Strategic Plans
Analysis in Joint
Commissioning Cycle
> Analysis key part of commissioning cycle.
> Analysis sets out thinking, reasoning, decisions for rest
of plan.
> Without robust analysis rest of plan will be weak and
lack credibility.
> Good information allows partnerships to analyse
effectively and sets basis for rest of plan.
Patient level data linking
> Health and social care linked data at patient/client
level has a number of benefits.
> Total resource across total population, segment of
population, by deprivation category, high resource
cohorts.
> Who uses joint services, does level of social care
make a difference to hospital admissions?
> Follow cohort through time to see if change to
service/care pathway is having desired effect.
Alcohol and Drug
> Define substance misuse cohort.
− Use data from criminal justice and ADP services
to augment data
− Prevalence and population characteristics
> Size and distribution of spend.
> Comparative to non substance misuse population.
> Follow as service is redesigned.
Breakdown of costs
Nonsubstance
misuse:
Social Care
25%
Other health
6%
Prescribing
16%
Substance
misuse:
Other health
4%
Prescribing
7%
Planned
admissions
12%
Emergency
admissions
36%
Planned
admissions
17%
Social Care
5%
Emergency
admissions
72%
Anticipatory Care Plans
> Health resource of 120 patients given ACPs.
> 2009/10 – 2012/13
− 583 A and E attendances (£60,000)
− 1345 outpatient appointments (£170,000)
− 6743 days in hospital (£2m)
− 31,455 Dispensed items (£311,000)
> Follow this cohort and non ACP cohort to
analysis impact of ACPs.
Health and Social Care by SIMD
65+ cost per capita
5,000
4,500
4,000
Day Care
Care Homes
Cost per capita (£)
3,500
Homecare
Respite (Internal)
3,000
Respite (External)
Meals
2,500
Community Alarms
Prescriptions
2,000
A&E
Geriatric Long Stay
1,500
Mental Health (IP)
Acute (elective)
1,000
Acute (non-elective)
500
Outpatient
0
1
2
3
4
5
6
SIMD Decile (CHP)
7
8
9
10
Dementia
> Define dementia cohort - from GP LTC register.
> Prevalence and population characteristics
> What health and social resources do dementia patients
use?
− Comparative to non dementia population
> Forecast future demand as a result of demographic
pressure
> Assist with planning and evaluating services redesign
Cost Attributable to Dementia
NHS Board X– individual level
analysis
>
Inpatient services at maximum capacity
>
Requirement to understand current utilisation of services. Who? how old? how often?
how long? Why?
>
Exploratory work – acute and community activity (SMR01 and SMR01E linkage),
length of stay analysis, admissions, allocated bed day analysis, available beds,
forecasting.
>
Granular analysis - study cohort of long stay patients
−
−
−
>
400 acute inpatients - linked to length of stay information (acute, community,
outwith HB treatment, total bed days)
Categorised by partnership (CHP), age band, admission type
Linked to delayed discharge, SPARRA, other local information info not on SMRs
Benefits of linked individual level data - understanding full hospital pathway, delayed
discharge prevention, informed decisions
Service Utilisation
Analysis Results
• Explorative analysis of acute bed days in 2011/12 by partnership indicates a potential
saving of 40 acute beds if occupied bed days consistent for all residents. This is due to a
marked divergence in acute length of stay between the two partnership groups.
• A study cohort of long stay patient showed that Partnership A used 35% more bed days
than partnership B with the associated number of stays only 2% higher.
• Community Hospital stay linked to delayed discharge - 50% of study cohort with a
stay in a community hospital were recorded as having a delayed discharge. Less than 1 %
who only had an acute hospital stay resulted in a delay.
• 60% of partnership A residents with a community element to their stay also had a delayed
discharge episode, this compares to 30% for partnership B residents.
• IRF mapping for 2010/11 shows partnership A 75+ per capita spend approximately
30% higher for emergency acute inpatients than partnership B.
> For more information on Integrated Resource
Framework (IRF) and patient/client level data linking
contact:
> Andrew Lee andrew.lee6@nhs.net 0131 275 7594.
> Ishbel Robertson ishbel.robertson@nhs.net 0141 282
2276.
> Christine McGregor
Christine.McGregor@scotland.gsi.gov.uk 0131 244
3394 or 07867 375242.