Too Few or Too Many?

The 130th Annual Meeting of APHA

4147.0: Tuesday, November 12, 2002 - 12:45 PM

Abstract #45987

Too Few or Too Many?

Carole A. Morris, Sue Payne, Dr, and Peter Donnelly, MD MPH MBA FRCP. Lothian NHS Board, Deaconess House, 148 Pleasance, Edinburgh, United Kingdom, +44 (0)131 536 9046, carole.morris@lhb.scot.nhs.uk

Background

The purpose of this paper is to look at Edinburgh’s performance against current and proposed targets concerning Coronary Artery Bypass Grafts (CABG) and Angioplasty, both separately and together as Total Revascularisation procedures. The main objective was to estimate the relative need for revascularisation and enable Edinburgh to look at the difference between actual provision and a ‘need’ adjusted estimated provision.

Methodology

Lothian Health, in Edinburgh, adopted the methodology used and proposed by the Coronary Heart Disease Task Force Group. This methodology looked at CABG and Angioplasty principal procedures performed broken down by specific age/sex groups and Deprivation Category over a five-year period. A ‘need’ factor was calculated for these breakdowns using Acute Myocardial Infarction Mortality Incidence Rates for Edinburgh against Scotland. ‘Need’ adjusted figures were devised using the individual ‘need’ factors and compared to Edinburgh’s actual figures to explore any differences.

Results

Using this methodology Edinburgh was found to have less overall ‘need’ than Scotland. Therefore overall revascularisation ‘need’ is being met but there are differences between the most affluent and most deprived areas in Edinburgh.

Conclusions

Whilst the methodology is open to contention, our work demonstrates that adjusting revascularisation activity for an indicator of need can show important differences in the need for PTCA or CABG within various subgroups of the population. Findings have proven valuable in discussions with our main provider of revascularisation procedures.

Learning Objectives:

At the end of the presentation, the audience will be able to

· Apply the methodology discussed to measure geographical differences in ways that account for population and need.
· Examine the effect of need with regard to comparing geographical areas against local and national targets.
· Discuss how routine data can be used to provide objective evidence to help decision-making.

Keywords: Health Needs, Heart Disease

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Health Services Research Contributed Papers #4: Canada and Scotland

The 130th Annual Meeting of APHA