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
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Improved Data Standards
Greater Consistency in Data Collection
Increased Numbers of Minimum Data Sets
National Metadata Repository (Meteor)
> Improved Public Reporting, e.g.:
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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
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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
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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
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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
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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
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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