I have not blogged about casemix yet, and with this post I intend to kick-start my attempt to share my comments, opinions, views on how health management everywhere have changed the way of doing things in hospitals by applying casemix ideas as an information tool involving the use of scientific methods to build the classifications of patient care episodes by classifying patients into classes or groups which are both clinically coherent and resource homogenous.
I learned about a news article from the South Wales Evening Post about how health management in Wales intends to change the case mix in their hospitals, because they claimed that the existing service is splintered between various sites and therefore inefficient.
To better understand the situation there, I ran an Internet check of healthcare services in Wales, so I could better comprehend what the article was reporting, and to focus on how casemix ideas were applied to bring about the changes at Morriston Hospital, Princess of Wales Hospital, Neath Port Talbot Hospital, and Singleton Hospital, namely the hospitals referred to in the article.
In Wales, seven Local Health Boards (LHBs) are responsible for planning and securing delivery of primary, community, secondary care services, and also the specialist services for their areas. Abertawe Bro Morgannwg (ABM) University Health Board is one of the largest Health Boards in Wales. It is responsible for three localities – Swansea, Neath Port Talbot and Bridgend areas (see map below of all Hospitals in these ABM localities).
Map credit : Abertawe Bro Morgannwg (ABM) University Health Board
It covers both primary (GPs, pharmacies, dentists and optometrists etc) and secondary (hospitals) care.
Photo credit : http://www.thisissouthwales.co.uk/
Morriston Hospital (left) covers the same geographical area as the City and County of Swansea and has around 750 beds. Morriston Hospital is the site of the major Accident and Emergency Department for Swansea and, with its accessibility to the South West Wales population, is recognised as the Major Trauma Centre for South West Wales.
Photo credit : http://www.wales.nhs.uk/
Princess of Wales Hospital (right) is a district general hospital located on the outskirts of Bridgend town in South Wales. This hospital provides a comprehensive range of acute surgery and medicine for patients of all ages, including inpatient, outpatient and day services, including Accident and Emergency Services.
Photo credit : http://www.thisissouthwales.co.uk/
Neath Port Talbot Hospital (left) has 270 beds and provides a range of inpatient, outpatient and day case services for the people of Neath and Port Talbot.
Photo credit : http://www.thisissouthwales.co.uk/
Lastly, Singleton Hospital (right) is a modern District General Hospital with 550 beds situated on Swansea Bay, adjacent to the campus of Swansea University.
Health authorities in the ABM localities plan to lose hospital beds as a result of a shake-up of health services due to take place during September or October 2012, although the planning for them had already started. As a result, Morriston will lose 23 beds and Singleton, 1 bed.
Health authorities think advances in patient care mean they no longer need as many beds as were necessary in the past.
The change of the case mix in the hospitals served by ABM will change as follows :
- Morriston Hospital will to continue to deal with emergency cases, along with Princess of Wales in the Bridgend area
- Morriston Hospital will take care of all complicated elective (pre-planned) orthopaedic operations from across the ABM area
- At the moment trauma and orthopaedics are also carried out at Neath Port Talbot Hospital;
- Trauma and orthopaedics will no longer be carried out at Neath Port Talbot Hospital but will become a centre of excellence for short-stay orthopaedic surgery
Patients who have had complicated surgery in the two acute hospitals (Morriston and Princess of Wales hospitals) will, as soon as they are well enough, be moved for rehabilitation in Singleton, Neath Port Talbot and Princess of Wales hospitals, depending on where they live; this will free up beds at Morriston for trauma and complex surgery, and it will also mean patients will recover closer to their homes and families.
The drive to rehabilitate results in quick turnover, and hopes to enhance the recovery process after surgery which in turn will lead to better outcomes and reduced readmission rates. For example, if patients have to travel to Morriston or Bridgend for major joint replacement the time they will be there will be much shorter. This according to Phillip and Julie 2011, patients with greatest needs are treated preferentially (vertical access equity as according to Phillip and Julie 2011).
ABM said the aim was to establish a level of care across the board area so that, no matter where people were from, patient health needs are treated alike (horizontal access equity as according to Phillip and Julie 2011).
Health chiefs in the ABM Area have insisted as long as the patient flow was right, the changes in trauma and orthopaedics do not represent any reduction of the service by withdrawing the service and by losing some beds. They also insisted cost-cutting was not the objective of this patient care exercise, but to actually lead to improvement in patient outcomes and pathways for specific patients, particularly the frail and elderly, who have fractured neck of femurs. ABM says that, in the past, elderly patients with serious fractures tended to spend a long time in hospital and their condition deteriorated, sometimes fatally.
ABM has also flagged up the need to strengthen links with social services, particularly to ensure elderly patients who need support at home are not stuck in hospital longer than necessary.
This case mix exercise in Wales seemed like a good idea given the reduction in beds. ABM remained confident there would be a sufficient number of beds to run the service and they could manage as they had built-in some capacity to expand if they do have a busy time.
ABM believes the change in casemix among its hospitals is sensible from all angles – finance, and patient care and also resolving ABM’s significant issues with junior doctor cover. I think the change in casemix has allowed for meaningful comparison of activity between hospitals managed by ABM in Wales.
Internet sources:
Abertawe Bro Morgannwg (ABM) University Health Board , viewed 30 July 2012, <http://www.wales.nhs.uk/sitesplus/863/home>
Phillip B & Julie B 2011, Casemix for Beginners, viewed 15 July 2012, <http://casemixconference2011.com.au/LiteratureRetrieve.aspx?ID=103882>
Abridged by R. Vijayan from an original article in the South Wales Evening Post, July 19, 2012
