Dr Rod Jones (ACMA)Healthcare Analysis & Forecasting

hcaf_rod@yahoo.co.uk

AimsOften we need to know, ‘how many do we

expect’ versus ‘how many are there’

Illustrate some of the issues using acute data

Suggest an approach to clinically meaningful comparisons for wider healthcare data sets

From experienceThe benchmarks are flawed

Supposed differences are often artefacts of the benchmark! Capitation formula allocation to PCT and subsequent PBR payment

to Trusts rely on different assumptions financial asymmetrySerious problems with the Data DefinitionsNHS site-based processes of counting & coding are

different Each site has a unique signature (especially small PCT run units!) Analyse zero day admissions separately Greater effect on the ‘diagnosis-based’ HRG and on specific

‘procedure-based’ HRGWhat works?

Adjust for age, sex, deprivation (IMD), ethnicity & studentsAnalyse using both HRG and OPCS procedure code

HRG are composites & the language of finance

From experience (contd)Look at the trend over time

Step changes & trendsUse FCE (not Spell) especially for proceduresAdd EL + EM for final analysis

EL/EM boundary is not the same in all hospitalsUse persons if fundamental disease incidence is

the issue

Zero day stay ‘elective’ >30% above expected

HRG

Chapter

Acute Site (numbered 1 to 13)

I II III IV V VI VII VIII IX X XI XII XIII

A                          

B      

C        

D          

E          

F          

G          

H      

J          

K          

L        

M          

P            

Q          

R              

S                          

Count 8 7 7 5 5 5 4 3 3 3 3 3 0

Acute site No I is a high PbR cost site. The real surgical day case rate at this site is low yet it counts very high volumes of events as a ‘day case’.

Index of Multiple Deprivation Intervention

rates are only as good as the

adjustment used to account for deprivation

IMD is very important and is highly non-

linear

The danger of averaging (Modifiable Areal Unit Property)

The average IMD for this LSOA is 29.9 The HRG described by red line has an apparent rate of 3 but a real rate of 3.7 for the benchmark

OPCS Procedure – excess as SDDescription

% EM 04/05 05/06 06/07 Comments

Q20 Other operations on uterus 7% 19 43 48 Mainly biopsy of lesion of uterus, outpatient procedures?

L13 Transluminal ops pulmonary artery 53% 32 25 33 Check the validity of clinical coding, far too high to be real

X29 Continuous infusion therap substance 13% 2 21 26 Oncology outpatient procedures re-classified as IP

H25 Endoscopic exam of lower bowel 7%  0 23 21 Endoscopy - rate is high

W19 Primary open reduction of fracture 84% 2  9 21 Change in coding in 05/06 or is this A&E work?

H22 Endoscopic exam of colon 2% -9 10 14 Endoscopy - rate is high, step change

M45 Endoscopic exam of bladder 2% 12 14 13 Endoscopy - rate is high

X40 Compensation for renal failure 8% 5 11 13 Renal dialysis - comissioning to clarify

L91 Other vein related operations 20% 8 11 12 Insertion of catheter - Oncology,etc OP procedures

M49 Other operations on bladder 6% 2 4 12 Introduction of therapeutic substance - OP Oncology?

B28 Other excision of breast 1% 9 9 11 Excision of lesion

V54 Other operations on spine 1% 5 4 8 Injection around spinal facet - OP/IP?

G45 Endoscopic exam upper GI tract 9% -21 8 5 Jump is OP re-classified to IP, step change

F09 Surgical removal of tooth 1% 4  3 6 Review of Dental