The White Paper “Equity and Excellence. Liberating the health service “stated that health service must focus on outcomes and quality standards. The aim must be to improve. Comparison of a trend in improvement/deterioration of over time of outcomes would be beneficial to both clinicians and commissioners.
Methods Trend was analysed in 3 key outcome measures for COPD for all 153 PTCs in England. The 3 outcome measures are COPD mortality per 1000 PCT population for 1993–2010, bed-days per 1000 PCT population for 2006/7–2010/11, and re-admission at 28 days for 2004/5–2010/11. Data from INHALE (www.inhale.nhs.uk) has been used and Dr Foster Intelligence for readmissions. Linear regression lines were fitted to the annual data for each PCT . An upward trend scored +1 (deterioration), no trend 0, downward trend –1(improvement). The scores were summated for each PCT resulting in a possible range of scores of +3 to –3.
Results The Table shows summated results. PCT mortality data was available for 152, bed-days for 151 and readmissions for 150 PCTs. Newham was the only PCT to improve in all 3 outcomes (score –3). 23 PCTs (15%)scored –2, of these 21 improved in one outcome, 2 improved in two outcomes but deteriorated in one; 78 PCTs (52%) scored –1, of these 74 improved in one outcome and 4 improved in two but deteriorated in one as well; 41 PCTs (27%) scored 0, of these 15 had improved in one outcome but deteriorated in another; 8 PCTs (0.5%) scored +1. There were no scores of +2 or +3.
Conclusions These data shows considerable variation in outcome trend data across England. COPD mortality has improved in most but not all areas over 17 years. Mortality has improved in more PCTs compared to a reduction in bed-days for COPD and readmissions. Readmissions have increased in more PCTs than the other 2 outcome measures. These variations are unexplained and need investigating. Analysis of trend data for outcomes is essential, for providers and commissioners, to identify services that are improving or deteriorating,