What is a “Deep Dive” pack?
CCGs have received a bespoke Commissioning for Value
insights pack. These packs, sometimes referred to a Level 1
packs, analyse data on spend and outcomes at a Programme
Budget level across a wide range of programmes.
Those packs identified candidate programmes which offered
the most value in return for improvement work – they
answered the question of - where to look.
Having selected one or more programmes to analyse in more
detail – a Deep Dive pack would examine pathways in more
detail to identify opportunities for improvements - What to
change.
The structure and content of Deep Dive packs has evolved
through work done by Right Care and Yorkshire and Humber
PHO (now PHE Knowledge and Intelligence Team) working
CCGs in Derbyshire and Yorkshire and Humber.
This anonymised example is taken from the work done by
YHPHO. The structure of a pack is not fixed and immutable
but it is based on a tried and tested successful approach. This
exemplar will give you a tangible feel for what a Deep Dive
pack would look like for your locality and your priority
programmes.
1
1
Commissioning for Value
Focus Pack
CCG: XXX CCG
Focus area: Cardiovascular pathway
Draft
Version 5.0
January 2013
2
Contents
Background and context
– Aims of the packs
– Packs as part of transformation process
2.
Methodology
– Analysis methods
3. Analysis
–
–
–
–
–
Summary messages
Analysis by pathway stage
Practice level variation
Secondary care quality
Bringing it all together
Contents
1.
4. Next Steps
5. Annexes
–
–
–
–
Annex 1: Detailed indicator spine charts
Annex 2: CCG Benchmarks
Annex 3: Data sources
Annex 4: What works
3
Aim of the packs
•
•
•
•
In September 2012, YHPHO produced Commissioning for Value Intelligence Packs for
every CCG in Yorkshire and Humber. These packs identified programme areas which
offered potential opportunities for improving outcome, quality and efficiency at local
level.
The packs included an offer to work with CCGs to develop this Focus Pack or ‘deep
dive’ looking at an agreed programme area to understand variation across the
pathway including GP practice benchmarking, working with local BI teams to identify
opportunities for improvement together with the best evidence on what works.
This work forms part of the health intelligence to support commissioning workstream
which has been funded since 2009/10 by PCT Chief Executives in Y&H.
In 2013/14 YHPHO’s specialist intelligence services will be part of the CSU business
intelligence offer.
Further support is available to use and explore the intelligence in this pack – contact
sue.baughan@york.ac.uk or jake.abbas@york.ac.uk.
Background
•
4
How these packs support service improvement
Background
5
Methodology used to produce this pack
Analysed wide range of indicators from across the pathway focussing on spend and quality
Identified key opportunities for value improvement and quantified potential impact
• Listed all the indicators where CGG is below average for cluster (see Annex)
• Quantified opportunity for indicators in bottom quintile from moving to average of top 40% for cluster
• Quantified additional financial opportunities for other indicators from moving to average of top 40% for cluster
• Quantification does not mean that the ‘saving’ or improvement can actually be made, but may however answer the question
‘Is it going to be worth focussing on this area?’
Methodology
• Analysed wide range of national benchmarked data to identify indicators where CCG is below the average for its cluster
group
• Identified indicators where CCG is in worst quintile within its cluster
• Analysed practice based variation to identify practices which consistently compare poorly against their national clusters
Reviewed national evidence base to identify potential interventions linked to opportunities
• Pulled together examples of ‘what works’ against ‘opportunity’ areas across the pathway
• Identified ‘high performing’ CCGs from cluster to support potential service/pathway review
6
Summary: Prevention and Prevalence
Summary
Prevention
• 4/5 indicators are below the average of the top 40% benchmark group
• If the CCG reached the average of the top 40% in its benchmark group, 1,978
fewer people with a long term condition would smoke
• The CCG is in the highest quintile for binge drinking. This is based on a PCT
modelled estimate from the Health Survey for England. If the estimate is
correct then 20,161 fewer people would binge drink if the CCG reduced its
rate to the benchmark average for the top 40%. The CCG may want to
triangulate this with other indicators, for example alcohol related admissions
Prevalence
• 9/10 indicators are above the average of the 40% benchmark group
• For CHD, stroke and hypertension the observed prevalence can be compared
with that expected given the characteristics of XXX CCG’s population. For
CHD the expected to observed ratio exceeds that of the 40% benchmark
group.
