This document outlines the health target definitions that apply in 2014/15. As health targets form part of wider DHB monitoring framework and accountability arrangements, these definitions should be read in conjunction with further information about DHB planning, monitoring and reporting arrangements for
2014/15, available at www.nsfl.govt.nz.
Health target Target goal Page reference
Shorter stays in
Emergency
Departments
Improved access to elective surgery
Shorter waits for cancer treatment
Faster cancer treatment
Increased immunisation
Better help for smokers to quit
More heart and diabetes checks
95 percent of patients will be admitted, discharged, or transferred from an Emergency Department (ED) within six hours.
The volume of elective surgery will be increased by at least 4,000 discharges per year.
All patients ready-for-treatment, wait less than four weeks for radiotherapy or chemotherapy.
The 62-day faster cancer treatment indicator will be the next cancer health target from quarter two 2014/15.
85 percent of patients referred with a high suspicion of cancer wait
62 days or less to receive their first treatment (or other management) to be achieved by July 2016.
90 percent of eight months olds will have their primary course of immunisation (six weeks, three months and five months immunisation events) on time by July 2014 and 95 percent by
December 2014.
• 95 percent of hospitalised patients who smoke and are seen by a health practitioner in public hospitals are offered brief advice and support to quit smoking
• 90 percent of enrolled patients who smoke and are seen by a health practitioner in General Practice are offered brief advice and support to quit smoking
• Progress towards 90 percent of pregnant women who identify as smokers, at the time of confirmation of pregnancy in general practice or booking with a Lead Maternity Carer, being offered brief advice and support to quit smoking.
90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years.
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5
8
10
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17

Target Champion – Prof Mike Ardagh, National Clinical Director of ED Services
Summary information
Indicator: 95 percent of patients will be admitted, discharged, or transferred from an Emergency
Department (ED) within six hours.
Measures
Type:
Target:
Reporting
Output Type: Data and exception
Targets set in DHB’s Annual Plans Reporting frequency: Quarterly
Source data/template for reporting provided by: Data provided by DHBs, template on NSFL
Delivery against this measure supports the health and disa bility system outcome of ‘New Zealanders living longer, healthier and more independent lives’. Long stays in emergency departments (EDs) are linked to overcrowding of the ED, negative clinical outcomes and compromised standards of privacy and dignity for patients. Less time spent waiting and receiving treatment in the emergency department therefore improves the health services DHBs are able to provide. It also impacts on the Ministerial priority of improved hospital productivity by ensuring resources are used effectively and efficiently.
Reducing ED length of stay will improve the public’s confidence in being able to access services when they need to, increasing their level of trust in health services, as well as improving the outcomes from those services.
Increasing performance in this measure will also result in a more unified health and disability system, because a coordinated, whole of system response is needed to address the factors across the whole system that influence ED length of stay. Through the intermediate outcomes the target contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives
The following actions and activities are examples of initiatives that have a proven impact on this measure:
1. Good diagnostic work to identify the main factors impacting on ED length of stay, therefore ensuring that the main bottlenecks and constraints are addressed first.
2. Implementing programmes such as The Productive Ward – Releasing Time to Care or Optimising the Patient Journey which, among other things, help to improve the flow from ED through the hospital by freeing up resources.
3. Organising services differently so that non urgent cases can be treated more quickly.
4. Improving the pathways that patients take through the community, ED and hospital when getting treated for common conditions.
5. Improving hospital processes, like the discharging of patients, to help free up hospital beds that patients can move into after their ED treatment.
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Each DHB will be required to submit the following data to the Ministry on a quarterly basis for each of their ED facilities of level 3 and above, and some agreed level 2 facilities:
1. Numerator: number of patient presentations to the ED with an ED length of stay less than six hours, and
2. Denominator: number of patient presentations to the ED.
A reporting template will be supplied by the Ministry for the reporting of this data.
Those DHBs that do not met the 95 percent target for the quarter must also provide narrative comment on the activities undertaken during the quarter, and planned for the coming quarter, to meet the target and improve the quality of acute care, and any difficulties encountered.
National Non-Admitted Patient Collection (NNPAC)
Since 1 July 2009 the National Non-Admitted Patient Collection (NNPAC) database has included fields for the recording of data relating to the Shorter Stays in ED Health Target. The Ministry will continue to compare the numerator and denominator data provided each quarter by DHBs with the corresponding data obtained from NNPAC. The Ministry will then engage as needed with DHBs outside of the reporting process to examine and rectify any differences between these data sources.
Explanation of terms:
1. ED length of stay for a patient equals the time period from time of presentation , to time of admission , discharge or transfer .
2. Time of presentation is the time of first contact between the patient and the triage nurse or clerical staff, whichever comes first.
3. Time of admission is the time at which the patient is physically moved from ED to an inpatient ward, or the time at which a patient begins a period of formal observation . The physical move will follow, or be concurrent with, a formal admission protocol, but it is the patient movement that stops the clock, not associated administrative decisions or tasks.
4. Inpatient wards include ED Observation Units or Inpatient Assessment Units (or units with a similar function) 1 . Under certain circumstances, a ‘decant’ ward designed to deal with surge capacity will qualify as an inpatient ward. Key criteria are that patients should be in beds rather than on trolleys, and be under the care of appropriate clinical staff.
5. Formal observation means that patients are in an ED observation bed, an observation unit, or similar. Key criteria are that the area or unit should have dedicated staffing, have patients in beds rather than on trolleys, and be located in a dedicated space. Limited exceptions to these criteria, to allow patients t o be ‘observed’ in a monitored environment, should be formally approved by the
Clinical Director of the ED and discussed with the National Clinical Director of ED Services.
6. Time of discharge is the time at which a patient being discharged from the ED to the community physically leaves the ED. For the avoidance of confusion, if a patient’s treatment is finished and they are waiting in the ED facilities only as a consequence of their personal transport arrangements for pickup, they can be treated as discharged for the purposes of this measure.
7. Time of transfer is the time at which a patient being transferred to another facility physically leaves the ED. While a patient is still in the ED, either receiving ongoing care, or awaiting transport, ED length of stay continues. Time of transfer can only be recorded when the patient physically leaves the ED.
Inclusions and exclusions:
1. Data provided to the Ministry will be provided at facility level for all EDs of level 3 and above, and those agreed level 2, within each DHB, according to the role delineation model as elaborated in the
ED service specification. Where a DHB has more than one facility, the overall percentage
1 For further information please refer to the Guidance Statement: ED Observation and ED Assessment Units on http://www.hiirc.org.nz/page/18737/guidance-statement-ed-obervation-andinpatient/?section=9088&contentType=451&tab=822
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calculated for the DHB will be a weighted result, not a simple average of the results of individual facilities. The performance of individual facilities has been reported from Quarter 1, 2013/14.
2. All presentations between 00:00 hours on the first day of the quarter, and 00:00 hours on the first day of the next quarter, are included except:

