costs

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Unwarranted Variation

Some variation may be accounted for by local population characteristics, but much is unwarranted and due to the different ways services are organised and delivered. What is achievable for patients in one area should be possible in all areas.

Unwarranted variation in respiratory healthcare wastes resources and adversely affects an individual’s chance of receiving timely and accurate diagnosis, of being offered appropriate treatment, of requiring emergency admission to hospital and of recovering after an exacerbation.

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Questions will Generate Answers

By triangulating data from a number of sources, this analysis draws on a wide evidence base.

But the main purpose of the benchmarking packs is not to provide answers.

By highlighting unwarranted variation, the packs can be used to stimulate local dialogue about the quality of care that is commissioned and delivered.

Their value lies in helping us to formulate robust questions that clinicians and commissioners will want to address.

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How do our Systems Compare with the Best?

So where expenditure is relatively high and outcomes relatively poor, where there are high rates of mortality, admission and length of stay compared with socio-demographically similar PCTs…..

Commissioners and clinicians will want to know whether local providers have similar systems and offer similar services to the best performing providers.

Your Director of Public Health, Quality Observatory and Public Health Observatory will be able to assist in interpreting the data and framing the questions.

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Some Questions about Service Quality

1. Is there a local programme of case finding for COPD to ensure early diagnosis, to optimise proactive management and to

minimise risk of expensive hospital admission

2. Do GP practices and community providers offer: quality-assured diagnosis support for self-management quality clinical review in line with NICE guidance appropriate referral for LTOT assessment and pulmonary rehab Appropriate assessment and review of oxygen requirement

3. Do hospitals offer: access to specialist respiratory care early measurement of blood gas status and assessment for NIV optimal management of co-morbid conditions early supported discharge or hospital at home

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1. Local PCT Benchmarkingfor selected indicators

Analysis by Julian Flowers for ERPHO/APHO

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Five Measures of Variation

Burden and Detection• Prevalence and gap between observed and expected prevalence

Admission Rates• Per 1000 COPD registered patients

Hospital Utilisation• Emergency bed days/1000 PCT residents,

Quality Indicators• Readmission rates, hospital mortality

Cost • In patient cost per 1000 population

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Prevalence

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COPD Admissions

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Emergency Bed Days

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COPD Readmissions

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In Hospital Mortality

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In Patient Cost

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2. Health Investment Analysis For Selected PCTs

Commissioning Analysis and Intelligence TeamDepartment of Health

QIPP Right Care

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Health Investment slide packs - Respiratory

The following Health Investment slides use programme budgeting tools to highlight variation in health care at PCT and practice level.

For each SHA region, respiratory slide packs have been produced for selected PCTs where the evidence suggests that there may be significant variation in spend and outcome.

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Respiratory Health Investment PacksYorkshire and the Humber

The following selected slides illustrate some of the key findings for two PCTs in the Yorkshire and the Humber:

1. NHS Sheffield

2.NHS Calderdale

The full slide packs for each PCT are available separately.

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NHS Sheffield Health Investment analysis

QIPP Right Care

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Programme Budgeting Spreadsheet – Sheffield PCT Expenditure per 100,000 population (weighted by age, sex and need) on Respiratory Systems category – Green circle shows that the PCT has a high spend compared to most PCTs, both nationally (blue diamonds), and in similar PCT cluster (purple triangles)

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[2008/09] Each diamond represents a disease category and shows spend and outcomes compared to the national average – In Sheffield PCT Respiratory and Circulation have a higher spend with worse outcome when compared to other PCTs nationally.

Mortality from all circulatory diseases: Under 75s

Mortality from all cancers: Under 75s

Patients on enhanced CPA receiving early FU

Mortality from bronchitis, emphysema, COPD

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[2007/08] Programme Budget Atlas – Respiratory Systems Expenditure per 100,000 population (weighted for age, sex and need) – Darker areas represent higher spend – Sheffield spend is above average.

