Clinical policies for optimal care: variation in content and evidence cited

Session: 

Oral session: Understanding and using evidence (3)

Date: 

Tuesday 18 September 2018 - 11:10 to 11:30

Location: 

Carrick 3

All authors in correct order:

Rooshenas L1, Ijaz S1, Richards A1, Savovic J1
1 University of Bristol, UK
Presenting author and contact person

Presenting author:

Sharea Ijaz

Contact person:

Sharea Ijaz
Jelena Savovic
Abstract text
Background:
As part of our collaboration with the NHS Sustainability and Transformation Plan (STP) we identified locally performed procedures with high excess costs. Clinical commissioning groups' (CCG) policies for funding these procedures vary across the UK.

Objectives:
1) Identify local CCGs' policies for procedures with high excess costs.
2) Identify comparative policies enforced by CCGs with low excess costs
3) Compare 'high' vs 'low' CCG policies and cited evidence.
4) Compare policy content with national guidance.

Methods:
We identified CCG policies for the 'top 10' procedures in our local STP with the highest excess cost. We then identified CCG policies from the lowest spending STPs for the same procedures. Two authors independently searched for policies, then agreed the optimal search method. If a policy was not found, we recorded this. We analysed identified policies qualitatively for variations in clinical pathways. We cross-tabulated the evidence cited in policies from high vs low-spend areas for each procedure. We examined the findings in relation to national guidelines.

Results:
Finding local policies was easier using free-text searching in Google, compared with searching CCG websites. In contrast, national guidelines (NICE/SIGN) were easier to locate within respective websites. The first case study, for the 'excision of bone' procedure, showed that policies from high and low-spend areas varied considerably, in terms of the clinical pathways and diagnostic tests required prior to performing the procedure. Furthermore, the use of evidence in policies differed: the low-spend area CCG policy cited systematic reviews and clinical trials, whereas the policy from the high-spend CCG did not. We will present further results from other case studies.

Conclusions:
This is the first empirical, systematic examination of evidence use in local UK healthcare policies and its impact on practice. The findings provide methodological insights into optimal methods of evidence extraction and appraisal of local policies. They also produce insights into how local decision-makers use and interpret scientific evidence.

Consumer involvement:
A Health Systems Panel, set up to look at issues around optimal care, advised us on data extraction from a public perspective. They will later advise on the design of the optimal care research proposal.

Relevance to patients and consumers: 

A large proportion of our (CLAHRC West, Bristol) evidence synthesis work is carried out in liaison with the local decision makers including public contributors. The variation in policies on surgical procedures across the country is of direct relevance to patients many of whom could avoid an unnecessary procedure if the right evidence is used for all policies consistently. Involving healthcare consumers in the project can get us closer to the aim of optimal care for all.