Balancing the costs and quality of different memory service

models

Dr Judy RubinszteinDr Marelna Van Rensburg

Dr Zerak Al-Salihy, Dr Deborah Girling,

Dr L ouise Lafortune,Dr Murali Kartha, Prof Carol Brayne

Aims

• Evaluate average unit cost to secondary care for patients presenting with memory problems in a Memory Clinic based service

(Gp A) and a Traditional ( CMHT based) service ( Gp B).

• Evaluate quality of diagnostic service offered to patients and carers.

Methods

• Adapted Client Service Receipt Inventory (CSRI)

• Questionnaire about quality of diagnostic service provided, devised for study

Unit Costs for Health and Social Care (2011)Service Unit Cost (with on

costs)Consultant Psychiatrist

£162

Registrar £73Ass Sp £131CMHT ( OP) £44Psychologist £60CT/ MRI £121/£198Psych tests £9Mileage 54p/mile

Quality Questionnaire: Diagnostic Assessment

Response times for assessmentDementia blood screenPre-diagnostic counsellingExamination of cognition, behaviour, functioningAdvanced planning discussionsAssessment of risk

Typical pathway and costs for Gp A

screen/assign Pre-Dx

CounsellingDx

Office

DV Post Dx Advice

Group B

DV (medical)

•No F/U

DV (medical)

•Assign•DVs for post Dx advice, team

DemographicsA (n=33) B (n=33) Comments

Age (mean) 80 84 0.03 (Significant)

Min-Max 65-92 66-97

Females 58% 67%

MMSE (median) 24 25 NS (n=32 both groups)

ACE-R 67 - (Gp B, 9 done)

Education 15 15 Not recorded 4 in Gp A, 20 in Gp B

Diagnoses (NS)

AD VD LBD MCI Depression Other0

10

20

30

40

50

60

A (%)B (%)

Dementia Blood Screen from GPGroup A Group B

Yes 100% 73%

Significantly more in Group A Fisher Exact P=0.02

Pre-Diagnostic Counselling

Prediagnostic Counselling Gp A GP B

Yes 97% 6 %

Highly Significant Difference on Chi Sq

Days to be seenGroup A Group B

Mean days ( SE) 25 ( 2.6) 20 (3.4)

t=1.21 P=0.23 (NS)

Diagnostic Assessment: informal

Evidence of informal assessment ( NS differences) in nearly all of patients including assessments of 1) Functioning 2) Behaviour 3) Global severity 4) Depression 5) Carer assessment : Gp A> Gp B

Diagnostic assessment (formal scales)

Formal assessment Gp A> Gp B • Functioning (P<0.0001) ( BDI)• Behaviour (P<0.0001) ( CBI)• Global (P<0.0001) (HoNos, EQ5D)

Brain Scans

Risk Assessment Gp A Gp B

Documented in 94% 67%

Fisher Exact, P =0.02

Post Diagnostic Advice

Medications Prescribed (65%)

Diagnostic info

100% of letters to GP had diagnosis

Copying of letters to Pts/ Carers

88%

42%

Group A

Group B

Total Costs

Group A Group B

Pounds

Costs by Type (Means)

Direct Office Travel time

Mileage MDT Scans Drugs Psych Tests

£0

£50

£100

£150

£200

£250

£300

Group A

Group B

Conclusions

• Costs less for Gp A than Gp B but not significantly so.

• BUT, Gp A (memory clinic service) can offer a higher quality service with more specialist and multi-disciplinary care.

Outcome of Study

• Valuable input to both services re cost and quality of service

• Developed useful cost and quality tools for evaluating a memory service

• Cost data may be useful to Unit Costs for Health and Social Care compendium

• Planning an academic paper!

What did I learn?

• In real world, services change and develop. • Neither services are the same as when project

done! • Involving staff with data collection/discussion

at both ends critical to success.• Similar stakeholder info re perceived quality of

services would be useful.

Acknowledgements

• *Dr Judy Rubinsztein• ¥Dr Marelna Van Rensburg• **Dr Zerak Al-Salihy, • ¥ D Girling,• *Dr L Lafortune• *Dr Murali Kartha, • *Prof Carol Brayne• *Receive support from NIHR CLAHRC, University of

Cambridge, • ¥ CPFT= Cambridge and Peterborough FT• **Norfolk and Suffolk FT

Acknowledgements

• Sam Norton (statistician, CLAHRC)• John Battersby ( ERPHO, advice on

demographic matching)• Multidisciplinary staff in both Groups A and B