Viewpoint - Go for sophisticated pathways analysis

Tom Mulhern urges commissioners to mind the gap between simplistic pathway data and actual patient experience.

Dr Mulhern: fascinating results
Dr Mulhern: fascinating results

If GP consortia are to be effective commissioners, they must ensure their healthcare IT lets them make 'apples with apples' comparisons between providers.

Patient pathways are a case in point. A hospital trust or other would-be provider may produce reams of statistics to illustrate the 'typical' pathway. This can be checked using readily available software which shows that a given trust treated a specific number of patients, and had X outpatient appointments and Y inpatient stays.

But there can be a yawning gap between such simplistic figures and the actual experience of patients seen by specific consultants. That gap could reveal an apparently good system yields unnecessarily poor outcomes and low patient satisfaction levels.

Efficiency and efficacy
A consortium needs a whole other layer of data to properly understand whether a provider's offering is efficient and effective. Fortunately there are IT options that will allow it to uncover the very core of what is happening within a system.

Seeing data showing what happens to a patient cohort at different stages in the pathway is a world away from the genuinely illuminating ability to follow and analyse individual cases from referral to discharge. A good example is cataract treatments, which are generally straightforward and standardised procedures. By using a tool such as Map of Medicine it is possible to see what a best-practice pathway would be: two outpatient appointments in advance, day case surgery and two outpatient follow-ups.

Naturally there will be variations. However, when we started examining actual patient experience the results were fascinating.

One trust had 40 significant variations (after discounting small anomalies) between the pathways of substantial numbers of patients. This looks rather unusual, but that is not to say that because something is atypical it is necessarily wrong. Rather, it is that commissioners need appropriate evidence to ask the right questions.

They need to understand differences in caseload and mix between trusts, departments and consultants. Without that level of detail, attempts at comparisons must be treated with immense caution.

Surgical mortality figures
Remember when publication of surgical mortality figures first started there was concern that the surgeons who were the last hope for the most frail and sick patients, would be seen as poor performers because relatively more of their patients died.

Consortia also need to avoid judging by snapshots in time by looking at performance over a number of years. This is possible as there is a full set of records showing patient referrals from across England back to 2006.

This is an enormously rich resource. While mining it can mean looking at what happens at each local trust from which a consortium could viably buy services, it also enables them to benchmark organisations against their peers elsewhere.

  • Tom Mulhern is founder of healthcare business intelligence solutions provider Ardentia,

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