Patients who do not wait for treatment; these will be removed from both the denominator and the numerator.

GP referrals that are assessed at the ED triage desk (using the Australasian Triage Scale), but are then directed to an Admission and Planning Unit or similar unit without further ED intervention. Here the term ‘ED intervention, sufficient for inclusion in the measure, can encompass more detailed nursing assessment (over and above triage) and minor procedures such as analgesia or administration of intravenous fluids, for instance.

Patients that present to the ED for pre-arranged outpatient-style treatment.
3. No exceptions from measurement are made for particular clinical conditions.
In certain situations it may be that good clinical practice or a particular service model will compromise the ability to meet Health Target expectations. Where this situation arises, the Ministry will discuss this with the DHB affected and the definition can be re-interpreted on a case-by-case basis where relevant.
All DHBs are expected to achieve the target percentage for this Health Target.
The following achievement scale will be applied during quarters one to three:
Rating:
Achieved The DHB has met the target percentage for the quarter
Partially Achieved The DHB has not met the target percentage but the narrative comment provided satisfies the assessor that the DHB is on track to compliance.
Not Achieved The DHB has not met the target percentage for the quarter and the quantitative information provided does not satisfy the assessor that the DHB is on track to compliance.
Only Achieved or Not Achieved ratings will be awarded in quarter four based on whether the DHB has achieved or not achieved the target.
In addition to the target, each DHB is expected to collect and internally monitor their performance against a range of more specific quality measures. The monitoring of additional performance measures is intended to complement the Short Stays in ED health target by providing a concrete and comparable measure of the quality and outcomes of acute care. As the purpose is to inform internal DHB improvement and quality, DHB performance against these measures is not required to be routinely reported to the Ministry. However, the Ministry may request to review them if there are concerns about performance or quality. The selected measures should span the spectrum of acute care – from primary care, through secondary services (including ED), to post-hospital primary and community care. The
Ministry will provide further information prior to the beginning of the 2014/15 year.
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Target Champion – Clare Perry, Manager, Elective Services
Summary information
Indicator: The volume of elective surgery will be increased by at least 4,000 discharges per year.
Measures Reporting
Type:
Target:
Output
Targets set in APs
Type:
Reporting frequency:
Exception
Quarterly
Source data/template for reporting provided by: Data supplied by DHB to National Minimum
Dataset, and report provided by Ministry. Report will be loaded on Quickr
Delivery against this measure supports the health and disability system outcome of ’New Zealanders living longer, he althier and more independent lives’
. The primary intermediate outcome is that
‘people receive better health and disability services’ . An additional intermediate outcome is that ‘the health and disability system and services are trusted and can be used wi th confidence’
. This measure will also support delivery of the Minister of Health’s priority of ‘improving hospital productivity’ .
Elective services are an important part of the health care system for the treatment, diagnosis and management of health problems. Increasing elective surgery by at least 4000 discharges year on year will result in better access to health and disability services for New Zealanders. Timely access to elective services is considered a measure of the effectiveness of the health system. Increasing delivery will improve access and reduce waiting times will increase public confidence that the health system will meet their needs.
Elective surgery is important to New Zealanders as these are essential services to improve quality of life by reducing pain or discomfort, and improving independence and wellbeing. Improved hospital productivity will be required to ensure the most effective use of resources so that year on year growth in electives can be achieved.
The continuing increase in delivery requires improvement in DHB-wide productivity and efficiency initiatives, development of regional services where appropriate, and collaboration between DHBs to improve patient access, reduce waiting times, and make better use of resources. It also requires shared clinical input to national service prioritisation tools and referral guidance.
