Unwarranted clinical variation in rehabilitation
NSW Agency for Clinical Innovation (ACI)
Duration: March – June 2017
The objective of this research project was to explore clinical variation in service delivery and outcomes for people who participated in rehabilitation in NSW public rehabilitation services. Utilising analysis of AROC rehabilitation data, the goal was to determine the factors which contribute to unwarranted clinical variation (UCV) and thereby identify opportunities and recommend strategies at both facility level and system level for reducing UCV in rehabilitation services.
What we did
The first stage of the project focused on data analysis and interrogated the AROC database. This stage aimed to translate the Australian Commission on Safety and Quality in Health Care’s definition of unwarranted clinical variation into the inpatient rehabilitation context by considering a variety of measures on entry to, during and at exit from inpatient rehabilitation, and identifying variations between facilities. In determining the factors which contribute to unwarranted clinical variation we identified opportunities for improvement and made initial recommendations of strategies at both facility level and system level for potentially reducing unwarranted clinical variation among inpatient rehabilitation services. At the request of ACI this analysis focused on three types of impairments: stroke, fractured hip and reconditioning. The analysis compared each NSW public facility with at least 20 episodes of the impairment being considered against each other, against the total NSW public inpatient rehabilitation data, and against the Australian national data. The analysis described facilities that were performing well and those that were not, using national data as the benchmark against which facilities were compared.
The second stage of the project involved consultation with AROC member stroke rehabilitation services. Senior rehabilitation staff at a range of (AROC member) rehabilitation services were contacted to explore their perceptions about the mechanisms which may result in, or contribute to reduction of, unwarranted clinical variation in key indicators as identified by the AROC data.
A final report was completed which identified that variation in processes and outcomes clearly exist in the NSW public inpatient rehabilitation sector. Variation across the three specific impairment categories of stroke, fractured hip and reconditioning were identified and enumerated. Using casemix adjustment, the variation attributable to the mix of patients was controlled for, leaving the remaining variation likely to be caused by differences in health system performance. Factors that underpin the identified differences in health system performance were reported and recommendations provided.
Project team: Tara Alexander, Jacquelin Capell, Frances Simmonds