Musculoskeletal conditions Available tools and data for Buckinghamshire, Oxfordshire and West Berkshire STP
November 2017
MUSCULOSKELETAL CONDITIONS (MSK)
MSK data and tools
3 main groups: 1. Inflammatory conditions (e.g.
rheumatoid arthritis) 2. Conditions of musculoskeletal pain
(e.g. osteoarthritis, back pain) 3. Osteoporosis and fragility fractures
MSK data and tools 2 Source: Arthritis UK, State of Musculoskeletal Health 2017
3 MSK data and tools Source: Arthritis UK, State of Musculoskeletal Health 2017
MSK Conditions
MSK BURDEN OF DISEASE
MSK data and tools
• MSK affects millions of people in the UK • MSK conditions are:
• The leading cause of years lived with disability (YLDs)*
• The third largest cause of disability adjusted life years (DALYs) in the UK today*
• Over 30 million working days are lost due to MSK conditions each year
MSK data and tools 4 *Source: Arthritis UK, State of Musculoskeletal Health 2017
5 MSK data and tools Source: Employer’s toolkit
MSK Burden of Disease
6 MSK data and tools Source: Employer’s toolkit
MSK Burden of Disease
MSK Burden of Disease YLDs* South East (all ages, 2016)
7 MSK data and tools
*Years lived with disability
Source: Global Burden of Disease Study 2016 (GBD 2016)
MSK Burden of Disease DALYs* South East (all ages, 2016)
8 MSK data and tools
* Disability-adjusted life years
Source: Global Burden of Disease Study 2016 (GBD 2016)
MSK PREVALENCE
MSK data and tools
Indicators include: • Arthritis or long-term joint problems • Long-term back problems • Rheumatoid Arthritis • Osteoporosis
MSK data and tools 9
MSK data and tools 10 Source: Public Health England, Fingertips MSK data and tools
Arthritis or long-term joint problem
MSK data and tools 11 Source: Public Health England, Fingertips MSK data and tools
Long-term back problem
MSK data and tools 12 Source: Public Health England, Fingertips MSK data and tools
Rheumatoid Arthritis
MSK data and tools 13 MSK data and tools Source: Public Health England, Fingertips
Osteoporosis
MSK RISK FACTORS
MSK data and tools
Risk factors include: • Obesity • Smoking • Physical inactivity • Alcohol use • Falls (risk factor / prevalence)
14 MSK data and tools
MSK data and tools 15 Source: Public Health England, Fingertips MSK data and tools
Obesity (QOF)
MSK data and tools 16 Source: Public Health England, Fingertips MSK data and tools
Smoking prevalence (QOF)
MSK data and tools 17 Source: Public Health England, Fingertips Note: LA boundaries do not correspond exactly to STP geographies
MSK data and tools
Physical inactivity
MSK data and tools 18 MSK data and tools
Alcohol (admissions as proxy)
Source: Public Health England, Fingertips Note: LA boundaries do not correspond exactly to STP geographies
MSK data and tools 19 MSK data and tools
Hospital admissions for falls
Source: Public Health England, Fingertips Note: LA boundaries do not correspond exactly to STP geographies
MSK COMORBIDITIES
MSK data and tools 20
Comorbidities include: • Cardiovascular disease • Depression • Diabetes • Lung Disease
MSK data and tools
Coronary heart disease (QOF) vs. prevalence of arthritis or long-term joint problem (All CCGs in England)
Source: PHE, Fingertips MSK data and tools 21 MSK data and tools
Physical health
Source: Public Health England, Fingertips
Depression (recorded prevalence) vs. prevalence of arthritis or long-term joint problem (All CCGs in England)
Source: PHE, Fingertips MSK data and tools 22 MSK data and tools
Mental health
Source: Public Health England, Fingertips
MSK TREATMENT
MSK data and tools
Treatment and outcomes indicators include: • Rate of hip replacements • Primary care prescribing • Spend on non-elective admissions
23 MSK data and tools
MSK data and tools
Oxfordshire CCG
West Kent CCG
Slough CCG
South Kent Coastal CCG Medway CCG
Dartford, Gravesham, Swanley CCG
Surrey Heath CCG
North East Hampshire and Farnham CCG
High Weald Lewes Havens CCG
24
Directly age and sex standardised rate of primary hip replacement procedures per 100,000 population by CCG of residence in the South East, 2014/15
MSK data and tools Sources: Hospital Episode Statistics, The Health and Social Care Information Centre. Copyright © 2016; 2014 mid-year population estimates (2011 Census based), Office for National Statistics.
Hip replacements
MSK data and tools 25 MSK data and tools Source: NHS England Analytical Service, Commissioning for Value data for cancer and MSK focus packs 2016 (Similar CCGS based on range of demographic data)
Primary care prescribing
MSK data and tools 26 MSK data and tools
Non-elective spend on admissions
Source: NHS England Analytical Service, Commissioning for Value data for cancer and MSK focus packs 2016 (Similar CCGS based on range of demographic data)
MSK TOOLS AND ANALYSIS
MSK data and tools
Tools to help commissioners locally include: • NHS RightCare pathway • Spend and Outcomes Tool (SPOT) • MSK return on investment tool • Musculoskeletal Disease Profile
27 MSK data and tools
MSK data and tools 28 MSK data and tools Source: NHS RightCare
NHS RightCare Focus Packs
• Falls and Fragility Fractures Pathway • optimal service for people who have suffered a fall or are
at risk of falls and fragility fractures
• ‘Where to look’ packs, available at: • CCG level • STP footprint areas
(Note: Buckinghamshire, Oxfordshire and Berkshire STP pack not produced due to incomplete spend data for 2015/16)
29 MSK data and tools Source: NHS RightCare, Commissioning for Value Where to Look pack, NHS Oxfordshire CCG (2017)
NHS RightCare CCG ‘Where to Look’ Pack Example of NHS Oxfordshire CCG
NHS RightCare: STP ‘Where to look’ packs Indicative example for Frimley Health STP – BOB STP pack not produced due to incomplete data
30 MSK data and tools Source: NHS England Analytical Service, Commissioning for Value data for cancer and MSK focus packs 2016
MSK data and tools 31 MSK data and tools
Spend and outcomes tool (SPOT)
• Tool to review spend against a selection of outcomes
• Includes Musculo Skeletal (MSK) • Helps identify programmes with outcomes that
are significantly different to similar local authorities or CCGs
Source: Public Health England, Spend and Outcomes Tool (SPOT)
MSK data and tools 32
Spend on Problems of Musculo Skeletal System vs. Hip fracture, % recovering to previous level of mobility at 30 days
MSK data and tools Source: Public Health England, Spend and Outcomes Tool (SPOT)
SPOT e.g. Hip fracture, recovering mobility
MSK data and tools 33 MSK data and tools Source: Public Health England, Musculoskeletal conditions: return on investment tool
Musculoskeletal: return on investment tool • Launched October 2017 • To help commissioners provide cost-effective
interventions for MSK conditions • Reviewed interventions include:
• Cognitive Behavioural Therapy (CBT) • STarT Back (Stratified Risk Assessment and
Care) • 'PhysioDirect - Early telephone assessment and
advice' • Self-referral to physiotherapy
MSK data and tools 34 MSK data and tools Source: Public Health England, Musculoskeletal Disease Profile
Musculoskeletal Disease Profile • Launched November 2017 • Data on a single platform to enable
commissioning of high value musculoskeletal services
• Covers: • health needs of local populations • amount of people accessing services • cost of services and; • outcomes services deliver