Measuring Health
Outcomes:
Capturing Complexity
NatStats Conference 2008
Dr Penny Allbon
Director
AIHW
Australian Institute of Health and Welfare
The complexity is growing
Australian Institute of Health and Welfare
How is the information
environment responding
Indicators
explosion
Data sets explosion
Australian Institute of Health and Welfare
Linked data sets
growing
Ehealth looming
Personal record
control emerging
Australian Institute of Health and Welfare
key drivers for measuring health
outcomes into the future
Assess how healthy we are and how this is
changing – monitoring and surveillance
the holy grail of attribution (health research)
the drive for effectiveness and efficiency of
services
Improve the outcomes of care and treatment
the individual’s desire to better understand
and control their own health
Australian Institute of Health and Welfare
Australia compares well
among OECD
Australian Institute of Health and Welfare
Broad cause mortality trends,
Australia
Australian Institute of Health and Welfare
Leading
burdens of
disease
Australian Institute of Health and Welfare
Burden of disease in 2003 by major disease group, subdivided into
that portion mostly unavoidable, that portion due to 14 burden of
disease risk factors, and other treatable or preventable burden
Malignant neoplasms
Cardiovascular disease
Mental disorders
Unavoidable
Nervous system
Burden due to 14 risk
factors (a)
Respiratory
Other treatable or
preventable (b)
Injuries
Diabetes mellitus
Musculoskeletal diseases
Other
0
100
200
300
DALYs ('000)
Source: AIHW & University of Queensland
400
500
Australian Institute of Health and Welfare
Projected health expenditure
($ billion 2003 prices)
2003
2033
Change
Diabetes
1.4
7.0
401%
Dental
5.1
12.4
144%
Cardiovascular
7.9
16.2
105%
Mental
4.3
8.5
97%
Cancer
2.8
5.2
84%
Injuries
5.6
9.4
67%
1.78
2.5
41%
71.4
162.3
127%
Maternal
Total
Australian Institute of Health and Welfare
What’s the impact of obesity?
Australia experienced significant increases in
obesity in the 2 decades to 2003 when heart
disease was declining
From the Harvard Nurses study we might conclude
that
increasing BMI means coronary heart
disease is decreasing at a slower rate than it
would otherwise.
Australian Institute of Health and Welfare
Cancer survival improving
Australian Institute of Health and Welfare
Cancer Data Improvement
Cancer Data Clearing House (AIHW)
Maintenance function - Improving
consistency, keeping up-to-date, reporting
Safety &quality
– volume/outcomes analysis?
Recording data on the staging of cancer
Outpatients – chemotherapy, radiotherapy.
Slow, can this be given priority?
Australian Institute of Health and Welfare
Potentially preventable hospitalisations (PPH) by remoteness
of patient, 2005–06
80
Vaccine-preventable
70
Acute
PPH per 1,000
60
Chronic
50
40
30
20
10
0
Major cities
Inner regional
Outer
regional
Remote
Very remote
Australian Institute of Health and Welfare
Push the basics
Keep basic order and cooperation –
standards, business rules, frameworks,
metadata expansion
Common concepts and definitions
Australian Institute of Health and Welfare
Facilitate re-use
Working together and coordinating effort –
within a collaborative framework
Central portal of what’s available? Use of
Clearing Houses?
Australian Institute of Health and Welfare
Think about priorities
Do we need a process to prioritize the
information requirements for the health
outcomes agenda?
Australian Institute of Health and Welfare
Balance privacy/access
Be pro-active in educating the public about
the usefulness of the information
Australian Institute of Health and Welfare
More data linkage
continue to build the capacity to link data –
securely and without scaring the horses.
From stovepipes
to
integrated systems
Australian Institute of Health and Welfare
Exploit ehealth well
Get the statistical capacity of ehealth
set up for maximum benefit
Statistical purpose
Information for analytical
purposes including public
health
and policy planning, safety
initiatives, disease detection,
research and education
Statistical benefits
Better planning and demand
management
Better epidemiology and public
health
Australian Institute of Health and Welfare
Patient (IHI) interacts
with clinician
Clinician raises a natural language
and/or form-based record
Human coding assisted
by guidelines
Map
Unit records with
coded values
Classifications
Aggregate reports
eg. NMDS,
device registry,
patient records
possibly linked by IHI
with consent
Map
Clinician or coder raises a terminology
or rule-based record
Machine coding
according to maps
Information for research and analysis: hybrid
Australian Institute of Health and Welfare
Simple truths for a complex world
Profile
Institutional strength
Expertise