Copyright 2011 Right Care

NHS Atlas of Variation in Healthcare for Children and Young People March 2012

Dr Ronny Cheung

Editor, Child Health Atlas

2

Why variation matters

• For Children & Families

• Equity of access

• Quality of care

• Appropriateness of care

• Improved outcomes

• For the NHS

• Inefficiency

• Poor value from limited resources

3

4

Unwarranted variation

“Variation that cannot be explained by patient illness or preference”

Prof J Wennberg,

Dartmouth Atlas of Variation

5

6

7

Categories Indicator Maps

Resources 1. Expenditure on community child health

Health promotion & Disease prevention

2-4: Immunisation rates5: Breastfeeding

Neonatal care 6. Perinatal mortality7. Retinopathy of prematurity testing8. Admission rates of full term infant9. Readmissions of newborns

Disorders of blood 10. Sickle Cell disease admissions

Endocrine, metabolic and nutritional 11-12. Diabetes: HbA1c<10% & DKA rates

Mental health 13. Inpatient admissions for mental health

Learning Disability 14. Rates of children with SEN

Neurological problems 15-16. Epilepsy: emergency admission & LOS

Hearing 17. Newborn screening18. Grommet insertion rates

Respiratory 19. Asthma: emergency admissions20-21. Bronchiolitis: admissions & LOS22. Tonsillectomy rates

Gastrointestinal 23. Endoscopy rates24. Inflammatory bowel disease: admissions

Genitourinary system 25. Orchidopexy performed by age 2yrs

Emergency care 26. A&E attendance rates under 4yrs

End-of-Life care 27. Deaths in hospital for children with life-limiting conditions

8

Diabetes: Diabetic ketoacidosis rate

Percentage of children 0-15yrs with previously diagnosed diabetes admitted to hospital for DKA 2009-2010

Threefold variation

9

Epilepsy: Emergency admission rate

for children with epilepsy per population aged 0-17yrs 2007/8-2009/10

Over fourfold variation

10

Asthma: Emergency admission rate

for children with asthma per population aged 0-17yrs 2007/8-2009/10

Nearly fivefold variation

11

Perinatal mortality rate

per all births 2007-9

Twofold variation

12

Percentage of children with statement of special educational needs

in primary school children in state-funded schools, by LA at Jan 2011

Sixfold variation

13

Tackling variations

• Key questions

• Is the variation warranted or unwarranted?

• If unwarranted, what are the causes?

• What can we do to address the causes?

• Key steps

• Tackle high priority areas

• Commissioning for value

• System-based approach

• Clinical leadership

• Clinical networks

14

ChiMat provides information and intelligence which will help you examine and address questions which the NHS Atlas of Variation in Healthcare for Children and Young People may raise for your local area.

For example, ChiMat’s Disease Management Information Toolkit (DMIT) allows PCTs to compare their emergency admission rates, bed-days and lengths of stay with a range of different comparators for children with asthma, diabetes and epilepsy. It is designed to highlight variations at PCT level and allow benchmarking to inform the commissioning decision-making process for children’s services.

Other useful tools include:

ChiMat Data Atlas which brings together a range of data and statistics on child and maternal health into one easily accessible hub.

Local Authority Child Health Profiles 2012 which provide a snapshot of child health and well-being for each local authority in England using key health indicators, which enables comparison locally, regionally and nationally

About ChiMat

15

Thank you

Follow Right Care online:

-Subscribe to get a weekly digest of our blog in your inbox-Receive Occasional eBulletins-Follow us on Twitter @qipprightcare

www.rightcare.nhs.uk