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
screen/assign Pre-Dx
CounsellingDx
Office
DV Post Dx Advice
Group B
DV (medical)
•No F/U
DV (medical)
•Assign•DVs for post Dx advice, team
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)
AD VD LBD MCI Depression Other0
10
20
30
40
50
60
A (%)B (%)
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
88%
42%
Group A
Group B
Total Costs
Group A Group B
Pounds
Costs by Type (Means)
Direct Office Travel time
Mileage MDT Scans Drugs Psych Tests
£0
£50
£100
£150
£200
£250
£300
Group A
Group B
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