1. Dr Rod Jones (ACMA) Healthcare Analysis & Forecasting hcaf_rod@yahoo.co.uk

2. Aims Often we need to know, how many do we expect versus how many are there Illustrate some of the issues using acute data Suggest an approach to clinically meaningful comparisons for wider healthcare data sets

3. From experience The benchmarks are flawed Supposed differences are often artefacts of the benchmark! Capitation formula allocation to PCT and subsequent PBR payment to Trusts rely on different assumptions financial asymmetry Serious problems with the Data Definitions NHS site-based processes of counting & coding are different Each site has a unique signature (especially small PCT run units!) Analyse zero day admissions separately Greater effect on the diagnosis-based HRG and on specific procedure-based HRG What works? Adjust for age, sex, deprivation (IMD), ethnicity & students Analyse using both HRG and OPCS procedure code HRG are composites & the language of finance

4. From experience (contd) Look at the trend over time Step changes & trends Use FCE (not Spell) especially for procedures Add EL + EM for final analysis EL/EM boundary is not the same in all hospitals Use persons if fundamental disease incidence is the issue

5. Zero day stay elective >30% above expected HRG Chapter Acute Site (numbered 1 to 13) IIIIIIIVVVIVIIVIIIIXXXIXIIXIII A B C D E F G H J K L M P Q R S Count8775554333330 Acute site No I is a high PbR cost site. The real surgical day case rate at this site is low yet it counts very high volumes of events as a day case.

6. Index of Multiple Deprivation Intervention rates are only as good as the adjustment used to account for deprivation IMD is very important and is highly non-linear

7. The danger of averaging (Modifiable Areal Unit Property) The average IMD for this LSOA is 29.9 The HRG described by red line has an apparent rate of 3 but a real rate of 3.7 for the benchmark

8. OPCS Procedure – excess as SD Description % EM04/0505/0606/07Comments Q20 Other operations on uterus7%194348Mainly biopsy of lesion of uterus, outpatient procedures? L13 Transluminal ops pulmonary artery53%322533Check the validity of clinical coding, far too high to be real X29 Continuous infusion therap substance13%22126Oncology outpatient procedures re-classified as IP H25 Endoscopic exam of lower bowel7% 02321Endoscopy - rate is high W19 Primary open reduction of fracture84%2 921Change in coding in 05/06 or is this A&E work? H22 Endoscopic exam of colon2%-91014Endoscopy - rate is high, step change M45 Endoscopic exam of bladder2%121413Endoscopy - rate is high X40 Compensation for renal failure8%51113Renal dialysis - comissioning to clarify L91 Other vein related operations20%81112Insertion of catheter - Oncology,etc OP procedures M49 Other operations on bladder6%2412Introduction of therapeutic substance - OP Oncology? B28 Other excision of breast1%9911Excision of lesion V54 Other operations on spine1%548Injection around spinal facet - OP/IP? G45 Endoscopic exam upper GI tract9%-2185Jump is OP re-classified to IP, step change F09 Surgical removal of tooth1%4 36Review of Dental