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Improving Patient Outcomes: Addressing Low Effectiveness Procedures in Healthcare

This presentation discusses the identification and analysis of Low Effectiveness Procedures (LEPs) within Betsi Cadwaladr University Health Board, requested by Public Health Wales. It examines the demand and variation associated with high-volume elective surgeries like tonsillectomy and hysterectomy. The goal is to reduce harm and waste while enhancing patient care through evidence-based recommendations. Key findings highlight significant variations in procedure rates across North Wales, with steps outlined for clinical engagement and monitoring. The findings intend to support informed decision-making and effective patient commissioning.

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Improving Patient Outcomes: Addressing Low Effectiveness Procedures in Healthcare

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  1. Low Effectiveness Procedures: Demand & Variation 06/10/10 LEPS: Demand & Variation Presenters: Andrew Jones, Rob Atenstaedt, Siobhan Jones

  2. Background Betsi Cadwaladr University Health Board requested support from Public Health Wales to: • Compile list low effectiveness procedures (LEPs) for Individual Patient Commissioning (IPC) Policy • Look at demand and variation for a small number of LEP’s (high volume elective surgical procedures) LEPS: Demand & Variation

  3. Drivers • ↓ harm, waste, variation • Financial • Evidence base on LEP’s e.g NICE, Public Health Wales • England already robustly performance managing PCT’s on LEP’s LEPS: Demand & Variation

  4. Better Care Better Value Better Care Better Value indicators monitor PCT’s on 5 key LEP’s: • tonsillectomy, • dilatation and curettage, • hysterectomy, • lower back surgery • myringotomy (grommets). LEPS: Demand & Variation

  5. Methodology • A rapid review of existing guidance from NICE, Public Health Wales and existing UK wide policies performed to identify LEP’s • Review of literature on demand and variation was undertaken • Detailed analysis of 14 high volume (>20/year) surgical procedures, using PEDW data (undertaken by Public Health Wales Observatory Analysis Team) LEPS: Demand & Variation

  6. Low Effectiveness Procedures • Collaboration between BCUHB & Public Health Wales • Lists treatments/procedures/ therapies which should not be available or limited availability • 70 LEPs identified – included as appendix to the Health Board’s IPC Policy • Recommended course of action, with current advice and OPCS code given • Procedures split between those should not used in any circumstance and should only be used under strict criteria (subdivided into low & high volume) • Cross-checked with neighbouring PCTs/ LHBs LEPS: Demand & Variation

  7. Analysis of surgical variation – results for North Wales • Analysis suggests significant variation in reported rates of common surgical procedures being undertaken across Wales • ↑ statistically significant rates of tonsillectomy, grommet insertion, removal varicose veins, haemorrhoidectomy, apicectomy and D&C/hysteroscopy • ↔ Hysterectomy, removal wisdom teeth, removal gallstones • ↓ elective caesarean delivery, removal skin lesions, cosmetic orthodontic procedures, removal of ganglia & lumber spine procedures LEPS: Demand & Variation

  8. LEPS: Demand & Variation

  9. LEPS: Demand & Variation

  10. LEPS: Demand & Variation

  11. LEPS: Demand & Variation

  12. Limitations of data analysis • PEDW set up to track hospital activity for payments – not epidemiological analysis • Coding – Variation/ Primary procedure codes / Specificity • Impossible to tell if procedure clinically appropriate – only illustrates numbers/rates across Wales LEPS: Demand & Variation

  13. Clinical engagement process • Purpose of variation report to support clinical engagement and discussion • Limitations of data analysis clearly highlighted Presentations on IPC policy/variation report to: • HB Board of Directors, • LNC, LMC and Medical Staff Committees X3 joint with HB • Relevant Clinical Programme Group Board meetings LEPS: Demand & Variation

  14. Clinical engagement process • Issues with data and coding of procedures highlighted eg haemorrhoidectomy, orthodontics • Clinicians given opportunity to identify other procedures from own specialties to include on LEP list e.g. labial reduction • LEPs shared with colleagues in other HB’s across Wales e.g. Cardiff & Vale to inform consistent approach LEPS: Demand & Variation

  15. Outcomes • IPC policy appendix produced – ratified as Health Board policy • Draft report which included literature review on demand and variation & data analysis produced • Revisions to IPC policy and LEP list following feedback from clinicians LEPS: Demand & Variation

  16. Outcomes • HB group now in place to monitor LEPs • Urgent review of clinical pathways and waiting lists for LEP’s was conducted • Clinical engagement with GP’s re: referral processes • Public Health Observatory to turn draft variation paper into all-Wales resource – clinician feedback on coding issues fed in to this process • Formal establishment of Wales project to harmonise IPC LEPS: Demand & Variation

  17. Learning points • Very powerful tool to start clinical engagement process • Clinical engagement takes time…. • Important Role of LHB Medical Directorate • Information professionals should ideally be consulted in advance for advice on coding issues. Balanced in this case against timeliness • Efficiency of doing at all Wales level - circulated within professional forums, crossed CEO NHS Wales desk LEPS: Demand & Variation

  18. Acknowledgements • Jo Charles • Claire Jones • Sian ap Dewi • Hugo Cosh • Ciaran Humphreys • Rhys Gibbon • Martin Duerden (BCU HB) LEPS: Demand & Variation

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