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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.
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Commissioning for Value Focus Pack
CCG: XXX CCGFocus area: Cardiovascular pathway
DraftVersion 5.0
January 2013
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Contents
1. 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
4. Next Steps5. Annexes
– Annex 1: Detailed indicator spine charts– Annex 2: CCG Benchmarks– Annex 3: Data sources– Annex 4: What works
Contents
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 [email protected] or [email protected].
Background
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How these packs support service improvement Background
Methodology used to produce this pack
Analysed wide range of indicators from across the pathway focussing on spend and quality• 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
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?’
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
Methodology
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Summary: Prevention and Prevalence Sum
mary
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.
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Summary: Management in primary care
• 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
Summ
ary
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Summary: Management in secondary care and end of life care
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
Summ
ary
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
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%
4/5 • Binge drinking (p) (11.8 % higher)• Percentage of patients registered with a GP with a long term condition who smoke
(4.4 % higher)
20,161 fewer people 1,978 fewer people
9/10 • None None
18/22 • None None
Where does the CCG compare poorly against its benchmark group?Analysis by pathway stage (1)
Prevention
Prevalence/ diagnosis
Management in
Primary Care
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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
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%
60/66 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)
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
£2.9M £0.4M £0.2M
2/2 None None
1/1 Death at home or usual place of residence (p) (66.3 % higher) 78 more people
Where does the CCG compare poorly against its benchmark group?Analysis by pathway stage (2)
\Management in Secondary Care
Social Care
End of life Care11
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Where to focus: Understanding practice variation
• 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
Analysis
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Where to focus: Understanding practice variationAnalysis
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.
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Where to focus: Top 3 GP practices with CVD indicators in the bottom quintile of the practice cluster and opportunities* in brackets
AnalysisX Practice Y practice Z practice
Primary care
• % CHD BP <=150/90 (15), • % CHD cholesterol <=5 mmol/l (10), • % CHD patients aspirin, alternative anti-
platelet 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),
• % 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)
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)
• 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)
• 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.
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Bringing it all together – Where to focus, what could work, who should we speak to
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
Analysis
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Other local intelligence to add in………
CCGs should consider what local intelligence is available to further triangulate with the intelligence in this pack. This may include:
• 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
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Annexes
Annex 1: Spine Charts
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Minimum value in cluster Maximum value in cluster
Key:
PreventionWorse outcome Better outcome
PrevalenceHigher prevalence / Worse outcome
Lower prevalence / Better outcome
AnnexesOpportunities
No opportunity
1978 people
359 people
20161 people
5654 people
Opportunities
2514 people
No opportunity
1067 people
83 people
3006 people
3492 people
288 people
200 people
544 people
142 people
Annex 1: Spine Charts
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Worse outcome / Higher spend
Primary Care
Better outcome / Lower spend
Annexes
Opportunities
84 people
No opportunity
61 people
182 people
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
Annex 1: Spine Charts
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Secondary Care Worse outcome / Higher spend
Better outcome / Lower spend
AnnexesOpportunities
£1M
£105k (total savings)
381 people
£0.6M
£587k (total savings)
127 people
£0.72M
£2.94M
£0.18M
£0.86M
£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
Annex 1: Spine Charts
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Secondary Care continued Worse outcome / Higher spend
Better outcome / Lower spend
Annexes
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)
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
Annex 1: Spine charts
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Social care / End of LifeWorse outcome / Higher spend
Better outcome / Lower spend
Opportunities
78 people
£0.4M
26 people
Annexes
Annex 2: Interim CCG cluster classification
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Cluster Description 1 Slightly older population and lower population from Asian and Black groups. Low deprivation and low population
density.
