NatStats08 Conference Informing the Nation – Measuring Health Outcomes Dr David Filby Executive Director Policy and Intergovernment Relations 20 November 2008 MEASURING HEALTH OUTCOMES 1. What has happened in Australia over the past 15 years? 2. Recent initiatives 3. What are the implications of these reforms? 4. Measurement challenges 5. What new health outcomes measurement areas deserve consideration? 6. Conclusions What has happened in Australia over the past 15 years? > National Health Information Agreements > Cross-Jurisdictional Health Information Committees • • • • Improved Data Standards Greater Consistency in Data Collection Increased Numbers of Minimum Data Sets National Metadata Repository (Meteor) > Improved Public Reporting, e.g.: • • • • • Australia’s Health Review of Government Services (R.O.G.S.) Australian Hospital Statistics National Health Performance Framework Aboriginal and Torres Strait Islander Health Performance Framework > More emphasis on implications of the data, not just quality of the numbers > But still narrow scope, inconsistency and debate More Recently …. > COAG Reforms in Commonwealth-State Financial Arrangements • Movement towards measuring: Health Outcomes rather than just Health System Activity Outputs or Inputs Performance Indicators against Targets Commitment to public reporting on Outcomes and Outputs by both levels of Government > State-based Plans and Policies with a focus on Outcomes • Many focus on Whole-of-Government approaches to services and outcomes Example - South Australia’s Strategic Plan – “Health” targets > T2.1 Smoking Reduce the percentage of young (15-29yo) cigarette smokers by 10 percentage points between 2004 and 2014. > T2.2 Healthy Weight Increase the proportion of South Australians 18 and over with healthy weight by 10 percentage points by 2014. > T2.4 Healthy South Australians Increase the healthy life expectancy of South Australians by 5% for males and 3% for females by 2014. > T2.5 Aboriginal Healthy Life Expectancy Lower the morbidity and mortality rates of Aboriginal South Australians. > T2.6 Chronic Diseases Increase by 5 percentage points the proportion of people living with a chronic disease whose self-assessed health status is good or better. > T2.7 Psychological Wellbeing Equal or lower than the Australian average for psychological distress by 2014. > T6.3 Early childhood – Birthweight Reduce the proportion of low birthweight babies. Example – SA Health Strategic Plan – Performance Measures > 1. Strengthen primary health care • • • • Number of general practitioners participating in GP Plus Health Care programs. Proportion/number of people enrolled in self-management and integrated health care plans. Potentially preventable hospital admissions rate, including potentially preventable hospitalisations by quintile of socioeconomic disadvantage (by area of residence). Proportion of eligible persons who receive a voluntary health assessment. > 2. Enhance hospital care • • • • • • • Elective surgery waiting times, public hospitals. Hospitalisation rates for selected chronic conditions. National targets for public hospital emergency department waiting times. Level of consumer satisfaction with hospital services. Number of adverse events/sentinel events. Proportion of patients entering hospital as a ‘Day of Surgery Admission’ (DOSA). Hospital inpatients Relative Stay Index (RSI). Example – SA Health Strategic Plan – Performance Measures > 3. Reform mental health care • • • • • Percentage of people with a mental illness who receive care for their condition. Number of unplanned mental health readmissions within 28 days. Proportion of eligible mental health clients with improved HoNOS scores (Health of the Nation Outcome Scales). Rates of community follow-up for people within the first seven days of discharge from hospital. Number of active mental health clients with a care plan. > 4. Improve the health of Aboriginal people • • • • • • • Proportion of Aboriginal low birthweight babies. Aboriginal Infant mortality rate. Prevalence of chronic health conditions in Aboriginal people. Percentage of Aboriginal staff in SA Health workforce. Number of hospital admissions of Aboriginal people due to injury and poisoning. Number of GP health checks. Number of ‘Family Home Visiting‘ contacts for Aboriginal people. Measurement Implications of these Plans > Requires measurement of: • Health outcomes as well as outputs • Performance against targets > Current measurement tools may be rudimentary and imprecise > Outcomes are multi-factorial and multi-sectoral (not just derived from the Health Department) > More complex reporting requirements > Outcome measures development has common issues at both the State and Commonwealth levels Challenges in Measuring Health Outcomes > Indigenous Identification • Deaths data for monitoring of mortality, life expectancy • Births data to identify indigenous fathers as well as mothers • Still room to improve in hospitals • Non-hospital collection generally poor • Data linkage, audits, training > Primary Health Care • Nearly all measure patient visits, not purpose or outcomes • Significance of linkage to assess access to service across a variety of sectors • Large number of private, independent providers Challenges in Measuring Health Outcomes (cont’d) > Develop meaningful measures • Attribution • Agreed definitions, etc • Benchmarks > > > > Compliance Consistency Accountability Improving information quality and accountability to the public on health outcomes requires consideration of the following: • Privacy and Confidentiality • Data and Information Security What new Health Outcomes Measurement areas deserve consideration? > Patient Experiences and Patient Satisfaction > Alternative Data Sources: • Population Surveys • Research Studies • Data to emerge from proposed eHealth initiatives • Better use of Registries’ Data • Health Care Summaries and Care Plans > Data Linkage • NCRIS and PHRN • SA NT DataLink (aims to link health and nonhealth datasets) > Other Techniques: e.g. Data Mining CONCLUSIONS > We have come a long way in our ability to measure and report in health; but still • Very hospital focussed • Activity rather than outcome focussed • Little information on private activity > Challenge is to: • Be clear about the outcomes we want • Determine priority measures for those outcomes • Consistently provide quality data on those measures In order to enable the Australian Community to be better informed on the status and progress of their health and the health system