Power of PROMs Data to Support Commissioning of Varicose Vein Procedures

Transcription

1 Power of PROMs Data to Support Commissioning of Varicose Vein Procedures Valerie Corris, Senior Health Information Analyst, NEQOS PROMs Summit 7 December 2016

2 Commissioning Principals Commissioning for value - ability to commission high quality healthcare for the whole population within the funds available. Safe avoiding harm to patients from care that is intended to help them. Effective providing evidence-based care with a clear benefit. Person-centred providing care that is respectful / responsive to individuals needs & values. Timely reducing waits and sometimes harmful delays. Efficient avoiding waste and unnecessary costs. Equitable providing care that does not vary in quality because of a person s characteristics. NHS does not fund healthcare for cosmetic reasons alone

3 NICE Guidance There is no definitive system for identifying which people will benefit the most from interventional treatment and no established framework within the NHS for the diagnosis and management of varicose veins. (NICE CG168) NICE Clinical Guideline 168 (July 2013) and Quality Standard (August 2014) for Varicose Veins in the legs Referral to vascular service for varicose veins causing symptoms or complications Assessment by duplex ultrasound Suitable intervention hierarchical approach for use of endovenous ablation, foam sclerotherapy and surgical procedures. Compression hosiery offered as permanent treatment only if no other procedures are suitable. If incompetent varicose tributaries are to be treated, consider treating them at the same time NICE Interventional Procedure guidance Endovenous mechano-chemical ablation (IPG435) Ultrasound-guided foam sclerotherapy (IPG440) Transilluminated powered phlebectomy (IPG37) Radiofrequency ablation (IPG8)

4 RCS Guidance

5 Activity by Providers

6 Activity by CCGs

7 Choice of Procedure

8 Trend data - National

9 Primary Diagnosis Providers that rarely operate on patients with inflammation and/or ulcers

10 Multiple Admissions

11 Financial Analysis HRG Description 2014/15 Tariff Primary Unilateral Varicose Vein Procedures without complications (CC) 912 Primary Unilateral Varicose Vein Procedures with CC (includes ulceration) 1,023 Primary Bilateral Varicose Vein Procedures without CC 1,153 Primary Bilateral Varicose Vein Procedures with CC (includes ulceration) 1,347 Redo Unilateral Varicose Vein Procedures without CC 1,189 Redo Unilateral Varicose Vein Procedures with CC (includes ulceration) 1,189 Redo Bilateral Varicose Vein Procedures without CC 1,549 Redo Bilateral Varicose Vein Procedures with CC (includes ulceration) 1,549

12 Financial Analysis CCG code Activity Rate (Indirectly Standardised Ratio) Actual Total (No. of procedures) Expected Total if rate equal to national rate (No. of procedures) Difference between Actual & Expected (No. of procedures) Expenditure for actual activity ( ) Opportunity for savings ( ) A , ,509 B , ,339 C , ,775 D , ,283 E ,942 89,242 F ,094 80,409 G ,639 74,723 H ,298 71,457 I ,038 67,933 J ,470 66,803 K ,808 L ,298 M ,896 NE&C ,865 1,477 1,388 2,798,468 1,495,475 Source: North East Quality Observatory System (NEQOS) Copyright 2014/15

13 Aberdeen Varicose Vein Questionnaire (AVVQ) Preoperative Scores More symptoms Less Symptoms Data Source: NHS Digital August 2016 (2014/15 operations) Data Source: NHS Digital August 2016 (2014/15 operations) 13

14 Patient Reported Outcomes AVVQ - Adjusted Health Gain Scores Best Worst Data Source: NHS Digital August 2016 (2014/15 operations) Note: Negative scores indicate improvement in symptoms 14

15 Patient Reported Outcomes

16 Patient Reported Outcomes

17 Patient Reported Outcomes

18 PROMs Data Quality

19 PROMs Data Quality

20 PROMs Data Quality Current limitations of PROMs data Wide variation in participation across providers in England. Less than 20% of cases have sufficient data to calculate Health Gain. Patients having multiple admissions within year may be included more than once. Outcomes are not routinely reported by type of procedure.

21 Conclusions Value based commissioning requires that scarce NHS resources are provided for high quality care of proven benefit. PROMs data can support measuring outcomes but at present the power to do this is limited by: Low and variable participation rates across Trusts Inability to view outcomes for the different types of procedures PROMs data is only part of the picture and needs to be supported by other process data that indicate compliance with NICE Quality Standard such as: Type of procedure Unilateral vs. bilateral Multiple procedures within a year Commissioners need to ensure that access to this is information is part of the contract and should aim to include: Aberdeen Varicose Vein Questionnaire as part of the referral process Process measures around the provision of different types of procedures

22 Acknowledgements: Presentation was put together by Dr Liz Lingard, former Deputy Director of NEQOS, and Valerie Corris, Senior Health Information Analyst, NEQOS. Clinical advice was provided by Prof Stansby, Newcastle upon Tyne Hospitals NHS Foundation Trust. North East Quality Observatory Service (NEQOS) Ridley House Henry Street Newcastle upon Tyne NE3 1DQ +44 (0) NEQOS is jointly hosted by Northumberland, Tyne & Wear and South Tees Hospitals NHS Foundation Trusts North East Quality Observatory Service (NEQOS) 2016