HSJ Data Briefing - Potentially overused elective treatments - London

There have been numerous reports, papers and articles published discussing the commissioning of or reduction in commissioning of treatments of 'low clinical value' or 'low priority' as well as the definitions of such lists; for example, Save to invest - Commissioning for equity (London Health Observatory, 2007); Reducing spending on low clinical value treatments (Audit Commission, 2011). A common theme of these reports is the variation in the application of these lists across the country. This month's Performance Healthcheck provides an example analysis of 10 elective treatments that sometimes feature on these lists and the variations that appear across PCTs and nationally over time. You can change region, or view national data.

National data

National time trend analysis of potentially overused elective treatments.

Excel spreadsheet Download full PCT Time Trend data

Search by treatment

Select a procedure from the dropdown to view data for each PCT specific to the relevant treatment chosen.

Search by PCT

Select a PCT from the dropdown to view data for each treatment.

Methodology

Description:
Analysis of the number of elective treatments per 1,000 population.
Definition:

Spells: total number of spells for each treatment.

Population: total registered population within each PCT (female only where relevant).

Rate per 1,000 pop: total number of spells divided by PCT population multiplied by 1,000 for each treatment.

Technical definition of treatments

All spells with an elective admission method code (11-13) and a dominant procedure code or HRG v3.5 code of one of the below treatments:

Abdominal excision of uterus: OPCS code Q07

Dilation and curettage/hysteroscopy: OPCS codes Q103, Q18 and ICD10 Code O04 is not primary diagnosis

Inguinal, umbilical and femoral hernia: HRG v3.5 codes F73,F74

Knees: HRG v3.5 codes H03,H04

Lumbar spine procedures: OPCS codes V25,V26,V28,V33,V34,V363,V382-6,V393-7,V404,V40-V41(+Z665), V433,V44-V46(+Z665),V473,V485-6,V493,V50(+Z665),V52(+Z675),V54(+Z665),V563,V573,V583,V593,V603,V613,V623,V633,V66-V67

Myringotomy with/without grommets: OPCS code D15 (excluding E081,E201,F291,F34,D191 in any position)

Primary hip replacements: HRG v3.5 codes H80,H81

Tonsillectomy: OPCS codes F341,F344

Vaginal excision of uterus (without repair of prolapsed): OPCS code Q08 (excluding P23 in any position)

Varicose veins: HRG v3.5 code Q11

Basis
NHS Primary Care Trusts
Data sources & Time frame

January 2006 - December 2010 by calendar year

Data between April 2005 and March 2008 is frozen.

April 2005 - March 2006 - Hospital Episode Statistics (HES)

April 2006 - March 2009 - Frozen Secondary Uses Services (SUS) - Hospital Admitted Patients

SUS extracts are used from April 2009 onwards - non frozen SUS extract.

Secondary Uses Services (SUS) Commissioning Data set - non frozen SUS extract.

Data licence acknowledgments
Secondary Uses Services (SUS) - Hospital Admitted Patients - Copyright: Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
Notes

Treatments are based on procedures initially identified by Croydon PCT (the "Croydon List") and a synthesis of other such lists from PCTs across the country. The Croydon List procedures 'were selected based on reviews of current PCT exclusion/clinical exception/priority setting policies as well as a review of the evidence, such as NICE guidelines and reviews undertaken by Public Health Departments.1'

Small numbers (i.e. counts between 1 and 5) have been masked with '*' and rates per population affected by this have been masked with '**'.

1 London Health Observatory - Commissioning for equity series - Save to invest, Developing Criteria-based commissioning for planned healthcare in London, N. Malhotra, R. Feleke, February 2007

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