Balancing the costs and quality
of different memory service
models
Dr Judy Rubinsztein
Dr Marelna Van Rensburg
Dr Zerak Al-Salihy,
Dr Deborah Girling,
Dr L ouise Lafortune,
Dr Murali Kartha,
Prof Carol Brayne
Aims
• Evaluate average unit cost to secondary care
for patients presenting with memory
problems in a Memory Clinic based service
(Gp A) and a Traditional ( CMHT based)
service ( Gp B).
• Evaluate quality of diagnostic service offered
to patients and carers.
Methods
• Adapted Client Service Receipt Inventory
(CSRI)
• Questionnaire about quality of diagnostic
service provided, devised for study
Unit Costs for Health and Social Care
(2011)
Service
Consultant
Psychiatrist
Registrar
Ass Sp
CMHT ( OP)
Psychologist
CT/ MRI
Psych tests
Mileage
Unit Cost (with on
costs)
£162
£73
£131
£44
£60
£121/£198
£9
54p/mile
Quality Questionnaire:
Diagnostic Assessment
Response times for assessment
Dementia blood screen
Pre-diagnostic counselling
Examination of cognition, behaviour, functioning
Advanced planning discussions
Assessment of risk
Typical pathway and costs for Gp A
DV
screen/assign
Pre-Dx
Counselling
Dx
Post Dx
Office
Advice
Group B
DV
(medical)
• No F/U
DV
(medical)
• Assign
• DVs for post Dx
advice, team
Demographics
A (n=33)
B (n=33)
Comments
Age (mean)
80
84
0.03 (Significant)
Min-Max
65-92
66-97
Females
58%
67%
MMSE (median)
24
25
NS (n=32 both
groups)
ACE-R
67
-
(Gp B, 9 done)
Education
15
15
Not recorded 4 in
Gp A, 20 in Gp B
Diagnoses (NS)
60
50
40
30
A (%)
B (%)
20
10
0
AD
VD
LBD
MCI
Depression
Other
Dementia Blood Screen from GP
Yes
Group A
Group B
100%
73%
Significantly more in Group A
Fisher Exact P=0.02
Pre-Diagnostic Counselling
Prediagnostic Counselling
Gp A
GP B
Yes
97%
6%
Highly Significant
Difference on Chi Sq
Days to be seen
Group A
Group B
Mean days ( SE)
25 ( 2.6)
20 (3.4)
t=1.21
P=0.23 (NS)
Diagnostic Assessment: informal
Evidence of informal assessment ( NS differences)
in nearly all of patients including assessments of
1) Functioning
2) Behaviour
3) Global severity
4) Depression
5) Carer assessment : Gp A> Gp B
Diagnostic assessment (formal scales)
Formal assessment Gp A> Gp B
• Functioning (P<0.0001) ( BDI)
• Behaviour (P<0.0001) ( CBI)
• Global (P<0.0001) (HoNos, EQ5D)
Brain Scans
Risk Assessment
Documented in
Fisher Exact, P =0.02
Gp A
Gp B
94%
67%
Post Diagnostic Advice
Signposting
67%
49%
Third sector
70%
24% *
Advance planning discussions
55%
45%
Medications Prescribed (65%)
Diagnostic info
100% of letters to GP had diagnosis
Copying of letters to Pts/ Carers
Group A
88%
Group B
42%
Total Costs
P
o
u
n
d
s
Group A
Group B
Costs by Type (Means)
£300
£250
Group A
£200
Group B
£150
£100
£50
£0
Direct
Office
Travel time
Mileage
MDT
Scans
DrugsPsych Tests
Conclusions
• Costs less for Gp A than Gp B but not
significantly so.
• BUT, Gp A (memory clinic service) can offer a
higher quality service with more specialist
and multi-disciplinary care.
Outcome of Study
• Valuable input to both services re cost and
quality of service
• Developed useful cost and quality tools for
evaluating a memory service
• Cost data may be useful to Unit Costs for
Health and Social Care compendium
• Planning an academic paper!
What did I learn?
• In real world, services change and develop.
• Neither services are the same as when project
done!
• Involving staff with data collection/discussion
at both ends critical to success.
• Similar stakeholder info re perceived quality of
services would be useful.
Acknowledgements
•
•
•
•
•
•
•
•
*Dr Judy Rubinsztein
¥Dr Marelna Van Rensburg
**Dr Zerak Al-Salihy,
¥ D Girling,
*Dr L Lafortune
*Dr Murali Kartha,
*Prof Carol Brayne
*Receive support from NIHR CLAHRC, University of
Cambridge,
• ¥ CPFT= Cambridge and Peterborough FT
• **Norfolk and Suffolk FT
Acknowledgements
• Sam Norton (statistician, CLAHRC)
• John Battersby ( ERPHO, advice on
demographic matching)
• Multidisciplinary staff in both Groups A and B