Commissioning for quality
CRAB equips commissioners with the tools to make informed decisions based on genuine clinical evidence.
CCGs and GPs are accountable for making commissioning decisions on the basis of evidence-based practice, best value, and quality and safety. CRAB combines all of these in one single source.
This may lead to some clinical practice being called into question, 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.
See examples below of how CRAB can give you a clearer picture of quality in your area and save you money.
Better management of acute referrals
Surgical patients are high-cost. The comparative benefits of surgery must 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, inform 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 genuinely fast-tracked. Acute providers are often laying on at least one additional clinic per month to clear backlogs at significant expense.
CRAB can provide a solid, auditable evidence base for ensuring appropriate referrals are made in appropriate timescales Consequently, CRAB offers healthcare economies the wherewithal to manage patient flows more effectively.
Commissioning for quality
Do you know if providers are delivering the best quality? Do you have the evidence to commission not just from the best hospitals, but the best units? (Click on the image to enlarge.)
CRAB is unique because it can show you the best outliers by showing where excellent results are being delivered even for the most difficult cases.
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.
Do you judge quality simply on the basis of mortality rates and readmissions?
The true picture may be very different (click on the image to enlarge).
CRAB shows the difference between unadjusted mortality and the true picture when case-mix and complexity of patients treated is taken into account.
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.
Make effective use of critical care facilities
HDU and ITU beds are frequently in short supply. This graph shows a three month facilities trend report (click to enlarge).
This is not an uncommon picture, but the answer doesn’t have to be an 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.