• For stroke a further 83 cases and for hypertension a further 3,492 would
need to be observed to achieve the expected to observed ratio of the 40%
benchmark group.
7
Summary: Management in primary care
Summary
• 18/22 indicators are below the average of the top 40% benchmark group
• QOF indicators have been used but excepted patients have not been
included in the denominator
• There are no indicators in the bottom quintile compared to the benchmark
group
• There are three primary care management indicators where over 150
patients would benefit if the CCG moved to the average of the top 40%
benchmark group
– % CHD patients treated with a beta-blocker (182 more people)
– % CHD patients who have had a flu immunisation (202 more people)
– % hypertension patients with a record of BP <=150/90 (371 more people)
• £1.2 million reduced prescribing spend in primary care if CCG reduced to
average of the 40% benchmark group
8
Summary: Management in secondary care and end of life care
Summary
Management in secondary care
• 60/66 indicators are below the average in the top 40% benchmark group
• CVD, and within that classification, CHD and heart failure emergency
admissions are all high (bottom quintile) compared to the benchmark group
• Although the rate of elective CHD admissions is relatively low, the cost of
admission is relatively high (£270k more than average of top 40% benchmark
group).
• LOS for CHD elective (280 bed days higher), stroke (over 3000 bed days
higher) and angiography (over 1000 bed days higher) are all relatively high
when compared to the average of the top 40% benchmark.
End of life care
• An additional 78 people would die at home if the CCG rate matched that of
the top 40% benchmark group
9
Where does the CCG compare poorly against its benchmark group?
Analysis by pathway stage (1)
Number of Indicators (/of those
looked at) where CCG below the
average for the top two
quintiles – (best 40% in its
benchmark group)
See Annex for full list
Prevention
Indicators in the bottom quintile v benchmark group
- difference between NHS XXX CCG and the benchmark average of the top 40% in
brackets, (p) – PCT based indicator
Opportunity
if NHS XXX CCG were to equal the
benchmark average of the top 40%
 20,161 fewer people
4/5 • Binge drinking (p) (11.8 % higher)
• Percentage of patients registered with a GP with a long term condition who smoke  1,978 fewer people
(4.4 % higher)
9/10
• None
 None
Prevalence
/ diagnosis
18/22 • None
 None
Management
in
Primary Care
10
Where does the CCG compare poorly against its benchmark group?
Analysis by pathway stage (2)
Number of Indicators (/of
those looked at) where CCG
below the average for the top
two quintiles – (best 40% in its
benchmark group)
See Annex for full list
\
Management in
Secondary Care
Social Care
Indicators in the bottom quintile v benchmark group
- difference between NHS XXX CCG and the benchmark average of the top 40% in
brackets, (p) – PCT based indicator
60/66 










Opportunity
if NHS XXX CCG were to equal the
benchmark average of the top 40%
CVD emergency admissions (DSR) (27.2% higher),
CHD emergency admissions (DSR) male (44.2% higher),
CHD emergency admissions (DSR) female (53.3% higher),
Heart failure emergency admissions (DSR) male (43.8% higher),
CHD: average cost per elective admission (female) (38.4% higher),
Non-elective Angioplasty procedures (DSR) males (48.9% higher),
CHD: average LOS per elective admissions (male) (83.1% higher),
Stroke: average LOS per emergency admissions (female) (90.2% higher),
Stroke: average LOS per emergency admissions (male) (112.4% higher),
Angiography: average LOS per procedure (101.8% higher),
Proportion of non-STEMI patients seen by member of cardiology team (p) (-12.3%
lower),
 Non elective spend (p) (52.1% higher),
 Ambulance spend (p) (55.9% higher),
 A&E spend (p) (69.7% higher)
2/2  None
 381 fewer people
 117 fewer people
 66 fewer people
 34 fewer people
 £161k (total cost savings)
 45 fewer procedures
 202 bed days
 1,693 bed days
 1,695 bed days
 1,089 bed days
 12% of non-STEMI patients
