Using risk stratification to quantify the value of Oxfordshire CCGs case management service.
For several years Oxfordshire CCG commissioned a case management service with the aim of reducing emergency admissions for high-risk patients. Due to the inherent difficulties in measuring events that didn’t occur, there was no consensus on whether this service achieved an improved outcome for patients and therefore no confirmation that continuing to commission this service represented value.
SCW was commissioned to undertake an evaluation to map out what would happen if nothing was done to change this approach, and to measure this against the outcomes delivered as a result of commissioning the case management service. The aim of the study was to provide a definitive answer.
What we delivered
Through collaboration with academic colleagues in the Department of Primary Healthcare at Oxford University, we delivered a comprehensive analysis, evaluation and report of three risk groups and assessed two key outcomes; A&E attendances and emergency admissions.
The report provided a meaningful comparison by using a ‘retrospective matched controls’ methodology (as promoted by the Nuffield Trust) to provide a control group to review against the group of patients who were receiving the service.
Risk stratification tools matched the control group patient-by-patient, comparing key demographics such as age, disease prevalence, and risk of emergency admission.
By using matched case-control to evaluate the impact of the case management service, we provided Oxfordshire CCG with a fully quantified and definitive view as to whether this service fulfilled the aims of achieving better outcomes for patients, and therefore whether it represented good value.
Oxfordshire CCG was able to make better informed commissioning decisions regarding the value of continuing to commission the service, for which the annual cost was around £1 million per annum.
The methodologies developed through our work can be easily replicated for other customers (subject to the agreement of the requisite time and resource).
The matched case-control evaluation used a rigorous methodology which allowed us to examine the effectiveness of our local case management service. Consequently, we were able to make an informed decision about whether to re-commission it and to explain our actions convincingly to a wider audience Dr Karen Kearley, Oxfordshire Clinical Commissioning Group
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