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Admission Rates – an example of ‘Intelligent Information’

Admission Rates – an example of ‘Intelligent Information’. Dr Rod Jones (ACMA) Healthcare Analysis & Forecasting hcaf_rod@yahoo.co.uk. Aims. Often we need to know, ‘how many do we expect’ versus ‘how many are there’ Illustrate some of the issues using acute data

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Admission Rates – an example of ‘Intelligent Information’

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  1. Admission Rates – an example of ‘Intelligent Information’ Dr Rod Jones (ACMA) Healthcare Analysis & Forecasting hcaf_rod@yahoo.co.uk

  2. Aims • Often 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

  3. From experience • The 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 asymmetry • Serious problems with the Data Definitions • NHS 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’ HRG • What works? • Adjust for age, sex, deprivation (IMD), ethnicity & students • Analyse using both HRG and OPCS procedure code • HRG are composites & the language of finance

  4. From experience (contd) • Look at the trend over time • Step changes & trends • Use FCE (not Spell) especially for procedures • Add EL + EM for final analysis • EL/EM boundary is not the same in all hospitals • Use persons if fundamental disease incidence is the issue

  5. Zero day stay ‘elective’ >30% above expected 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’.

  6. 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

  7. 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

  8. OPCS Procedure – excess as SD

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