Using online maps to address unwarranted variation in health

Writing in the Health Service Journal this week (subscription needed) paediatric registrar Dr Ronny Cheung highlights the NHS Atlas of Variation in Healthcare and in particular the Child Health Atlas as a useful tool in helping NHS commissioners reduce unwarranted variation in healthcare.

Unwarranted variation is a term associated with the work of professor Jack Wennberg who spent four decades documenting the geographic variation in the healthcare that patients receive in the United States. His assertion is that the variation occurs because healthcare is complex and there are many influencing factors. These include socioeconomic factors, differences in population age or gender and also innovation in healthcare delivery – which may lead to improvements in the quality of healthcare services delivered in one area.

Wennberg also believes that some variation is unwarranted. In other words, it should not be happening and can occur because healthcare professionals are not practising according to evidence-based clinical standards, or there is variation in clinical performance. It has also been shown that where there are high levels of healthcare provision, there are higher admission rates and more outpatient appointments.

The Child Health Atlas was devised as a way of illustrating the variation in healthcare children receive across 27 indicators of child health. It was compiled by the Child and Maternal Health Observatory and for the first time provides a visual online demonstration of variations across the breadth of child health services provided in England. You can read how ChiMat worked with InstantAtlas here. The Child Health Atlas allows users to view any of the 27 indicators at upper tier Local Authority or PCT level. The extent of the variation is considerable. For example, perinatal mortality varies twofold among PCTs in England and breastfeeding rates threefold

The intention is that clinicians, commissioners and service users will be able to identify priority areas for improving outcome, quality and productivity. The question is, now that we have the tools to reduce unwarranted variation in the shape of the Child Health Atlas, whether we will see a coordinated effort. Commissioners, local authorities (now responsible for public health) and provider organisations will have to work together to reduce variation. However, there are some who believe this in increasingly unlikely and that health and social care delivery is likely to be fragmented as a result of the Health and Social Care Act. As with so many things in healthcare delivery, it is going to be a case of having to wait and see.