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 XXX CCG is in cluster 5. Annexes
NHS Airedale, Wharfedale and Craven CCG NHS Kernow CCG NHS Redbridge CCGNHS Bury CCG NHS Lancashire North CCG NHS Scarborough and Ryedale CCGNHS Calderdale CCG NHS Leeds North CCG NHS Slough CCGNHS Cannock Chase CCG NHS Leeds West CCG NHS South Devon and Torbay CCGNHS Central London (Westminster) CCG NHS Lincolnshire East CCG NHS South Kent Coast CCGNHS Croydon CCG NHS Lincolnshire West CCG NHS South Reading CCGNHS Cumbria CCG NHS Medway CCG NHS Southend CCGNHS Dudley CCG NHS Newark & Sherwood CCG NHS Southern Derbyshire CCGNHS Eastbourne, Hailsham and Seaford CCG NHS North Durham CCG NHS Telford & Wrekin CCGNHS Erewash CCG NHS North East Essex CCG NHS Thurrock CCGNHS Greater Huddersfield CCG NHS North Lincolnshire CCG NHS Wandsworth CCGNHS Greater Preston CCG NHS North Tyneside CCG NHS Warwickshire North CCGNHS Hillingdon CCG NHS North, East, West Devon CCG NHS West Lancashire CCGNHS Hounslow CCG NHS Northumberland CCG NHS West Norfolk CCGNHS Isle of Wight CCG NHS Norwich CCG NHS Wyre Forest CCG
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Annex 3: Full indicator list
Pathway Indicator Data sourcePrevention Smoking (p) Modelled Estimates from Health Survey for England, 2006-08
Binge drinking (p) Modelled Estimates from Health Survey for England, 2007-08 Obesity (p) Modelled Estimates from Health Survey for England, 2006-08 Percentage of patients registered with a GP with a long term condition
who smokeQuality and Outcomes Framework 2011/12
Four week quitters as a proportion of estimated adult smokers (p) Smoking cessation 2011/12 ONS Mid year population estimates 2010, Modelled Estimates from Health Survey for England, 2006-08
Prevalence CHD prevalence Quality and Outcomes Framework 2011/12 Stroke prevalence Quality and Outcomes Framework 2011/12 Hypertension prevalence Quality and Outcomes Framework 2011/12 Heart Failure prevalence Quality and Outcomes Framework 2011/12 Heart failure due to LVD register prevalence Quality and Outcomes Framework 2011/12 Atrial fibrillation prevalence Quality and Outcomes Framework 2011/12 CVD prevention register prevalence Quality and Outcomes Framework 2011/12 CHD expected to observed ratio Modelled estimates of prevalence, Eastern Region Public Health
Observatory, December 2011 Stroke expected to observed ratio Modelled estimates of prevalence, Eastern Region Public Health
Observatory, December 2011 Hypertension expected to observed ratio Modelled estimates of prevalence, Eastern Region Public Health
Observatory, December 2011Primary
care% CHD patients BP <=150/90 Quality and Outcomes Framework 2011/12
% CHD patients cholesterol <=5 mmol/l Quality and Outcomes Framework 2011/12 % CHD patients aspirin, alt anti-platelet therapy or anti-coagulant taken Quality and Outcomes Framework 2011/12 % CHD patients treated with a beta-blocker Quality and Outcomes Framework 2011/12 % CHD patients influenza immunisation Quality and Outcomes Framework 2011/12 % of patients with history of MI treated with an ACE inhibitor, aspirin or
etcQuality and Outcomes Framework 2011/12
% newly diagnosed patients with angina referred for specialist assessment Quality and Outcomes Framework 2011/12 % hypertension patients with a record of BP Quality and Outcomes Framework 2011/12 % hypertension patients BP <=150/90 Quality and Outcomes Framework 2011/12 % TIA/stroke patients BP <=150/90 Quality and Outcomes Framework 2011/12 % TIA/stroke patients with a record of cholesterol Quality and Outcomes Framework 2011/12 % of TIA/stroke patients cholesterol was <=5mmol/l Quality and Outcomes Framework 2011/12
Annexes
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Annex 3: Full indicator list (continued)
Pathway Indicator Data sourcePrimary
