Physiology Diagnostics & the Atlas of Variation
Professor Sue Hill OBE
Chief Scientific Officer for England
Physiology Diagnostics
• 8 Clinical services
–
–
–
–
–
–
–
–
Audiology
Cardiac Physiology
Gastrointestinal Physiology
Neurophysiology
Ophthalmic & Vision Science
Respiratory Physiology & Sleep Physiology
Urodynamics
Vascular Technology
• > 300 different tests
• > 15 million tests undertaken pa, demand
growing
• Key component of most clinical pathways
What does the Atlas tell us?
Test
Variation
After exclusions
Audiology assessments *
11x
5x
New born hearing tests o
4x
2.5x
Sleep studies *
79x
23x
COPD patients with FEV recorded #
1.3x
1.2x
Urodynamic tests *
144x
23x
Electrocardiography *
34x
4x
Diagnostic invasive
electrophysiology *
n/a
829x
Peripheral neurophysiology *
124x
37x
* national data collected monthly since 2008
# from GP database (QoF) data
O from National Screening Programme data
Challenging variation - Audiology
• Data shows a 11 fold difference
between highest and lowest areas
(still 5 fold after exclusions)
• Why is Norfolk so different to Suffolk?
Or Hillingdon and Hounslow?
- Can we account for this variation?
• Undiagnosed and untreated audiology
issues can profoundly affect an
individual’s ability to communicate
– and so the rest of their health
Interventions
to reduce unwarranted variation
• Providing a ‘feedback loop’ challenge to the commissioning
system – empowering clinicians in services and informing
contract management
• For patients: ensuring a fresh focus on the identification of
undiagnosed, and untreated conditions and the prevention of
disease progression
• Improving adoption of new technology & service redesign
• Quality assurance and peer review systems (such as IQIPS –
Improving Quality In Physiological Sciences)
• Tackling workforce shortages
Equipment
Management
&
Calibration
Performance
to SOPs &
guidelines
Knowledge
management
Diagnostic
services
MDT delivery
Advice and
expertise
Technical &
Clinical
interpretation
Quality
Systems &
Assurance
Diagnostic
services in
NHS –
getting it
right
Getting it right –
Mike Richards’s Vision
…we need to harness robust and timely
information from other sources to provide a more
rounded picture of a trust….
Accreditation and peer review already play an
important role in quality improvement …. I strongly
believe that such schemes have a key role to play in
the future of hospital inspection.
We need to use information from these schemes to
feed directly into CQC monitoring processes and
the development of trust-specific key lines of enquiry
for use at inspections.‘
Professor Sir
Mike Richards,
Chief Inspector
of Hospitals
Taking the Atlas forward in future
• The Atlas of Variation represents a subset of
diagnostic procedures – those that are monitored and
recorded nationally
• Some important diagnostics do not have sufficient data
to build a variation picture
– eg rate of EEG testing for epilepsy
• Need to focus on impact on patient experience and
outcomes when selecting additional indicators
Any questions?