Non-Elective Activity Monitoring Devon, Plymouth and Torbay Report, 212-13 1. Background and Rationale 1.1 The Devon Public Health Intelligence Team have previously undertaken quarterly analyses of emergency hospital admission rates by Complex Care Team (CCT) for the area covered by the former NHS Devon Primary Care Trust. 1.2 These analyses have been developed to cover both emergency admissions, as a measure of initial admission avoidance, and non-elective bed days, as a measure of overall use of non-elective beds across acute and community hospital settings. The area covered has also been expanded to include CCTs in Plymouth and Torbay. 1.3 This report looks at both overall levels of emergency and non-elective activity, along with a set of Ambulatory Care Sensitive (ACS) conditions agreed by Public Health and GP leads, which are particularly amenable to the work of CCTs and community interventions to reduce admissions and bed days. The selected conditions are Coronary Heart Disease, Angina, Chronic Obstructive Pulmonary Disease, Asthma, Dehydration and Gastroenteritis, Cellulitis, Influenza, Pneumonia and Diabetes Complications. 1.4 In light of significant variations in hospital activity by age, sex and deprivation, a standardised rate is used which adjusts for these factors at a CCT level. These rates compare the actual number of admissions with the expected number for the area given its age, sex and deprivation structure. This process is known as indirect standardisation, which sets a rate of 1 for the reference area (Devon, Plymouth and Torbay), with higher/lower values representing higher/lower activity rates. For example, if a CCT has an emergency admission rate of 9, it means it has 9 emergency admissions for every 1 that would be expected if the pattern of admissions by age, sex and deprivation was identical to Devon, Plymouth and Torbay as a whole. 2. Findings 2.1 Figures 1 to 4 show standardised activity rates by Clinical Commissioning Group and Locality across Devon. Admission rates are significantly lower in the Eastern Locality, and are significantly higher in the Northern and Western Localities, and are average in South Devon and Torbay. Bed Day rates are significantly lower in South Devon and Torbay, and are significantly higher in all NEW Devon localities. For the Page 1 of 1
selected ACS conditions, in the Western Locality both admission and bed day rates were significantly higher, whereas both admissions and bed day rates were significantly lower in the Northern Locality. Within the Eastern Locality admission rates for the selected ACS conditions were significantly lower, whilst bed day rates were significantly higher. This suggests that whilst admissions are avoided, lengths of stay are longer, meaning that more bed days are used relative to other areas. The opposite is evident in South Devon and Torbay, where admission rates are significantly higher but bed day rates are significantly lower. 2.2 Figures 5 to 8 highlight admission and bed day rates by CCT. This reveals that for all emergency admissions, 13 CCTs were significantly lower, eight were significantly higher, and 11 were not significantly different, with the lowest rates seen in CCTs in the Eastern Locality such as, Axe Valley, and. For non-elective bed days, 14 CCTs were significantly lower, 14 were significantly higher, and four were not significantly different, with the lowest rates seen in the five Torbay CCTs. For selected ACS condition admissions, six CCTs were significantly lower, six CCTs were significantly higher, and 2 were not significantly different, with the lowest rates seen in Axe Valley and other Eastern and Northern Devon CCTs. For selected ACS condition bed days, 17 CCTs were significantly lower, 1 were significantly higher, and five were not significantly different, with the lowest rates seen in Bideford and Northam, Paignton North and. 2.3 Figures 9 and 1 illustrate the share of non-elective bed day activity between acute hospitals and community hospitals both in percentage terms (figure 9) and as a share of the standardised rate for non-elective bed days (figure 1), across Devon, Plymouth and Torbay. The lowest community hospital shares are seen in Plymouth, Exeter and, along with, which does not have a community hospital. Shares are higher in areas distant from acute with prominent community hospitals, particularly in parts of East Devon, North Devon and Teignbridge. 2.4 Figures 11 to 12 show admission and bed day rates by Eastern Locality GP practice. These do not cover the selected ACS conditions as the levels of activity at a practice level would be too low to allow for meaningful comparisons using annual data. Clock Tower Surgery in Exeter, which covers homeless and vulnerably housed persons and other vulnerable groups, has the higher activity levels. The five practices with the lowest standardised rates of emergency admissions were Hatherleigh, Bampton, Lynton, Moretonhampstead, and Wembury. The five practices with the lowest standardised rates of non-elective bed days were Bampton, Withycombe Lodge, Exe Valley, Yealm, and Greenswood. Charts identifying individual practices can be found in the Clinical Commissioning Group Locality reports and Complex Care Team supplementary reports available here: http://www.devonhealthandwellbeing.org.uk/jsna/performance/urgent-care-report/ 2.5 Figure 13 shows estimated excess activity, revealing how many admissions and bed days would have been saved if CCTs had the same age, sex and deprivation standardised rate as the CCT with the lowest rate in Devon, Plymouth and Torbay. Within the Devon, Plymouth and Torbay area in 212-13, 17,348 emergency admissions would have been saved if all areas had the same activity rates as Page 2 of 1
