A retrospective analysis to determine the effect of independent treatment centres on the case mix for microsurgical training

Barsam, Allon; Heatley, Catherine J.; Sundaram, Vinita; Toma, Naoki

doi:10.1038/sj.eye.6702718

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…Nonetheless, existing research highlights some important issues. In the case of cataract surgery, for example the casemix complexity of hospital patients appears to have increased since the advent of treatment centres [33]. Furthermore, although patients treated in treatment centres generally experience lower rates of emergency readmission [27], risk-adjusted health outcomes are variable, with a recent study finding that outcomes for hernia patients are poorer than those achieved by NHS hospitals [32].…”

Section: Discussionmentioning

confidence: 99%

Are English treatment centres treating less complex patients?

Street¹,

Sivey²,

Mason³

et al. 2010

Health Policy

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Section: Discussionmentioning

confidence: 99%

Are English treatment centres treating less complex patients?

Street¹,

Sivey²,

Mason³

et al. 2010

Health Policy

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“…Based on data for 129 cataract patients seen in an NHS hospital, Barsam and colleagues reported an increase in case-mix complexity after the opening of a nearby ISTC. 11 A study by Browne compared 769 patients treated in six ISTCs with 1895 Private sector treatment centres are treating less complex patients than the NHS patients treated in 20 NHS providers and found that those treated in ISTCs had less complex conditions. 12 The authors caution against extrapolation because few ISTCs participated and the sample of patients was small.…”

Section: Discussionmentioning

confidence: 99%

Private sector treatment centres are treating less complex patients than the NHS

2010

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SummaryObjectives In England, patients can choose to have their NHS elective care delivered by private (or 'independent sector') providers or by the NHS. Providers are paid a fixed tariff for each type of procedure. Our objectives were to compare NHS providers with private treatment centres in terms of (a) the quality of data coding and (b) patient complexity.Design We compared elective patients aged 18 years and over treated in the NHS and private sectors using the Hospital Episode Statistics (HES) data for [2007][2008]. The absence of diagnostic information was used as a measure of data quality. We analysed differences in complexity for each of the 30 Healthcare Resource Groups (HRGs) that together account for 78% of coded private treatment centre activity. Statistical significance was assessed at the 1% level. Setting Hospitals and treatment centres.Main outcome measures Patient complexity was assessed by four characteristics: age; number of diagnoses; number of procedures; and income deprivation of residential area.Results NHS providers treated almost 7 million adult elective patients in [2007][2008]. Fewer than 100,000 patients were treated by private providers (1.3% of elective activity). Less than 1% of NHS patients lacked diagnostic information compared to 36% of patients treated by private providers. For the top 30 HRGs, NHS patients had significantly (p<0.01) higher levels of co-morbidity, underwent more procedures and were more likely to come from deprived areas compared with patients treated by private providers. Although patients treated in private settings tended to be younger, the difference was not statistically significant.Conclusions Some private companies provide poor quality data. In general, the NHS is treating more complex patients than private providers. If complexity drives costs, then a fair reimbursement system would require higher payments for NHS providers.

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“…The utilization of Independent Sector Treatment Centers, which tend to select low-risk surgical patients, has not only reduced the number of cases available for training, but also led to a distillation of surgical complexity in National Health Service units. 3 This, combined with recent evidence of the relative risk of elective surgical procedures in the hands of a trainee compared with a consultant, further reduces potential opportunities for surgical training. 11 This study assessed the attitudes and methods of cataract surgery training in the U.K. from the perspective of the trainers.…”

Section: Discussionmentioning

confidence: 99%

“…The utilization of Independent Sector Treatment Centers, which tend to select low-risk surgical patients, has reduced the number of cases suitable for training. 3 The survey of ophthalmic surgical trainees found general dissatisfaction with training and identified 3 main areas of concern 1 : (1) attitudes and skills of consultant trainers, (2) poorly structured training programs even within recognized training rotations, (3) limited opportunities in the operating room and for wet laboratory practice.…”

mentioning

confidence: 99%