PROFILING OUTPATIENT WORKLOAD - PRACTICE VARIATIONS BETWEEN CONSULTANT FIRMS AND HOSPITALS IN SOUTH-WEST ENGLAND

Objectives-To describe the variation in outpatient new to old ratios b etween consultants and between providers for seven high volume special ties (four surgical, three medical). Design-This was a descriptive stu dy at consultant and provider unit level based upon patient administra tion system data from the South and West Regional Health Authority for the financial year 1992-93. Additional components of variance analysi s was used to distinguish individual consultant effects from host inst itution effects. Setting-The former South Western Regional Health Auth ority area from Gloucestershire to Cornwall. Subjects-Altogether 345 c onsultant firms in seven specialties grouped into 13 provider unit gro ups. Main Measures-New to old ratio, omitting elective inpatients foll owed up as outpatients. Results-Variation between consultants is great er in surgical than in medical specialties, while absolute levels of n ew to old ratios tend to be higher in surgical specialties than in med ical. Variation between provider unit groups is also greater in surgic al specialties. Analysis of variance shows that more total variance is attributable to provider unit group in gynaecology than in other spec ialties. Conclusions-Within individual specialties there is evidence o f substantial variation that is not attributable to underlying differe nces in morbidity patterns. There is evidence of marked variation in t erms of both individual consultants and institutions, a finding that p rovides the springboard for further analytical work. Published routine outpatient activity statistics should distinguish between new referra ls, inpatient follow up, and clinic rebookings.