1/1  Death at home or usual place of residence (p) (66.3 % higher)
 78 more people
 £2.9M
 £0.4M
 £0.2M
 None
End of life Care
11
11
Where to focus: Understanding practice variation
Analysis
• Practices have been compared against other practices within their practice
cluster for all the indicators where data is available at practice level
• This information is presented here to form the basis of a discussion between
the PHO, Business Intelligence in the CSU and the CCG about how further
analysis could support practices in reducing unexplained practice variation
• The number of indicators where the practice is in the bottom quintile for the
practice cluster has been compared on the next slide and the opportunities
for the practices with the highest number of indicators in the bottom quintile
has been quantified on the subsequent slide
• Practices will have less influence on management in secondary care than
they do on management in primary care and this should be taken into
account in the way CCGs interpret the information on practice variation
12
Where to focus: Understanding practice variation
Analysis
Number of CVD indicators in the bottom quintile of the practice cluster
Note, some of the data are based on small numbers. Statistical significance has not been tested and should not be inferred. The
data are presented to identify potential areas of improvements rather than providing a definitive comparison of performance.
13
Where to focus: Top 3 GP practices with CVD indicators in the bottom
quintile of the practice cluster and opportunities* in brackets
X Practice
Secondary
care
•
•
•
•
•
•
CVD emergency admissions (70),
CVD elective admissions (54),
CHD emergency admissions (45),
CVD elective admissions: LOS (21),
CHD elective admissions: LOS (12),
CVD: average cost per elective
admission (£13.6k),
• CVD emergency admissions
)weighted cost) (£33.8K),
• CVD elective admissions (weighted
cost) (£70.9k)
Z practice
• % CHD BP <=150/90 (19),
• % CHD aspirin, alternative anti-platelet
therapy taken (9),
• % hypertension BP <=150/90 (82),
• % TIA/stroke BP <=150/90 (10),
• % TIA/stroke record of cholesterol (10),
• % HF patients confirmed echocardiogram
(1),
• % AF treated with anti-coagulation drug
therapy (3)
• % CHD cholesterol <=5 mmol/l (30),
• % CHD aspirin, alternative anti-platelet
therapy taken (22),
• % CHD influenza immunisation (33),
• % history of MI treated with an ACE
inhibitor (3),
• % hypertension record of BP (111),
• % hypertension BP <=150/90 (156),
• % of new stroke referred (7),
• % HF confirmed echocardiogram (2),
• % AF treated with anti-coagulation drug
therapy (9)
•
•
•
•
•
•
•
CVD emergency admissions (32),
CHD emergency admissions (8),
Stroke emergency admissions (4),
HF emergency admissions (5),
CVD elective admissions: LOS (40),
CHD elective admissions: LOS (6),
Stroke emergency admissions: LOS
(284),
• Stroke: average cost per emergency
admission (£19.9k),
• CVD emergency admissions
(weighted cost) (£63.5k)
Analysis
Primary • % CHD BP <=150/90 (15),
care • % CHD cholesterol <=5 mmol/l (10),
• % CHD patients aspirin, alternative antiplatelet therapy taken (7),
• % CHD treated with beta-blocker (11),
• % CHD influenza immunisation (15),
• % hypertension BP <=150/90 (40),
• % TIA/stroke BP <=150/90 (4),
• % TIA/stroke record of cholesterol (2),
• % TIA/stroke influenza immunisation (3),
• % stroke non-haemorrhagic, history of TIA,
record anti-platelet agent (1),
• % HF confirmed echocardiogram (0),
Y practice
•
•
•
•
•
CVD emergency admissions (25),
CHD emergency admissions (10),
HF emergency admissions (5),
CHD elective admissions: LOS (26),
CVD: average cost per elective
admission (£30.7k),
• Stroke: average cost per
emergency admission (£17.3k)
* If they were to equal the practice cluster average
• Note, X practice does not have a practice cluster assigned to it and has been compared to the national average. Some of the
secondary care opportunities calculated for this practice are greater than the number of original admissions due to small numbers
and comparison to the national average.
