The data packs recently made available by the Department of Health to all primary care trusts as part of world class commissioning bundle together a wide range of measures to help PCTs measure their own performance. They also reveal some interesting insights.
Take emergency admissions. They cost an average PCT more than£50m per year, so PCTs try hard to reduce unnecessary ones such as those from ambulatory care sensitive conditions, where admission is avoidable through timely care. But is concentrating on avoidable conditions the most effective strategy?
The metric on rate of emergency admissions has been standardised for age and sex, so it is at first surprising that there is twofold variation in the rate. However, more than two thirds of the variation is linked to deprivation (see first graph).
After allowing for deprivation (work deprivation explains more than any other component), the variation is still substantial, with rates at some PCTs up to 20 per cent higher or lower than the norm. Representing up to£10m for the average PCT, the remaining variation is worth looking at.
Of all the world class commissioning metrics, the remaining variation is most significantly associated with the percentage of short stay emergency admissions. So, if your hospital has a high percentage of short stay admissions, then your PCT is likely to have a noticeably higher overall admission rate (see second graph).
Readmissions following non-elective admission also contribute significantly to the unexplained variation. Analysis which allows for the interaction between the various effects confirms these results. The correct analysis also reveals that readmission following elective admission is also a significant factor.
What is surprising is the lack of relationship between emergency admissions and two other important world class commissioning metrics, both assumed to contribute to the variation. Neither the percentage of admissions for ambulatory care sensitive conditions nor the percentage of admissions from “frequent users” appear to contribute to the observed variation in overall emergency admission rate.
The numbers seem to be suggesting the best bet to reduce emergency admissions is to focus on short stays and readmissions, in that order.
We will use more metrics from the data packs to prompt discussion between PCTs and their auditors about use of resources assessments.