Horizon scanning for Arden GEM CSU: variation

Showing posts with label variation. Show all posts

Tuesday, 19 November 2019

BMJ Quality & Safety 2019;28:1032-1038.

This paper examines the discrepancies in observed variation and underlying true variation between geographies or organisations, and the impact of chance. In particular it considers why crude estimates of variation can be misleading and how familiar statistical tools used in medical research can avoid these common problems by identifying true variation.
Examples used include suicide rate for English local authorities and liver disease mortality rate for English local authorities.

A technique to understand hospital catchment populations for children and young people by modelling the historical flow of emergency admissions from each local area. This allows the population each hospital serves to be identified and their demographic characteristics to be estimated. These catchment populations for children support work to understand if differences are related to how different hospitals manage a condition or because they serve a unique population.
See also "There’s no longer a catch: a new way to measure how children and young people are treated”, Nuffield Trust comment, 25 April 2019

Abstract

This research paper provides empirical evidence on the relationship between health outcomes and health expenditures in England using Data Envelopment Analysis (DEA) and Quantile Regression (QR) to analyse data from 151 Primary Care Trusts in England across seven Programme Budget Categories. The deprivation index and budget shortfalls against formula were used to adjust for factors affecting efficiency that were outside of the control of PCT managers.
Results suggest that setting a cost-effectiveness criterion for NICE may not be capable of being synthesised using scientific methods alone, but involve political judgements.

Evidence from FOI requests conducted in 2017 shows that 47 out of 208 CCGs (22.6%) have established policies to restrict reconstruction services for non-clinical reasons, with a further nine CCGs (4.3%) having draft policies or informal restrictions in place (see p18/19). The report makes recommends for CCGs to support shared decision making, availability of surgery and patient expectations.
At the same time new guidelines have been published by the Association of Breast Surgery Guidance for the Commissioning of Oncoplastic Breast Surgery

Following wide ranging engagement this review has identified critical and unwarranted variations in all key resource areas across mental health and community health services. The review estimates that elimination of unwarranted variation could save the NHS nearly £1 billion in efficiencies by 2020/21.
Four key areas are staff, contract specification, technology and delivery. Structural issues identified include delayed transfer of care, wound care, community hospitals, Lifetime healthcare costs and Integrated care.
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