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Development of PCI Strategies: Catchments DemandVolumes South Central SHA

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This pack has been prepared following the Angioplasty Consensus meeting ... INENT. BCIS Peer. Balance of local interventions by Cardiac Network ... – PowerPoint PPT presentation

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Title: Development of PCI Strategies: Catchments DemandVolumes South Central SHA


1
Development of PCI StrategiesCatchments/Demand
/VolumesSouth Central SHA
  • Dr Stephen Green
  • DH Vascular Programme
  • 24th September 2008

2
Background
  • This slide pack has been prepared following the
    Angioplasty Consensus meeting held on 24th
    September 2008.
  • It is an SHA specific version of the presentation
    made by Stephen Green (Email stephen.x.green_at_dh.gs
    i.gov.uk)
  • It contains information about
  • Acute MI and CABG based tertiary catchment areas
    populations
  • Projected future numbers of revascularisations
    and PCIs
  • Modelling future Trust PCI numbers
  • The balance of local interventions (angiography
    and PCI) by cardiac network
  • MINAP data on STEMI and nSTEMI by hospital
    cardiac network showing expected STEMI numbers
    per year and per week.

3
Catchment Populations
  • DGH/Secondary - defined by where Acute MIs go
  • Tertiary Centres defined by where CABGs go

4
Identifying the flow of Acute MIs to define
DGH/ Secondary Trust Catchment Populations
5
Identifying the flow of CABGs to define Tertiary
Centre Catchment Populations
6
The National Map
Before the development of Wolverhampton
Basildon centres catchments
Acute MI Catchments
Tertiary CABG Catchments
7
South Central Tertiary Catchments
South Central Acute MI Catchments
8
Catchment Populations of Trusts Admitting Acute
MIs 1997 2004 (Controlled to England National
Population)
9
Catchment Populations of Trusts Admitting Acute
MIs 1997 2004 South Central SHA
10
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11
Future Numbers of Revascularisations
PCIsProjections
12
Cardiac Stocktake South East
  • Projections for the years 2008, 2010, 2015 for SE
    the whole of England
  • Projected national revascularisation rates of
    1900, 2200 2500 per million in 2015 based on
    weighted populations (age, sex and relative
    mortality)
  • PCIs based on projected national ratios of PCIs
    to CABG

13
Revascularisation Rates per Million Population
- Actual 2000/01 2006/7 Projected Rates of
1900, 2200 2500 by 2015 - England
Actual
Projection scenarios
Projections Based on Cardiac Stocktake (South
East) methodology projection years 2008, 2010
2015 national destination rates of 1900, 2200
2500 pmp by the year 2015
England
14
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15
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19
Modelling Trust PCI Numbers
  • Catchment areas based on where Acute MIs go but
    some Trusts may expand catchment for PCIs e.g.
    Royal Bournemouth, Royal Free
  • PCI numbers based on ratios referred to above
  • PCI numbers shown are the total PCIs expected for
    the Trust Acute MI catchment area (could model
    e.g. max of 85 local)

20
Modelling Trust PCI Numbers
  • Added into the picture
  • 1. BCIS Audit 2006 PCI Sites
  • 2. Trusts reporting PCI activity with PCI Waiting
    List returns in January 2008
  • 3. Trusts costing PCI in volumes 10 plus for
    2006/7 HRG4 reference costs
  • 4. Future intent to do PCI based on DH BLF Cath
    Lab survey
  • 5. BCIS Peer Review visits not yet showing up in
    other data sources

FUTURE INENT
BCIS Peer
21
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23
Balance of local interventions by Cardiac Network
  • Using HRG4 data about 2006/7 Year

24
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26
Different Patterns in the development of local
Angiography and PCI across the country
West Country Cardiac Network
Cheshire Mersey Cardiac Network
27
There will have been further movement since
2006/7 in some places
28
There will have been further movement since
2006/7 in some places
Pre opening of Basildon centre
29
MINAP DataSTEMI
  • What can MINAP tell us about
  • Potential PCI Numbers?
  • Average numbers of STEMIs per week
  • By SHA
  • By Cardiac Network
  • By Hospital

30
MINAP STEMI nSTEMI 2007 By SHA of Admission
Missing Data London Chest
FULL YEAR
31
MINAP STEMI IN HOURS OUT OF HOURS 2007 By
SHA of Admission
Missing Data London Chest
Based on 55 In Hours / 45 Out of Hours
FULL YEAR
32
MINAP STEMI IN HOURS OUT OF HOURS 2007 Per
Week (average) - By SHA of Admission
Missing Data London Chest
Based on 55 In Hours / 45 Out of Hours
AVE PER WEEK
33
MINAP STEMI IN HOURS OUT OF HOURS 2007 By
Cardiac Network of Admission
Missing Data London Chest
Based on 55 In Hours / 45 Out of Hours
FULL YEAR
34
MINAP STEMI IN HOURS OUT OF HOURS 2007 Per
Week (average) By Cardiac Network of Admission
Missing Data London Chest
Based on 55 In Hours / 45 Out of Hours
AVE PER WEEK
35
MINAP STEMI 2007 By Hospital of Admission
FULL YEAR
36
MINAP STEMI 2007 Per week (average) - By
Hospital of Admission
AVE PER WEEK
37
MINAP STEMI 2007 Per Week (average) By
Hospital of Admission
AVE PER WEEK
South Central SHA
38
MINAP STEMI 2007 Per Week (average) By
Hospital of Admission
AVE PER WEEK
South West SHA
39
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41
CONCLUSIONS
  • We know what existing catchment areas look like
    SHA groups will have copies of those this
    afternoon
  • Future number of PCIs have been projected across
    the country under different assumptions we know
    which Trusts look viable at the 400 PCIs p.a
    level SHA groups will have copies of those this
    afternoon
  • MINAP has the number of STEMIs that have been
    reported
  • We can therefore make a broad assessment of the
    total number of PPCIs in and out of hours by SHA,
    network hospital
  • Combining this with recommended CTB times will
    provide the site options for effective economic
    implementation of PPCI
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