low effectiveness procedures demand variation
Download
Skip this Video
Download Presentation
Low Effectiveness Procedures: Demand & Variation

Loading in 2 Seconds...

play fullscreen
1 / 18

Low Effectiveness Procedures: Demand & Variation - PowerPoint PPT Presentation


  • 80 Views
  • Uploaded on

Low Effectiveness Procedures: Demand & Variation. 06/10/10. Presenters: Andrew Jones, Rob Atenstaedt, Siobhan Jones. Background. Betsi Cadwaladr University Health Board requested support from Public Health Wales to:

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Low Effectiveness Procedures: Demand & Variation' - asasia


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
low effectiveness procedures demand variation
Low Effectiveness Procedures: Demand & Variation

06/10/10

LEPS: Demand & Variation

Presenters: Andrew Jones, Rob Atenstaedt, Siobhan Jones

background
Background

Betsi Cadwaladr University Health Board requested support from Public Health Wales to:

  • Compile list low effectiveness procedures (LEPs) for Individual Patient Commissioning (IPC) Policy
  • Look at demand and variation for a small number of LEP’s (high volume elective surgical procedures)

LEPS: Demand & Variation

drivers
Drivers
  • ↓ harm, waste, variation
  • Financial
  • Evidence base on LEP’s e.g NICE, Public Health Wales
  • England already robustly performance managing PCT’s on LEP’s

LEPS: Demand & Variation

better care better value
Better Care Better Value

Better Care Better Value indicators monitor PCT’s on 5 key LEP’s:

  • tonsillectomy,
  • dilatation and curettage,
  • hysterectomy,
  • lower back surgery
  • myringotomy (grommets).

LEPS: Demand & Variation

methodology
Methodology
  • A rapid review of existing guidance from NICE, Public Health Wales and existing UK wide policies performed to identify LEP’s
  • Review of literature on demand and variation was undertaken
  • Detailed analysis of 14 high volume (>20/year) surgical procedures, using PEDW data (undertaken by Public Health Wales Observatory Analysis Team)

LEPS: Demand & Variation

low effectiveness procedures
Low Effectiveness Procedures
  • Collaboration between BCUHB & Public Health Wales
  • Lists treatments/procedures/ therapies which should not be available or limited availability
  • 70 LEPs identified – included as appendix to the Health Board’s IPC Policy
  • Recommended course of action, with current advice and OPCS code given
  • Procedures split between those should not used in any circumstance and should only be used under strict criteria (subdivided into low & high volume)
  • Cross-checked with neighbouring PCTs/ LHBs

LEPS: Demand & Variation

analysis of surgical variation results for north wales
Analysis of surgical variation – results for North Wales
  • Analysis suggests significant variation in reported rates of common surgical procedures being undertaken across Wales
  • ↑ statistically significant rates of tonsillectomy, grommet insertion, removal varicose veins, haemorrhoidectomy, apicectomy and D&C/hysteroscopy
  • ↔ Hysterectomy, removal wisdom teeth, removal gallstones
  • ↓ elective caesarean delivery, removal skin lesions, cosmetic orthodontic procedures, removal of ganglia & lumber spine procedures

LEPS: Demand & Variation

limitations of data analysis
Limitations of data analysis
  • PEDW set up to track hospital activity for payments – not epidemiological analysis
  • Coding – Variation/ Primary procedure codes / Specificity
  • Impossible to tell if procedure clinically appropriate – only illustrates numbers/rates across Wales

LEPS: Demand & Variation

clinical engagement process
Clinical engagement process
  • Purpose of variation report to support clinical engagement and discussion
  • Limitations of data analysis clearly highlighted

Presentations on IPC policy/variation report to:

  • HB Board of Directors,
  • LNC, LMC and Medical Staff Committees X3 joint with HB
  • Relevant Clinical Programme Group Board meetings

LEPS: Demand & Variation

clinical engagement process1
Clinical engagement process
  • Issues with data and coding of procedures highlighted eg haemorrhoidectomy, orthodontics
  • Clinicians given opportunity to identify other procedures from own specialties to include on LEP list e.g. labial reduction
  • LEPs shared with colleagues in other HB’s across Wales e.g. Cardiff & Vale to inform consistent approach

LEPS: Demand & Variation

outcomes
Outcomes
  • IPC policy appendix produced – ratified as Health Board policy
  • Draft report which included literature review on demand and variation & data analysis produced
  • Revisions to IPC policy and LEP list following feedback from clinicians

LEPS: Demand & Variation

outcomes1
Outcomes
  • HB group now in place to monitor LEPs
  • Urgent review of clinical pathways and waiting lists for LEP’s was conducted
  • Clinical engagement with GP’s re: referral processes
  • Public Health Observatory to turn draft variation paper into all-Wales resource – clinician feedback on coding issues fed in to this process
  • Formal establishment of Wales project to harmonise IPC

LEPS: Demand & Variation

learning points
Learning points
  • Very powerful tool to start clinical engagement process
  • Clinical engagement takes time….
  • Important Role of LHB Medical Directorate
  • Information professionals should ideally be consulted in advance for advice on coding issues. Balanced in this case against timeliness
  • Efficiency of doing at all Wales level - circulated within professional forums, crossed CEO NHS Wales desk

LEPS: Demand & Variation

acknowledgements
Acknowledgements
  • Jo Charles
  • Claire Jones
  • Sian ap Dewi
  • Hugo Cosh
  • Ciaran Humphreys
  • Rhys Gibbon
  • Martin Duerden (BCU HB)

LEPS: Demand & Variation

ad