Abstract
The National Service Framework (NSF) for Coronary Heart Disease, published in the UK in 2000, gave target intervention rates of 750 procedures per million population (pmp) for both percutaneous transluminal angioplasty (PTCA) and coronary artery bypass graft (CABG). This paper describes how one Regional Office of the Department of Health, with CABG and PTCA rates of around half the NSF target levels, designed a strategy to plan rationally to meet the derived population need for these procedures. A bottom-up needs assessment model was used to predict the population need for these procedures for the Eastern Region of the UK. The Excel-based model took account of the effects of demographic change, anticipated reduction in incidence of heart disease due to primary prevention programmes and the expected improvement in cardiology and cardiac surgery technologies. The model predicted that excess procedures would be required across the region over the next 20 years. Further access study modelling was used to determine the best location for additional tertiary cardiac centres. Further, a commissioning tool was produced that could compare the predicted need, including additional procedures needed to meet waiting list targets, with capacity available from a range of providers. These tools have been used successfully in the Eastern Region to increase the regional revascularization rates from 371 pmp CABG and 322 pmp PTCA in 2000 to planned rates of 453 pmp CABG and 447 pmp PTCA in 2002 / 2003, to recommend the building of a new tertiary cardiac centre in Essex in the next decade and to inform the commissioning of revascularization rates in three coronary heart disease networks.
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