Atlas of Healthcare Variation Webinar 4: From atlases to action - - PowerPoint PPT Presentation

Atlas of Healthcare Variation

Webinar 4: From atlases to action

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Atlas of Healthcare Variation Webinar 4: From Atlases to action

Dr Alan Davis – Clinical Director Catherine Gerard – Senior Analyst

Outline of webinar

• Present on

– Scope of the Campaign and the Collaborative – Variations analyses and the Opioids Atlas – How to use the Atlas data for quality improvement

• Opportunity for questions from the

audience

Introduction

• Campaign focus is on reducing error

and harm from high risk medicines

• National safe use of opioids

collaborative is a partnership between DHBs and the Commission running until April 2016

• Atlas supports this work by

describing community use of opioids and identifying DHB variation.

Campaign focus to date

Month Focus October Case for change November Identifying and mitigating error and harm December & January Partnering with patients and their whanau February Preventing error and harm March Safe use of opioids

Safe use of opioids

• Opioids are very effective in managing

severe pain

• But they are high risk and commonly

implicated in harm:

– Over-sedation – Respiratory depression – Other common adverse effects: nausea, vomiting, constipation, delirium, hallucinations, falls, hypotension, aspiration pneumonia, and addiction.

Atlases

Taxonomy of variation1

• Effective care
• Preference-sensitive care
• Supply-sensitive care

Appleby, Raleigh, Frosini et al. Variations in health care: the good, the bad and the inexplicable. Kings Fund (2011).

Unwarranted variation

Jack Wennberg: ‘Variation in the utilization of health care services that cannot be explained by variation in patient illness or patient preferences.’

Measuring variation

Tin openers and dials

• Concept from Carter and Klein
• Tin openers open up cans of worms
• Dials measure things

This is not a league table

• High is not necessarily better
• Low may not be worse
• The middle might not be right

Method

• Rate/1,000 population receiving:

– Strong opioids: fentanyl, methadone, morphine, oxycodone and pethidine – Weak opioids: tramadol, codeine and dihydrocodeine

• Sub-analyses by year (2011-2013),

age, ethnicity and gender

Atlas of healthcare variation

• Opioid dispensing by community

pharmacies: hospital discharge and primary care prescriptions

• Shows the rate of opioid use by

DHB of domicile

• No ideal rate is known but wide

variation may highlight areas of under- and overuse

• View atlas and explain how to

view and different ways of presenting the data

Key findings – strong opioids

• 3-fold variation
• Used more:

– European/Other 2-4 times rate – Increased significantly with age , on average 1 in 10 people aged 80+ in 2013 – Women > men

• 46% had a public hospital event

associated with dispensing

• 14% of people (9,300) receiving a strong
• pioid received it for 6 or more weeks.
• Oxycodone use decreased from 2011-

2013

Key findings – weak opioids

• 2-fold variation
• Used more:

– European/Other – Increased with age, up to 1 in 7 people aged 80+ – Women > men

These data raise questions

• Why do some DHBs have

consistently higher rates?

• Why are there marked ethnic

differences?

• What other combinations of

medicines are people on strong

• pioids receiving, eg

benzodiazepine use?

Suggested actions

• Resources for variations analyses
• n the Commission’ website
• Review number of prescribers
• Review other medications
• What is the variation by practice

/practitioner?

Number of prescribers?

What other medications?

• 46% people dispensed a

strong opioid for 6 or more weeks also received benzodiazepine/ zopiclone

Links to resources

Opioids atlas: http://www.hqsc.govt.nz/atlas/opioids/ Guides: http://www.hqsc.govt.nz/our-programmes/health-quality- evaluation/publications-and-resources/ Webinars: http://www.open.hqsc.govt.nz/medication/publications-and-resources/

Please use Q&A function to ask questions