14
Bringing it all together – Where to focus, what could work, who should
we speak to
•
•
Next step is to move from intelligence to action
CCG needs to identify from the summary slides where to focus and what could work
and which CCG may be an exemplar to follow
This table illustrates this approach
Annex 4 sets out more examples of ‘what works’ evidence included in the NHS
Atlases of Variation
Where to focus
What could work
Analysis
•
•
Who should we speak to? *
15
Other local intelligence to add in………
•
•
•
•
•
Practice variation analyses
Up to date intelligence from secondary care
Analysis from Acute Trust quality dashboard or other provider data
Contract monitoring data
Local prescribing data
Analysis
CCGs should consider what local intelligence is available to further triangulate
with the intelligence in this pack. This may include:
16
Annexes
17
Annex 1: Spine Charts
Minimum value in cluster
Maximum value in cluster
Prevention
Worse outcome
Better outcome
Opportunities
No opportunity
1978 people
Annexes
Key:
359 people
20161 people
5654 people
Prevalence
Higher prevalence
/ Worse outcome
Lower prevalence
/ Better outcome
Opportunities
2514 people
No opportunity
1067 people
83 people
3006 people
3492 people
288 people
200 people
544 people
142 people
18
Annex 1: Spine Charts
Worse outcome /
Higher spend
Better outcome /
Lower spend
Opportunities
84 people
No opportunity
61 people
182 people
Annexes
Primary Care
202 people
11 people
No opportunity
32 people
8 people
13 people
23 people
2 people
44 people
371 people
6 people
No opportunity
No opportunity
64 people
7 people
42 people
£1.7M
£1.21M
19
Annex 1: Spine Charts
Secondary Care
Better outcome /
Lower spend
Opportunities
£1M
£105k (total savings)
381 people
£0.6M
£587k (total savings)
127 people
£0.72M
£2.94M
£0.18M
£0.86M
Annexes
Worse outcome /
Higher spend
£0.41M
£0.18M
£94k (total savings)
£3k (total savings)
117 people
66 people
185 total bed days
379 total bed days
£110k (total savings)
£161k (total savings)
No opportunity
4 people
78 total bed days
202 total bed days
£232k (total savings)
70 procedures
58 procedures
1089 total bed days
£30k (total savings)
No opportunity
1 procedures
£29k (total savings)
45 procedures
8 procedures
242 total bed days
20
Annex 1: Spine Charts
Secondary Care continued
Better outcome /
Lower spend
Opportunities
18 minutes per patients
12% of non-STEMI patients
4 % of STEMI patients
3% of patients
£37k (total savings)
7 procedures
2 procedures
16 total bed days
£38k (total savings)
Annexes
Worse outcome /
Higher spend
No opportunity
96 total bed days
£39k (total savings)
£44k (total savings)
34 people
26 people
469 total bed days
316 total bed days
No opportunity
36 procedures
5 procedures
£139k (total savings)
£144k (total savings)
8 people
No opportunity
1693 total bed days
1695 total bed days
£20k (total savings)
3 procedures
10 total bed days
40% of patients
No opportunity
21
Annex 1: Spine charts
Worse outcome /
Higher spend
Better outcome /
Lower spend
Opportunities
78 people
£0.4M
26 people
Annexes
Social care / End of Life
22
Annex 2: Interim CCG cluster classification
NHS XXX CCG is in cluster 5.
2
Younger population and high Asian and Black population, very high deprivation and population density.
3
Average age population and average Asian and Black population. Average deprivation and higher population
density.
4
Older population, low deprivation and low population density.
5
Slightly older population and average Asian and Black population. Average deprivation and low population
density.
6
Much younger population and above average population from Asian and Black groups. High deprivation.
