Physiology Diagnostics & the Atlas of VariationProfessor Sue Hill OBEChief Scientific Officer for England
Physiology Diagnostics
• 8 Clinical services– Audiology– Cardiac Physiology– Gastrointestinal Physiology – Neurophysiology– Ophthalmic & Vision Science– Respiratory Physiology & Sleep Physiology– Urodynamics– Vascular Technology
• > 300 different tests
• > 15 million tests undertaken pa, demand growing
• Key component of most clinical pathways
What does the Atlas tell us?
Test Variation After exclusions
Audiology assessments * 11x 5x
New born hearing tests o 4x 2.5x
Sleep studies * 79x 23x
COPD patients with FEV recorded # 1.3x 1.2x
Urodynamic tests * 144x 23x
Electrocardiography * 34x 4x
Diagnostic invasive electrophysiology *
n/a 829x
Peripheral neurophysiology * 124x 37x
* national data collected monthly since 2008# from GP database (QoF) dataO from National Screening Programme data
Challenging variation - Audiology
• Data shows a 11 fold difference between highest and lowest areas (still 5 fold after exclusions)
• Why is Norfolk so different to Suffolk? Or Hillingdon and Hounslow?- Can we account for this variation?
• Undiagnosed and untreated audiology issues can profoundly affect an individual’s ability to communicate – and so the rest of their health
Interventions to reduce unwarranted variation
• Providing a ‘feedback loop’ challenge to the commissioning system – empowering clinicians in services and informing contract management
• For patients: ensuring a fresh focus on the identification of undiagnosed, and untreated conditions and the prevention of disease progression
• Improving adoption of new technology & service redesign
• Quality assurance and peer review systems (such as IQIPS – Improving Quality In Physiological Sciences)
• Tackling workforce shortages
Diagnosticservices
EquipmentManagement
&Calibration
Performance to SOPs &guidelines
QualitySystems &Assurance
Technical &Clinical
interpretation
Advice andexpertise
MDT delivery
Knowledgemanagement
Diagnosticservices in
NHS – getting it
right
Getting it right – Mike Richards’s Vision
…we need to harness robust and timely information from other sources to provide a more rounded picture of a trust….
Accreditation and peer review already play an important role in quality improvement …. I strongly believe that such schemes have a key role to play in the future of hospital inspection.
We need to use information from these schemes to feed directly into CQC monitoring processes and the development of trust-specific key lines of enquiry for use at inspections.‘
Professor Sir Mike Richards, Chief Inspector of Hospitals
Taking the Atlas forward in future
• The Atlas of Variation represents a subset of diagnostic procedures – those that are monitored and recorded nationally
• Some important diagnostics do not have sufficient data to build a variation picture – eg rate of EEG testing for epilepsy
• Need to focus on impact on patient experience and outcomes when selecting additional indicators
Any questions?