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[2007/08] Programme Budget Atlas - Respiratory Expenditure per 100,000 population (weighted for age, sex and need) filtered by ONS Cluster (Regional Centres) – Darker areas represent higher spend – Sheffield is above average compared to similar PCTs

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[2007/08] Programme Budget Atlas – Prevalence of COPD (QOF); Percent, all ages, Sheffield PCT has an above average prevalence of COPD

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[2007/08] Programme Budget Atlas – Fev1 checks for patients with COPD (QOF); Percent, all ages – Sheffield PCT has a low level of checks for patients with COPD

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[2007/08] Programme Budget Atlas – Respiratory Non-Elective Hospital Admissions per 100,000 population (weighted for age, sex and need) – Darker areas represent higher number of admissions – Sheffield PCT has a high number of Non-Elective Admissions

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[2007/08] Programme Budget Atlas – Respiratory Non-Elective Average Length of Stay per spell in hospital – Darker areas represent higher LOS – Sheffield PCT has a very high average LOS for Non-Elective Admissions

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[2007/08] Programme Budget Atlas – Respiratory Emergency Readmissions to hospital within 28 days of discharge – Darker areas represent higher number of readmissions – Sheffield PCT has a high number of Respiratory Emergency Readmissions

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[2008/09] NHS Comparators – GP Practice Level Comparison of Expenditure on Respiratory Emergency Admissions – Large variation between spend at practice level in Sheffield PCT

Easy to identify high and low spending practices. Can compare practices within groups based on

need of population

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NHS Calderdale Health Investment analysis

QIPP Right Care

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Programme Budgeting Spreadsheet – Calderdale PCT Expenditure per 100,000 population (weighted by age, sex and need) on Problems of the Respiratory System category – Green circle shows that the PCT has higher spend than most PCTs, both nationally (blue diamonds), and in similar PCT cluster (purple triangles)

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[2008/09] Each diamond represents a disease category and shows spend and outcome compared to the national average – In Calderdale PCT Respiratory has a higher spend with worse outcome when compared to other PCTs nationally.

Mortality from all circulatory diseases: Under 75s

Mortality from all cancers: Under 75s, Cancers was a high spend area in 2007/08

Patients on enhanced CPA receiving early FU

Mortality from bronchitis, emphysema, COPD

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[2007/08] Programme Budget Atlas - Respiratory Expenditure per 100,000 population (weighted for age, sex and need) filtered by ONS Cluster (Centres with Industry) – Darker areas represent higher spend – Calderdale is above average compared to similar PCTs

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[2007/08] Programme Budget Atlas – Respiratory Mortality data - Years of life lost under 75 years per 10,000 population (weighted for age, sex and need) – Darker areas represent more years of life lost – Calderdale is average nationally.

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2007/2008 Programme Budget Atlas – Prevalence of COPD (QOF); Percent, all ages FY, Calderdale PCT has slightly above average prevalence of COPD

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2007/2008 Programme Budget Atlas – Fev1 checks for patients with COPD (QOF); Percent, all ages – Calderdale PCT has a below average level of checks for patients with COPD

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2007/2008 Programme Budget Atlas – Vaccination against influenza for patients with COPD (QOF) Patients all ages – Calderdale PCT has a low vaccination rate against influenza for patients with COPD

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[2007/08] Programme Budget Atlas – Respiratory Non-Elective Hospital Admissions per 100,000 population (weighted for age, sex and need) – Darker areas represent higher number of admissions – Calderdale PCT has an average number of Non-Elective Admissions

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[2008/09] NHS Comparators – GP Practice Level Comparison of Expenditure on Respiratory Emergency Admissions – Large variation between spend at practice level in Calderdale PCT

Easy to identify high and low spending practices. Can compare practices within groups based on

need of population

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Conclusion

Benchmarking suggests there is significant unwarranted variation in the respiratory healthcare received by patients in this SHA region

What is achievable for patients in one area should be possible in all areas

By highlighting unwarranted variation, the packs can be used to stimulate local dialogue about the quality of care that is commissioned and delivered.

Their value lies in helping us to formulate robust questions that clinicians and commissioners will want to address.

Page 41: Respiratory Benchmarking Packs

Conclusion

Where expenditure is relatively high and outcomes relatively poor, where there are high rates of mortality, admission and length of stay compared with socio-demographically similar PCTs…..

Commissioners and clinicians will want to know whether local providers have similar systems and offer similar services to the best performing providers.