balancing the costs and quality of different memory service models
DESCRIPTION
Balancing the costs and quality of different memory service models. Dr Judy Rubinsztein Dr Marelna Van Rensburg Dr Zerak Al- Salihy , Dr Deborah Girling , Dr L ouise Lafortune , Dr Murali Kartha , Prof Carol Brayne. Aims. - PowerPoint PPT PresentationTRANSCRIPT
Balancing the costs and quality of different memory service
models
Dr Judy RubinszteinDr Marelna Van Rensburg
Dr Zerak Al-Salihy, Dr Deborah Girling,
Dr L ouise Lafortune,Dr Murali Kartha, Prof Carol Brayne
Aims
• Evaluate average unit cost to secondary care for patients presenting with memory problems in a Memory Clinic based service
(Gp A) and a Traditional ( CMHT based) service ( Gp B).
• Evaluate quality of diagnostic service offered to patients and carers.
Methods
• Adapted Client Service Receipt Inventory (CSRI)
• Questionnaire about quality of diagnostic service provided, devised for study
Unit Costs for Health and Social Care (2011)
Service Unit Cost (with on costs)
Consultant Psychiatrist
£162
Registrar £73Ass Sp £131CMHT ( OP) £44Psychologist £60CT/ MRI £121/£198Psych tests £9Mileage 54p/mile
Quality Questionnaire: Diagnostic Assessment
Response times for assessmentDementia blood screenPre-diagnostic counsellingExamination of cognition, behaviour,
functioningAdvanced planning discussionsAssessment of risk
Typical pathway and costs for Gp A
Group B
DemographicsA (n=33) B (n=33) Comments
Age (mean) 80 84 0.03 (Significant)
Min-Max 65-92 66-97
Females 58% 67%
MMSE (median) 24 25 NS (n=32 both groups)
ACE-R 67 - (Gp B, 9 done)
Education 15 15 Not recorded 4 in Gp A, 20 in Gp B
Diagnoses (NS)
Dementia Blood Screen from GPGroup A Group B
Yes 100% 73%
Significantly more in Group A Fisher Exact P=0.02
Pre-Diagnostic Counselling
Prediagnostic Counselling Gp A GP B
Yes 97% 6 %
Highly Significant Difference on Chi Sq
Days to be seenGroup A Group B
Mean days ( SE) 25 ( 2.6) 20 (3.4)
t=1.21 P=0.23 (NS)
Diagnostic Assessment: informal
Evidence of informal assessment ( NS differences) in nearly all of patients including assessments of 1) Functioning 2) Behaviour 3) Global severity 4) Depression 5) Carer assessment : Gp A> Gp B
Diagnostic assessment (formal scales)
Formal assessment Gp A> Gp B • Functioning (P<0.0001) ( BDI)• Behaviour (P<0.0001) ( CBI)• Global (P<0.0001) (HoNos, EQ5D)
Brain Scans
Risk Assessment Gp A Gp B
Documented in 94% 67%
Fisher Exact, P =0.02
Post Diagnostic Advice
Medications Prescribed (65%)
Diagnostic info
100% of letters to GP had diagnosis
Copying of letters to Pts/ Carers
Group A
Group B
Total Costs
Group A Group B
Pounds
Costs by Type (Means)
Conclusions
• Costs less for Gp A than Gp B but not significantly so.
• BUT, Gp A (memory clinic service) can offer a higher quality service with more specialist and multi-disciplinary care.
Outcome of Study
• Valuable input to both services re cost and quality of service
• Developed useful cost and quality tools for evaluating a memory service
• Cost data may be useful to Unit Costs for Health and Social Care compendium
• Planning an academic paper!
What did I learn?
• In real world, services change and develop. • Neither services are the same as when project
done! • Involving staff with data collection/discussion
at both ends critical to success.• Similar stakeholder info re perceived quality
of services would be useful.
Acknowledgements• *Dr Judy Rubinsztein• ¥Dr Marelna Van Rensburg• **Dr Zerak Al-Salihy, • ¥ D Girling,• *Dr L Lafortune• *Dr Murali Kartha, • *Prof Carol Brayne• *Receive support from NIHR CLAHRC, University of
Cambridge, • ¥ CPFT= Cambridge and Peterborough FT• **Norfolk and Suffolk FT
Acknowledgements
• Sam Norton (statistician, CLAHRC)• John Battersby ( ERPHO, advice on
demographic matching)• Multidisciplinary staff in both Groups A and B