Julia Wilkins, ICHP Head of Data and Analytics, explains how and why ICHP evaluations look at the whole health economy.
Call it lateral thinking, forward thinking, or joined-up thinking; individual NHS organisations are no longer judging the value of new interventions based on their potential impact on them alone – they also now take into account the effects of any changes on their partners and the system as a whole.
For example, will a new hospital-based intervention under consideration lead to an increased number of follow-up outpatient appointments or a greater need for ongoing clinical support from primary or community care? Alternatively, will it help patients benefit from a greater capacity for self management, reducing the need for ongoing clinical support – or even the need for adult social care in future years? Will patients benefit from a reduced burden of medication if they have this intervention?
This sort of real-world data insight can be hard for organisations to access when pulling together a business case for the NHS, as they may only have access to data from the organisation they are working with during a local pilot, for example, or to generic information from NHS Digital.
However, with ICHP’s access to national real-world data such as Hospital Episode Statistics (HES) and North West London’s Whole Systems Integrated Care (WSIC) dataset, we are able to evidence the benefits – or otherwise – of a new intervention to the whole health economy. WSIC is one of the most insightful healthcare datasets in the UK, containing data linked across primary, secondary, community, mental health and social care covering a population of over 2.4 million people.
Examples of working with real-world data
Over the last 18 months we’ve been evaluating UroLift, a medical device used in prostate surgery for men suffering with benign prostate hyperplasia (BPH). This has involved looking at the effects across the whole system, comparing the standard tissue resection operation (requiring an inpatient admission) with a new outpatient procedure involving the use of the Urolift device, a minimally invasive technique that moves the prostate lobes apart, obviating effects associated with tissue destructive procedures.
BPH affects a third of men in their 50s, rising to 80 per cent of men in their 70s. Over 18,000 traditional surgeries for the condition are performed across England each year.
The research was undertaken to measure the burden of care with the standard surgical treatment option in order to provide a benchmark against which newer treatment options, such as Urolift, could be measured. This includes investigating how a diagnosis is reached, the operation/intervention itself, the impact for the GP and the ongoing drug burden for patients – all of which can be measured post-intervention. Click here to find out more about the research.
Our analysis found reduced post-surgical complications and no new sexual dysfunction, as well as a reduced need for ongoing medication – meaning the benefits of the new intervention would be felt more widely than just within the hospital services.
Another real-world data analysis example includes a recent study together with the North West London CCGs looking at how diabetes apps can help patients manage their condition better and reduce dependence on medication. More than 400 patients from 18 GP practices tried out the new digital apps being tested over four months, and the results highlighted a significant reduction in the body mass index (BMI), blood pressure and blood sugar (HbA1c) levels in patients, the patients lost weight, and of the 118 who provided details of their medication, 20 per cent were able to stop taking the diabetes medication metformin during the trial.
Another exciting real-world data project includes the evaluation of a predictive algorithm that may be used by GPs to identify patients that have atrial fibrillation but do not yet have a diagnosis and so would benefit from anticoagulation medication to prevent stroke.
Learning and acting on insights
It’s important that we don’t just measure the positive impact of a new service on an individual patient at a specific time, but that we also measure the likely impact across the whole health system.
To avoid duplication and accelerate adoption, it’s also crucial that we share our evaluations and communicate the results back to the NHS so that others can learn and act on the insights too. Here at ICHP we work with our communications team to share our work making to be as accessible to the widest possible audience – helping to make a difference right across the system.
For more information email the ICHP team at b.i@imperialcollegehealthpartners.com.
