Commissioning for Quality
World Class Commissioning mandates primary care commissioners to consider not only cost, but to validate quality, safety and effectiveness of the care they broker from the acute sector or elsewhere: it applies to the decisions which underpin strategic withdrawal from expensive acute services, and the referrals which are still made. CRAB equips Commissioners with the tools to make informed decisions based on genuine clinical evidence.
PCTs and GPs will be accountable for making commissioning decisions on the basis of evidence-based practice, best value, and quality and safety. CRAB will combine all of these in a single source. This may lead to some acute clinicians being de-commissioned for poor competence, or some services being removed from the tariff list as being of no benefit, or harmful. Savings may be significant. Equally, clinical benefits for strategic shifts into community care will need to be demonstrable.
Find out more about how CRAB meets the objectives of World Class Commissioning.
See examples below of how CRAB can give you a clearer picture of quality in your area – and save you money.
Could your acute referrals be managed better?
Surgical patients are high-cost. The comparative benefits of surgery may be understood at least in outline prior to a specialist referral. Once a decision to treat is made, the outcomes can be benchmarked for quality, informing follow-up decisions for specific patients, and strategic decisions for future commissioning.
In a range of local studies, consistently only between 8% and 13% of cancer referrals are genuine fast-track. Acute providers are often laying on at least one additional clinic per month to clear backlogs, at significant expense. A litigious and domineering performance management culture militate against more conservative referral levels at this stage, without tools like CRAB to provide a solid, auditable evidence base.
GPs need protection from unfounded complaints. The system needs to be driven as efficiently as possible so that patients in genuine urgent need can receive care in time.
Installed locally, CRAB gives healthcare economies the wherewithal to manage patient flows more effectively.
Do you judge quality simply on the basis of mortality rates and readmissions? The true picture may be very different.
3 monthly risk adjusted report (click to enlarge)
CRAB shows the difference between unadjusted mortality and the true picture when account is taken of case-mix and complexity of patients treated. Notice that in the period when overall mortality is at its highest, case-mix adjusted quality is nevertheless good. Points plotted below the yellow line represent better than predicted outcomes, benchmarked against international as well as UK practice.
Are critical care facilities being used to best effect?
HDU and ITU beds are always in short supply. Care in these facilities is also extremely high cost.
3 monthly facilites trend report (click to enlarge)
This is not an uncommon picture. But the answer doesn’t have to be in expensive capital investment in new facilities. Hospitals have used CRAB effectively to achieve the same results by understanding individual patients’ care needs and reconfiguring nursing resource more efficiently.
Do you know providers are delivering best quality? Do you have the evidence to commission not just from the best hospitals, but the best units?
CRAB uniquely can show you the best outliers, by showing where excellent results are being delivered even for the most difficult cases.
Surgical outlier selection criteria (click to enlarge)
Quality can now be demonstrated in a uniquely positive way, and specific specialties, sub-specialties or even units and individuals can be singled out. Strategic commissioning takes on a whole new perspective.