, and 189,845 non-elective bed days would have been saved if all areas had the same activity rates as Paignton North. For the selected ACS conditions in 212-13, 3,683 emergency admissions would have been saved if all areas had the same activity rates as Axe Valley, and 24,433 non-elective bed days would have been saved if all areas had the same activity rates as. 3. Conclusion and next steps 3.1 These age, sex and deprivation standardised rates bring us closer to actual variations in local practice and care, rather than variations in population structure and underlying health needs. However, it is impossible to control for all factors that may affect admission rates such as distance from acute services, care home provision, wider health service provision and specific local needs. With this in mind, it is important that these reports are seen as tools to instigate further investigation into the factors behind lower and higher activity rates locally, rather than a definitive statement on the quality and effectiveness of local teams. Simon Chant Public Health Specialist (Intelligence) Devon County Council 3 July 213 Page 3 of 1
FIGURES Figure 1, Age Sex and Deprivation Standardised Emergency Admission Rates by CCG / Locality, 212-13 12 SAR Selected CCG / Locality Linear (Devon) 1 8 6 4 2 Eastern Locality Northern Locality Western Locality NEW Devon CCG South Devon and Torbay CCG Figure 2, Age Sex and Deprivation Standardised Non-Elective Bed Day Rates by CCG / Locality, 212-13 12 SAR Selected CCG / Locality Linear (Devon) 1 8 6 4 2 Eastern Locality Northern Locality Western Locality NEW Devon CCG South Devon and Torbay CCG Page 4 of 1
Figure 3, Age Sex and Deprivation Standardised Emergency Admission Rates by CCG / Locality for selected ACS conditions*, 212-13 12 SAR Selected CCG / Locality Linear (Devon) 1 8 6 4 2 Eastern Locality Northern Locality Western Locality NEW Devon CCG South Devon and Torbay CCG Figure 4, Age Sex and Deprivation Standardised Non-Elective Bed Day Rates by CCG / Locality for selected ACS conditions*, 212-13 12 SAR Selected CCG / Locality Linear (Devon) 1 8 6 4 2 Eastern Locality Northern Locality Western Locality NEW Devon CCG South Devon and Torbay CCG Page 5 of 1
Paignton North Bideford and Northam Paignton North Bideford and Northam Figure 5, Age Sex and Deprivation Standardised Emergency Admission Rates by Complex Care Team, 212-13 14 SAR Selected CCT Linear (Devon) 12 1 8 6 4 2 Figure 6, Age Sex and Deprivation Standardised Non-Elective Bed Day Rates by Complex Care Team, 212-13 14 SAR Selected CCT Linear (Devon) 12 1 8 6 4 2 Page 6 of 1
Bideford and Northam Paignton North Bideford and Northam Paignton North Figure 7, Age Sex and Deprivation Standardised Emergency Admission Rates by Complex Care Team for selected ACS conditions*, 212-13 16 SAR Selected CCT Linear (Devon) 14 12 1 8 6 4 2 Figure 8, Age Sex and Deprivation Standardised Non-Elective Bed Day Rates by Complex Care Team for selected ACS conditions*, 212-13 18 SAR Selected CCT Linear (Devon) 16 14 12 1 8 6 4 2 Page 7 of 1
Paignton North Bideford and Northam Grand Total Figure 9, Non-Elective Bed Day Acute and Community Hospital Percentage Shares by Complex Care Team, 212-13 Acute Bed Days Community Bed Days Grand Total Paignton North Bideford and Northam % 1% 2% 3% 4% 5% 6% 7% 8% 9% 1% Figure 1, Age Sex and Deprivation Standardised Non-Elective Bed Day Rates by Complex Care Team with Acute and Community Hospital Bed Day Share, 212-13 Acute SAR share Community SAR share 1 Page 8 of 1
Kingsteignton Pathfields Figure 11, Age Sex and Deprivation Standardised Emergency Admission Rates by GP Practice across wider Devon area, 212-13 6 SAR Linear (Devon) 5 4 3 2 1 Figure 12, Age Sex and Deprivation Standardised Non-Elective Bed Day Rates by GP Practice across wider Devon area, 212-13 8 SAR Linear (Devon) 7 6 5 4 3 2 1 Page 9 of 1
Figure 13, Excess Activity Compared to Complex Care Team with the lowest Standardised Activity Rates, 212-13 CCT Excess Emergency Admissions Excess Non- Elective Bed Days Excess Emergency Admissions (Selected ACS Conditions only) Excess Non- Elective Bed Days (Selected ACS Conditions only) 127 8,739-425 1,144 8,311 136 632 Bideford and Northam 63 9,749 59 357 325 5,553 25 17 238 552 121 129 239 3,65 66 324 261 5,89 65 545 44 3,451 141 282 172 4,479 89 1,54 338 4,96 68 672 615 5,257 89 81 976 13,837 199 1,624 417 8,19 85 865 146 6,36 37 891 377 2,345 85 453 214 2,27 6 493 1,53 7,997 282 1,31 171 4,353 64 293 Paignton North 262-89 547 43 1,792 17 237 2,16 15,197 352 3,276 177 4,682 33 51 2,4 16,242 45 2,961 384 4,357 1 859 569 4,32 131 755-4,46 37 712 477 819 128-794 1,43 168 323 518 7,721 95 517 187 3,197 47 265 1,619 21,46 32 2,315 Eastern Locality CCTs 3,461 68,465 799 8,213 Northern Locality CCTs 2,794 36,16 347 2,24 Western Locality CCTs 6,74 61,87 1,323 1,356 South Devon & Torbay CCTs 4,389 23,558 1,213 3,84 All Wider Devon Area CCTs 17,348 189,845 3,683 24,433 Notes These rates have been standardised to control for the effects of age, sex and deprivation, which all strongly influence admission rates for these conditions. This allows for more meaningful and direct comparisons between teams in different areas with different demographic structures and levels of healthcare need. The Devon, Plymouth and Torbay average is standardised to 1. *This report displays standardised admission rates for a selection of Ambulatory Care Sensitive (ACS) conditions amenable to the actions of CCTs. The conditions included are Diabetes complications, CHD, Angina, COPD, Asthma, Dehydration and gastroenteritis, Cellulitis, Influenza and Pneumonia. Page 1 of 1