Care % TIA/stroke patients influenza immunisation Quality and Outcomes Framework 2011/12 % stroke patients non-haemorrhagic with a record of anti-platelet agent Quality and Outcomes Framework 2011/12 % of new stroke/TIA patients referred for further investigation Quality and Outcomes Framework 2011/12 % HF patients confirmed by echocardiogram/specialist assessment Quality and Outcomes Framework 2011/12 % HF patients due to LVD treated with ACE inhibitor/ARB no
contraindication Quality and Outcomes Framework 2011/12 % HF patients due to LVD treated with ACE inhibitor/ARB and beta-blocker Quality and Outcomes Framework 2011/12 % atrial fibrillation patients treated with anti-coagulation drug therapy Quality and Outcomes Framework 2011/12 % atrial fibrillation patients with ECG/specialist confirmed diagnosis Quality and Outcomes Framework 2011/12 Primary care spend (p) Programme Budgeting, 2010/11 Prescribing spend for circulation NHS Comparators, 2010/11
Secondary care CVD emergency admissions (DSR)
Hospital Episode Statistics (HES) 2011/12, The NHS Information Centre for health and social care, ONS
CVD elective admissions (DSR) HES 2011/12, The NHS Information Centre for health and social care, ONS CVD: average cost per emergency admission HES 2011/12, The NHS Information Centre for health and social care, ONS CVD: average cost per elective admission HES 2011/12, The NHS Information Centre for health and social care, ONS Cost of CVD emergency admissions (per head in weighted population) NHS Comparators, 2010/11 Cost of CVD elective admissions (per head in weighted population) NHS Comparators, 2010/11 CHD emergency admissions (DSR) male HES 2011/12, The NHS Information Centre for health and social care, ONS CHD emergency admissions (DSR) female HES 2011/12, The NHS Information Centre for health and social care, ONS CHD elective admissions (DSR) male HES 2011/12, The NHS Information Centre for health and social care, ONS CHD elective admissions (DSR) female HES 2011/12, The NHS Information Centre for health and social care, ONS Heart failure emergency admissions (DSR) male HES 2011/12, The NHS Information Centre for health and social care, ONS Heart failure emergency admissions (DSR) female HES 2011/12, The NHS Information Centre for health and social care, ONS Stroke emergency admissions (DSR) male HES 2011/12, The NHS Information Centre for health and social care, ONS Stroke emergency admissions (DSR) female HES 2011/12, The NHS Information Centre for health and social care, ONS CHD: average cost per emergency admission (male) HES 2011/12, The NHS Information Centre for health and social care, ONS CHD: average cost per emergency admission (female) HES 2011/12, The NHS Information Centre for health and social care, ONS CHD: average cost per elective admission (male) HES 2011/12, The NHS Information Centre for health and social care, ONS CHD: average cost per elective admission (female) HES 2011/12, The NHS Information Centre for health and social care, ONS Heart Failure: average cost per emergency admission (male) HES 2011/12, The NHS Information Centre for health and social care, ONS Heart Failure: average cost per emergency admission (female) HES 2011/12, The NHS Information Centre for health and social care, ONS Stroke: average cost per emergency admission (male) HES 2011/12, The NHS Information Centre for health and social care, ONS Stroke: average cost per emergency admission (female) HES 2011/12, The NHS Information Centre for health and social care, ONS
Annexes
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Annex 3: Full indicator list (continued)
Pathway Indicator Data sourceSecondary
