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?