Primary care teams work harder in deprived areas. The study had two main limitations. Each hospital collects data prospectively on all eligible patients in a surgical category over a 3-month period.
It also conducts the census in England and Wales every 10 years. Whether or not they can be linked to ONS data will depend on their mortality status. Examining the relationship between the individual differences in pairs of scores and their means is also informative.
However, these data are often unavailable. We tested the hypothesis that the two methods postcode linking and GIS modelling had the same variability in predicting the "gold standard" scores using the Fligner-Killeen test for homogeneity of variances within R 2.
Our model may also avoid an underestimation of IMD scores in less deprived areas, and overestimation of scores in more deprived areas, seen when using postcode linked scores.
The Oxford hip score is also collected for those undergoing THR. This showed a small decrease in occupancy though some care needs to be taken in interpreting the model results here, as the admission days for elective patients are currently planned to accommodate weekday discharging.
The proposed method may be of use to researchers who do not have access to patient level spatially referenced data. The light-blue section E represents patients with SSISS data for whom a missing NHS number could not be traced and, therefore, whose record could not be linked to other data sets.
None the less the model showed the potential effectiveness of a range of modest and, arguably, achievable measures, to prevent this being realised.
This article has been cited by other articles in PMC.
VL and SB drafted the final paper with contributions from the wider team, and are the guarantors. Patients are registered at a practice rather than at an individual surgery site, so we made the assumption that patients would attend the nearest site if a practice had one or more branch surgeries.
Measuring agreement between deprivation scores We obtained practice population-weighted IMD score data for the three districts from published or unpublished sources.
The HES records for the episode of operation were extracted and subsequently all other records of hospital episodes relating to this same cohort of patients were extracted within the given time period, including critical care data see Appendix 5.
All hospitals participating in national SSI surveillance are required to follow the surveillance protocol outlining the follow-up methods and case definitions.
However, the seasonal nature of the reductions in admissions gave increased benefits, as the January peak in occupancy was more significantly reduced relative to other months.
The computer model was useful for investigating the scenarios for change in terms of patient flows and bottlenecks and as a device for facilitating discussion and comment. The district level analyses allowed us to determine the performance of the model for a relatively small number of practices within a defined area.
Received Jul 10; Accepted Sep 6. In this sense it can suggest what might be done, but not the desirability of such options and, without economic data, cannot predict the probable costs or cost savings.
We considered the three districts separately in order to determine the performance of the model in areas with different social and spatial characteristics. One of the 39 Rotherham practices was a small specialist practice providing care for asylum seekers and homeless people and was removed from this analysis.
Prior to analysis the data were anonymised to reduce the chance of disclosure by transforming NHS number and HSCIC identifiers to new identification numbers that bore no relationship to the originals. This study aimed to develop a Geographical Information Systems GIS based model that could better predict a practice population-weighted deprivation score in the absence of patient level data than simple practice postcode linkage.
The conceptual map provided a useful structure around which to base the stakeholder interviews, and participants often commented on the value of seeing the whole system in its entirety, often for the first time, and on the insights they gained about how other system components related to the part with which they were familiar.
The model suggests that further gains may arise if the NHS walk-in centre opened for longer hours for example until midnightthough patient satisfaction with walk-in centre care might reduce if waiting times there increased. We also thank the referees for their helpful comments.
We chose for our study the practices within the following three districts: Since the areas of concentric ring buffers of equal width are proportional to their distance from the central point, i. The postcode-linked method is more straightforward, in that it does not require such data, but makes the assumption that the deprivation score associated with the small area in which the practice resides provides a valid proxy for the socioeconomic deprivation experienced by the practice population as a whole.
Of these registered patients,lived within the broadly coterminous Rotherham Local Authority area. NJR data from to were provided by the Healthcare Quality Improvement Partnership and included the variables listed in Appendix 5. The degree to which the differences deviate from zero gives an indication of the level of disagreement between the predicted and the gold standard scores.
We then estimated the proportion of the practice population living in each LSOA by applying the Rotherham derived distance function.
Acute care hospitals in England that participated in mandatory SSI surveillance from 1 April to 31 March have contributed data for patients who underwent hip replacement. Use of primary health care and accident and emergency services for children under 5 years outside normal office hours.
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However, additional resources could be required in the NHS walk-in centre, and the practicalities and acceptability of re-directing patients in this way would need to be considered.
The HES data are designed to enable secondary use i.
IMD is a composite deprivation index containing seven domains:PUIC Home: Cost-effectiveness modelling report - - - ii - - - About the Peninsula Technology Assessment Group (PenTAG) The Peninsula Technology Assessment Group is part of the Institute of Health Service.
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