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Low Effectiveness Procedures: Demand & Variation

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:

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Low Effectiveness Procedures: Demand & Variation

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  1. Low Effectiveness Procedures: Demand & Variation 06/10/10 LEPS: Demand & Variation Presenters: Andrew Jones, Rob Atenstaedt, Siobhan Jones

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. LEPS: Demand & Variation

  9. LEPS: Demand & Variation

  10. LEPS: Demand & Variation

  11. LEPS: Demand & Variation

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. Acknowledgements • Jo Charles • Claire Jones • Sian ap Dewi • Hugo Cosh • Ciaran Humphreys • Rhys Gibbon • Martin Duerden (BCU HB) LEPS: Demand & Variation

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