NHS Airedale, Wharfedale and Craven CCG
NHS Bury CCG
NHS Calderdale CCG
NHS Cannock Chase CCG
NHS Central London (Westminster) CCG
NHS Croydon CCG
NHS Cumbria CCG
NHS Dudley CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Erewash CCG
NHS Greater Huddersfield CCG
NHS Greater Preston CCG
NHS Hillingdon CCG
NHS Hounslow CCG
NHS Isle of Wight CCG
NHS Kernow CCG
NHS Lancashire North CCG
NHS Leeds North CCG
NHS Leeds West CCG
NHS Lincolnshire East CCG
NHS Lincolnshire West CCG
NHS Medway CCG
NHS Newark & Sherwood CCG
NHS North Durham CCG
NHS North East Essex CCG
NHS North Lincolnshire CCG
NHS North Tyneside CCG
NHS North, East, West Devon CCG
NHS Northumberland CCG
NHS Norwich CCG
NHS Redbridge CCG
NHS Scarborough and Ryedale CCG
NHS Slough CCG
NHS South Devon and Torbay CCG
NHS South Kent Coast CCG
NHS South Reading CCG
NHS Southend CCG
NHS Southern Derbyshire CCG
NHS Telford & Wrekin CCG
NHS Thurrock CCG
NHS Wandsworth CCG
NHS Warwickshire North CCG
NHS West Lancashire CCG
NHS West Norfolk CCG
NHS Wyre Forest CCG
Annexes
Cluster
Description
1
Slightly older population and lower population from Asian and Black groups. Low deprivation and low population
density.
23
Annex 3: Full indicator list
Prevalence
Indicator
Smoking (p)
Binge drinking (p)
Obesity (p)
Percentage of patients registered with a GP with a long term condition
who smoke
Four week quitters as a proportion of estimated adult smokers (p)
CHD prevalence
Stroke prevalence
Hypertension prevalence
Heart Failure prevalence
Heart failure due to LVD register prevalence
Atrial fibrillation prevalence
CVD prevention register prevalence
CHD expected to observed ratio
Stroke expected to observed ratio
Hypertension expected to observed ratio
Primary
care
% CHD patients BP <=150/90
% CHD patients cholesterol <=5 mmol/l
% CHD patients aspirin, alt anti-platelet therapy or anti-coagulant taken
% CHD patients treated with a beta-blocker
% CHD patients influenza immunisation
% of patients with history of MI treated with an ACE inhibitor, aspirin or
etc
% newly diagnosed patients with angina referred for specialist
assessment
% hypertension patients with a record of BP
% hypertension patients BP <=150/90
% TIA/stroke patients BP <=150/90
% TIA/stroke patients with a record of cholesterol
% of TIA/stroke patients cholesterol was <=5mmol/l
Data source
Modelled Estimates from Health Survey for England, 2006-08
Modelled Estimates from Health Survey for England, 2007-08
Modelled Estimates from Health Survey for England, 2006-08
Quality and Outcomes Framework 2011/12
Smoking cessation 2011/12 ONS Mid year population estimates 2010,
Modelled Estimates from Health Survey for England, 2006-08
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Modelled estimates of prevalence, Eastern Region Public Health
Observatory, December 2011
Modelled estimates of prevalence, Eastern Region Public Health
Observatory, December 2011
Modelled estimates of prevalence, Eastern Region Public Health
Observatory, December 2011
Quality and Outcomes Framework 2011/12
Annexes
Pathway
Prevention
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
24
Annex 3: Full indicator list (continued)
Secondary
care
Indicator
% TIA/stroke patients influenza immunisation
% stroke patients non-haemorrhagic with a record of anti-platelet agent
% of new stroke/TIA patients referred for further investigation
% HF patients confirmed by echocardiogram/specialist assessment
% HF patients due to LVD treated with ACE inhibitor/ARB no
contraindication
% HF patients due to LVD treated with ACE inhibitor/ARB and betablocker
% atrial fibrillation patients treated with anti-coagulation drug therapy
% atrial fibrillation patients with ECG/specialist confirmed diagnosis
Primary care spend (p)
Prescribing spend for circulation
CVD emergency admissions (DSR)
CVD elective admissions (DSR)
CVD: average cost per emergency admission
CVD: average cost per elective admission
Cost of CVD emergency admissions (per head in weighted population)
Cost of CVD elective admissions (per head in weighted population)