care Angiography procedures (DSR) males HES 2011/12, The NHS Information Centre for health and social care, ONS Angiography procedures (DSR) females HES 2011/12, The NHS Information Centre for health and social care, ONS Angiography: average cost per procedure HES 2011/12, The NHS Information Centre for health and social care, ONS Non-elective Angioplasty procedures (DSR) males HES 2011/12, The NHS Information Centre for health and social care, ONS Elective Angioplasty procedures (DSR) males HES 2011/12, The NHS Information Centre for health and social care, ONS Non-elective Angioplasty procedures (DSR) females HES 2011/12, The NHS Information Centre for health and social care, ONS Elective Angioplasty procedures (DSR) females HES 2011/12, The NHS Information Centre for health and social care, ONS CABG procedures (DSR) males HES 2011/12, The NHS Information Centre for health and social care, ONS CABG procedures (DSR) females HES 2011/12, The NHS Information Centre for health and social care, ONS Angioplasty: average cost per elective procedure HES 2011/12, The NHS Information Centre for health and social care, ONS Angioplasty: average cost per non-elective procedure HES 2011/12, The NHS Information Centre for health and social care, ONS CABG: average cost per procedure HES 2011/12, The NHS Information Centre for health and social care, ONS Total cardiac resynchronisation therapy device procedures (p) Cardiac Rhythm Audit, 2010 New pacemaker implant procedures (p) Cardiac Rhythm Audit, 2010 New implantable cardioverter-defibrillator procedures (p) Cardiac Rhythm Audit, 2010 Carotid endarterectomy procedures HES 2011/12, The NHS Information Centre for health and social care, ONS Carotid endarterectomy: average cost per procedure HES 2011/12, The NHS Information Centre for health and social care, ONS Valve procedures HES 2011/12, The NHS Information Centre for health and social care, ONS Valve: average cost per procedure HES 2011/12, The NHS Information Centre for health and social care, ONS CHD: average LOS per emergency admission (female) HES 2011/12, The NHS Information Centre for health and social care, ONS CHD: average LOS per emergency admission (male) HES 2011/12, The NHS Information Centre for health and social care, ONS CHD: average LOS per elective admission (female) HES 2011/12, The NHS Information Centre for health and social care, ONS CHD: average LOS per elective admission (male) HES 2011/12, The NHS Information Centre for health and social care, ONS Stroke: average LOS per emergency admission (female) HES 2011/12, The NHS Information Centre for health and social care, ONS Stroke: average LOS per emergency admission (male) HES 2011/12, The NHS Information Centre for health and social care, ONS Heart Failure: average LOS per emergency admission (female) HES 2011/12, The NHS Information Centre for health and social care, ONS Heart Failure: average LOS per emergency admission (male) HES 2011/12, The NHS Information Centre for health and social care, ONS Angiography: average LOS per procedure HES 2011/12, The NHS Information Centre for health and social care, ONS Angioplasty: average LOS per procedure HES 2011/12, The NHS Information Centre for health and social care, ONS CABG: average LOS per procedure HES 2011/12, The NHS Information Centre for health and social care, ONS Valve: average LOS per procedure HES 2011/12, The NHS Information Centre for health and social care, ONS Carotid: average LOS per procedure HES 2011/12, The NHS Information Centre for health and social care, ONS Primary Angioplasty treatment time from calling for help (p) MINAP, 2010 Proportion of non-STEMI patients seen by member of cardiology team (p) MINAP, 2010
Annexes
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Annex 3: Full indicator list (continued)
Pathway Indicator Data sourceSecondary
care Percentage of 30 day mortality for STEMI cases (p) MINAP, 2010 TIA cases treated within 24 hours (p) Atlas 2.0 Stroke patients who spend 90% of their time on a stroke unit (p) Atlas 2.0 STEMI patients receiving primary angioplasty (p) Atlas 2.0 Elective and Daycase spend (p) Programme Budgeting, 2010/11 Non elective spend (p) Programme Budgeting, 2010/11 Outpatient spend (p) Programme Budgeting, 2010/11 Other secondary care spend (p) Programme Budgeting, 2010/11 Ambulance spend (p) Programme Budgeting, 2010/11 A&E spend (p) Programme Budgeting, 2010/11
Social care and End of
lifePercentage 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
Annexes
