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Balancing the costs and quality of different memory service models

Balancing the costs and quality of different memory service models. Dr Judy Rubinsztein Dr Marelna Van Rensburg Dr Zerak Al- Salihy , Dr Deborah Girling , Dr L ouise Lafortune , Dr Murali Kartha , Prof Carol Brayne. Aims.

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Balancing the costs and quality of different memory service models

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  1. Balancing the costs and quality of different memory service models Dr Judy Rubinsztein Dr Marelna Van Rensburg Dr Zerak Al-Salihy, Dr Deborah Girling, Dr L ouiseLafortune, Dr MuraliKartha, Prof Carol Brayne

  2. Aims • Evaluate average unit cost to secondary care for patients presenting with memory problems in a Memory Clinic based service (Gp A) and a Traditional ( CMHT based) service ( Gp B). • Evaluate quality of diagnostic service offered to patients and carers.

  3. Methods • Adapted Client Service Receipt Inventory (CSRI) • Questionnaire about quality of diagnostic service provided, devised for study

  4. Unit Costs for Health and Social Care (2011)

  5. Quality Questionnaire: Diagnostic Assessment Response times for assessment Dementia blood screen Pre-diagnostic counselling Examination of cognition, behaviour, functioning Advanced planning discussions Assessment of risk

  6. Typical pathway and costs for Gp A

  7. Group B

  8. Demographics

  9. Diagnoses (NS)

  10. Dementia Blood Screen from GP Significantly more in Group A Fisher Exact P=0.02

  11. Pre-Diagnostic Counselling

  12. Days to be seen

  13. Diagnostic Assessment: informal Evidence of informal assessment ( NS differences) in nearly all of patients including assessments of 1) Functioning 2) Behaviour 3) Global severity 4) Depression 5) Carer assessment : Gp A> Gp B

  14. Diagnostic assessment (formal scales) Formal assessment Gp A> Gp B • Functioning (P<0.0001) ( BDI) • Behaviour (P<0.0001) ( CBI) • Global (P<0.0001) (HoNos, EQ5D)

  15. Brain Scans

  16. Risk Assessment

  17. Post Diagnostic Advice

  18. Medications Prescribed (65%)

  19. Diagnostic info 100% of letters to GP had diagnosis

  20. Copying of letters to Pts/ Carers Group A Group B

  21. Total Costs Pounds Group A Group B

  22. Costs by Type (Means)

  23. Conclusions • Costs less for Gp A than Gp B but not significantly so. • BUT, Gp A (memory clinic service) can offer a higher quality service with more specialist and multi-disciplinary care.

  24. Outcome of Study • Valuable input to both services re cost and quality of service • Developed useful cost and quality tools for evaluating a memory service • Cost data may be useful to Unit Costs for Health and Social Care compendium • Planning an academic paper!

  25. What did I learn? • In real world, services change and develop. • Neither services are the same as when project done! • Involving staff with data collection/discussion at both ends critical to success. • Similar stakeholder info re perceived quality of services would be useful.

  26. Acknowledgements • *Dr Judy Rubinsztein • ¥Dr Marelna Van Rensburg • **Dr Zerak Al-Salihy, • ¥ D Girling, • *Dr L Lafortune • *Dr MuraliKartha, • *Prof Carol Brayne • *Receive support from NIHR CLAHRC, University of Cambridge, • ¥ CPFT= Cambridge and Peterborough FT • **Norfolk and Suffolk FT

  27. Acknowledgements • Sam Norton (statistician, CLAHRC) • John Battersby ( ERPHO, advice on demographic matching) • Multidisciplinary staff in both Groups A and B

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