CHD emergency admissions (DSR) male
CHD emergency admissions (DSR) female
CHD elective admissions (DSR) male
CHD elective admissions (DSR) female
Heart failure emergency admissions (DSR) male
Heart failure emergency admissions (DSR) female
Stroke emergency admissions (DSR) male
Stroke emergency admissions (DSR) female
CHD: average cost per emergency admission (male)
CHD: average cost per emergency admission (female)
CHD: average cost per elective admission (male)
CHD: average cost per elective admission (female)
Heart Failure: average cost per emergency admission (male)
Heart Failure: average cost per emergency admission (female)
Stroke: average cost per emergency admission (male)
Stroke: average cost per emergency admission (female)
Data source
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Quality and Outcomes Framework 2011/12
Programme Budgeting, 2010/11
NHS Comparators, 2010/11
Hospital Episode Statistics (HES) 2011/12, The NHS Information Centre for
health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
NHS Comparators, 2010/11
NHS Comparators, 2010/11
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
Annexes
Pathway
Primary
Care
25
Annex 3: Full indicator list (continued)
Indicator
Angiography procedures (DSR) males
Angiography procedures (DSR) females
Angiography: average cost per procedure
Non-elective Angioplasty procedures (DSR) males
Elective Angioplasty procedures (DSR) males
Non-elective Angioplasty procedures (DSR) females
Elective Angioplasty procedures (DSR) females
CABG procedures (DSR) males
CABG procedures (DSR) females
Angioplasty: average cost per elective procedure
Angioplasty: average cost per non-elective procedure
CABG: average cost per procedure
Total cardiac resynchronisation therapy device procedures (p)
New pacemaker implant procedures (p)
New implantable cardioverter-defibrillator procedures (p)
Carotid endarterectomy procedures
Carotid endarterectomy: average cost per procedure
Valve procedures
Valve: average cost per procedure
CHD: average LOS per emergency admission (female)
CHD: average LOS per emergency admission (male)
CHD: average LOS per elective admission (female)
CHD: average LOS per elective admission (male)
Stroke: average LOS per emergency admission (female)
Stroke: average LOS per emergency admission (male)
Heart Failure: average LOS per emergency admission (female)
Heart Failure: average LOS per emergency admission (male)
Angiography: average LOS per procedure
Angioplasty: average LOS per procedure
CABG: average LOS per procedure
Valve: average LOS per procedure
Carotid: average LOS per procedure
Primary Angioplasty treatment time from calling for help (p)
Proportion of non-STEMI patients seen by member of cardiology team (p)
Data source
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
Cardiac Rhythm Audit, 2010
Cardiac Rhythm Audit, 2010
Cardiac Rhythm Audit, 2010
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
HES 2011/12, The NHS Information Centre for health and social care, ONS
MINAP, 2010
MINAP, 2010
Annexes
Pathway
Secondary
care
26
Annex 3: Full indicator list (continued)
Social care
and End of
life
Indicator
Percentage of 30 day mortality for STEMI cases (p)
TIA cases treated within 24 hours (p)
Stroke patients who spend 90% of their time on a stroke unit (p)
STEMI patients receiving primary angioplasty (p)
Elective and Daycase spend (p)
Non elective spend (p)
Outpatient spend (p)
Other secondary care spend (p)
Ambulance spend (p)
A&E spend (p)
Data source
MINAP, 2010
Atlas 2.0
Atlas 2.0
Atlas 2.0
Programme Budgeting, 2010/11
Programme Budgeting, 2010/11
Programme Budgeting, 2010/11
Programme Budgeting, 2010/11
Programme Budgeting, 2010/11
Programme Budgeting, 2010/11
Annexes
Pathway
Secondary
care
Percentage of stroke patients discharged to home or usual place of
residence HES 2011/12, The NHS Information Centre for health and social care, ONS
Non health / social care spend per head (p)
Programme Budgeting, 2010/11
Death at home or usual place of residence (p)
PHO annual deaths extract, ONS
27