Identifying unwarranted variation in clinical practice between healthcare providers in England: Analysis of administrative data over time for the Getting It Right First Time programme

Abstract

Rationale, aims, and objectives The Getting It Right First Time programme aims to reduce variation in clinical practice that unduly impacts on outcomes for patients in the National Health Service (NHS) in England; often termed “unwarranted variation.” However, there is no “gold standard” method for detecting unwarranted variation. The aim of this study was to describe a method to allow such variation in recorded practice or patient outcomes between NHS trusts to be detected using data over multiple time periods. By looking at variation over time, it was hoped that patterns that could be missed by looking at data at a single time point, or averaged over a longer time period, could be identified. Methods This was a retrospective time‐series analysis of observational administrative data. Data were extracted from the Hospital Episodes Statistics database for two exemplar aspects of clinical practice within the field of urology: (a) use of ureteric stents on first emergency admission to treat urinary tract stones and (b) waiting times for definitive surgery for urinary retention. Data were categorized into 3‐month time periods and three rules were used to detect unwarranted variation in the outcome metric relative to the national average: (a) two of any three consecutive values greater than two standard deviations above the mean, (b) four of any five consecutive values greater than one standard deviation above the mean, and (c) eight consecutive values above the mean. Results For the urinary tract stones dataset, 24 trusts were identified as having unwarranted variation in the outcomes using funnel plots and 23 trusts using the time‐series method. For the urinary retention data, 18 trusted were identified as having unwarranted variation in the outcomes using funnel plots and 22 trusts using the time‐series method. Conclusions The time‐series method may complement other methods to help identify unwarranted variation.

Safety of day‐case paediatric tonsillectomy in England: an analysis of administrative data for the Getting It Right First Time programme

“…We think this variation is unlikely to be due to unmeasured differences in case-mix or patient preference and, given the additional resource requirement of overnight stay, appears unwarranted [3][4][5]. The key barriers to increasing day-case rates identified by the GIRFT ENT national report were reluctance to change current practice; lack of day-case infrastructure; concern that outcomes would be compromised; and the belief that day-case rates were already 'optimal' [6].…”

“…In the UK, the Getting It Right First Time (GIRFT) programme was established by the Department of Health and Social Care as an initiative to investigate variation in healthcare delivery and patient outcomes between hospital Trusts in England. Variation between Trusts is unwarranted unless justified by patient case-mix, patient preference, equivocal evidence of effectiveness of a particular patient management approach or intractable resource constraints [3][4][5].…”

Harnessing the potential of data‐driven strategies to optimise transfusion practice

“…In England, for example, the Getting it Right First Time (GIRFT) programme, is a NHS programme looking to improve the quality of care and reduce cost by reducing variation. 1 While some variability in transfusion practice is to be expected due to individual differences in patient care and preferences, deviating too far from evidence-based recommendations can be detrimental to patient and healthcare outcomes and is associated with higher healthcare costs. 2 Much of the work to date in healthcare has been focussed on describing and visualising variation but with arguably less research aimed at addressing why variation in practice occurs and how to reduce it.…”

“…Documentation of variation in practice does however serve a critical purpose in informing major national initiatives. In England, for example, the Getting it Right First Time (GIRFT) programme, is a NHS programme looking to improve the quality of care and reduce cost by reducing variation 1 . While some variability in transfusion practice is to be expected due to individual differences in patient care and preferences, deviating too far from evidence‐based recommendations can be detrimental to patient and healthcare outcomes and is associated with higher healthcare costs 2 .…”

Do outcomes of ureteroscopic stone treatment vary with stone composition? A prospective analysis

“…This may be because outcomes for different stone compositions are similar, regardless of the treatment modality, but this is not well reported. It is becoming increasingly important to minimise variation between healthcare providers to achieve good outcomes, but without knowledge of the optimal treatment for differing stone types, this is difficult to achieve [ 12 ]. The aim of this study was to explore whether the outcomes of URSL vary with differing stone composition.…”