musculoskeletal conditionstvscn.nhs.uk/wp-content/uploads/2017/11/msk-mohit-sharma.pdf ·...

Musculoskeletal conditions Available tools and data for Buckinghamshire, Oxfordshire and West Berkshire STP

November 2017

MUSCULOSKELETAL CONDITIONS (MSK)

MSK data and tools

3 main groups: 1. Inflammatory conditions (e.g.

rheumatoid arthritis) 2. Conditions of musculoskeletal pain

(e.g. osteoarthritis, back pain) 3. Osteoporosis and fragility fractures

MSK data and tools 2 Source: Arthritis UK, State of Musculoskeletal Health 2017

3 MSK data and tools Source: Arthritis UK, State of Musculoskeletal Health 2017

MSK Conditions

MSK BURDEN OF DISEASE

MSK data and tools

• MSK affects millions of people in the UK • MSK conditions are:

• The leading cause of years lived with disability (YLDs)*

• The third largest cause of disability adjusted life years (DALYs) in the UK today*

• Over 30 million working days are lost due to MSK conditions each year

MSK data and tools 4 *Source: Arthritis UK, State of Musculoskeletal Health 2017

5 MSK data and tools Source: Employer’s toolkit

MSK Burden of Disease

6 MSK data and tools Source: Employer’s toolkit

MSK Burden of Disease

MSK Burden of Disease YLDs* South East (all ages, 2016)

7 MSK data and tools

*Years lived with disability

Source: Global Burden of Disease Study 2016 (GBD 2016)

MSK Burden of Disease DALYs* South East (all ages, 2016)


* Disability-adjusted life years

Source: Global Burden of Disease Study 2016 (GBD 2016)

MSK PREVALENCE

MSK data and tools

Indicators include: • Arthritis or long-term joint problems • Long-term back problems • Rheumatoid Arthritis • Osteoporosis

MSK data and tools 9

MSK data and tools 10 Source: Public Health England, Fingertips MSK data and tools

Arthritis or long-term joint problem


Long-term back problem


Rheumatoid Arthritis

MSK data and tools 13 MSK data and tools Source: Public Health England, Fingertips

Osteoporosis

MSK RISK FACTORS

MSK data and tools

Risk factors include: • Obesity • Smoking • Physical inactivity • Alcohol use • Falls (risk factor / prevalence)



Obesity (QOF)


Smoking prevalence (QOF)

MSK data and tools 17 Source: Public Health England, Fingertips Note: LA boundaries do not correspond exactly to STP geographies

MSK data and tools

Physical inactivity

MSK data and tools 18 MSK data and tools

Alcohol (admissions as proxy)

Source: Public Health England, Fingertips Note: LA boundaries do not correspond exactly to STP geographies


Hospital admissions for falls

Source: Public Health England, Fingertips Note: LA boundaries do not correspond exactly to STP geographies

MSK COMORBIDITIES


Comorbidities include: • Cardiovascular disease • Depression • Diabetes • Lung Disease

MSK data and tools

Coronary heart disease (QOF) vs. prevalence of arthritis or long-term joint problem (All CCGs in England)

Source: PHE, Fingertips MSK data and tools 21 MSK data and tools

Physical health

Source: Public Health England, Fingertips

Depression (recorded prevalence) vs. prevalence of arthritis or long-term joint problem (All CCGs in England)

Source: PHE, Fingertips MSK data and tools 22 MSK data and tools

Mental health

Source: Public Health England, Fingertips

MSK TREATMENT

MSK data and tools

Treatment and outcomes indicators include: • Rate of hip replacements • Primary care prescribing • Spend on non-elective admissions


MSK data and tools

Oxfordshire CCG

West Kent CCG

Slough CCG

South Kent Coastal CCG Medway CCG

Dartford, Gravesham, Swanley CCG

Surrey Heath CCG

North East Hampshire and Farnham CCG

High Weald Lewes Havens CCG

24

Directly age and sex standardised rate of primary hip replacement procedures per 100,000 population by CCG of residence in the South East, 2014/15

MSK data and tools Sources: Hospital Episode Statistics, The Health and Social Care Information Centre. Copyright © 2016; 2014 mid-year population estimates (2011 Census based), Office for National Statistics.

Hip replacements

MSK data and tools 25 MSK data and tools Source: NHS England Analytical Service, Commissioning for Value data for cancer and MSK focus packs 2016 (Similar CCGS based on range of demographic data)

Primary care prescribing


Non-elective spend on admissions

Source: NHS England Analytical Service, Commissioning for Value data for cancer and MSK focus packs 2016 (Similar CCGS based on range of demographic data)

MSK TOOLS AND ANALYSIS

MSK data and tools

Tools to help commissioners locally include: • NHS RightCare pathway • Spend and Outcomes Tool (SPOT) • MSK return on investment tool • Musculoskeletal Disease Profile


MSK data and tools 28 MSK data and tools Source: NHS RightCare

NHS RightCare Focus Packs

• Falls and Fragility Fractures Pathway • optimal service for people who have suffered a fall or are

at risk of falls and fragility fractures

• ‘Where to look’ packs, available at: • CCG level • STP footprint areas

(Note: Buckinghamshire, Oxfordshire and Berkshire STP pack not produced due to incomplete spend data for 2015/16)

29 MSK data and tools Source: NHS RightCare, Commissioning for Value Where to Look pack, NHS Oxfordshire CCG (2017)

NHS RightCare CCG ‘Where to Look’ Pack Example of NHS Oxfordshire CCG

NHS RightCare: STP ‘Where to look’ packs Indicative example for Frimley Health STP – BOB STP pack not produced due to incomplete data

30 MSK data and tools Source: NHS England Analytical Service, Commissioning for Value data for cancer and MSK focus packs 2016


Spend and outcomes tool (SPOT)

• Tool to review spend against a selection of outcomes

• Includes Musculo Skeletal (MSK) • Helps identify programmes with outcomes that

are significantly different to similar local authorities or CCGs

Source: Public Health England, Spend and Outcomes Tool (SPOT)


Spend on Problems of Musculo Skeletal System vs. Hip fracture, % recovering to previous level of mobility at 30 days

MSK data and tools Source: Public Health England, Spend and Outcomes Tool (SPOT)

SPOT e.g. Hip fracture, recovering mobility

MSK data and tools 33 MSK data and tools Source: Public Health England, Musculoskeletal conditions: return on investment tool

Musculoskeletal: return on investment tool • Launched October 2017 • To help commissioners provide cost-effective

interventions for MSK conditions • Reviewed interventions include:

• Cognitive Behavioural Therapy (CBT) • STarT Back (Stratified Risk Assessment and

Care) • 'PhysioDirect - Early telephone assessment and

advice' • Self-referral to physiotherapy

MSK data and tools 34 MSK data and tools Source: Public Health England, Musculoskeletal Disease Profile

Musculoskeletal Disease Profile • Launched November 2017 • Data on a single platform to enable

commissioning of high value musculoskeletal services

• Covers: • health needs of local populations • amount of people accessing services • cost of services and; • outcomes services deliver

PHE NETWORKS [email protected]


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