The following actions and activities are examples of initiatives that have a proven impact on this measure:
1. The Electives Initiative which provides ring fenced funding to improve access to elective surgery.
2. The Ambulatory Initiative, which supports improving access to diagnostics and specialist assessment and which is reducing waiting times for people requiring elective surgery.
3. Improved production planning and monitoring frameworks to ensure targets are achieved, or appropriate remedial plans in place to ensure people have access to promised services.
4. Improving theatre productivity and ward efficiency, including increasing day surgery and day of surgery admission rates will increase capacity for elective surgery.
5. Adoption of new approaches for assessment and treatment such as non contact First Specialist
Assessments and primary care options for direct access to treatment lists
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The number of elective surgical discharges provided nationally will increase by at least 4,000 discharges per annum.
DHBs will be required to report on progress quarterly on an exception basis against the target agreed in their Annual Plan. This level of reporting will provide early warnings of any DHB that may be experiencing difficulty in achieving their annual target and provide the opportunity for corrective actions to be undertaken.
Reporting period
Quarterly reporting. Note reporting for this measure operates on a delayed timetable – not as per the
Operational Policy Framework – as the hospital activity needed for reporting is not available until one month after the quarter ends. Data will be made available to DHBs via the Electives Services Quickr website. Electives Services Managers, and General Managers Funding and Planning will be notified via email that the data is available.
Expectations
At a national level DHBs will deliver at least 4,000 elective discharges each year in surgical specialties.
Each DHB will identify a minimum level of elective surgery to be provided to the people living in its regions in the 2014/15 Annual Plan. The level of surgery to be provided should be determined by the
DHB’s actual level of service in the previous financial year - 2012/13 (previous year at the time of issue of planning advice), the level of service planned and projected in the current financial year - 2013/14
(current year at the time of issue of planning advice), and the achievement of equitable access to elective surgery relative to other DHBs.
There will be three levels of achievement for this indicator; Achieved, Partially Achieved and Not
Achieved. A rating will be determined for each indicator.
Quantitative measures
DHBs will set a target number of publicly funded, casemix included, elective discharges in a surgical specialty (defined by surgical purchase units excluding dental) for people living within the DHB region.
Performance will be measured from surgical purchase units, excluding dental, and including MS02016 and S40007 using data from the National Minimum Data Set (NMDS).
Achievement Levels
R Rating
Achieved
Partially Achieved
Not Achieved
Full Year Quarterly (year to date)
DHB delivers their agreed target number of elective surgical discharges.
DHB delivers their agreed target number of elective surgical discharges.
DHB does not deliver their agreed target but delivers more elective surgical discharges than the previous year, or is within 1% of plan.
DHB is within 1% of plan
OR
DHB delivers less than their agreed quarterly target but submits a report that meets Ministry approval by providing the reasons for underdelivery and an action plan as to how it will address the under-delivery and achieve the full year target.
DHB delivers less than the number of elective surgical discharges required for partially achieved (above).
DHB delivers less than their agreed quarterly target and either does not submit a report or does not submit a report that meets Ministry approval.
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Target Champion – Dr Andrew Simpson National Clinical Director, Cancer
.
Summary information
The length of time taken for a patient referred with

a high-suspicion 1 of cancer 2 (without a confirmed pathological diagnosis of cancer at referral)

where the triaging clinician believes the patient needs to be seen within two weeks to receive their first treatment 3 (or other management) for cancer.
Measures
Type:
Target
Output
85 percent of patients referred with a high suspicion of cancer wait 62 days or less to receive their first treatment (or other management) to be achieved by July 2016.
Source data/template for reporting provided by:
Reporting
Type:
Reporting frequency:
Data report
Quarterly (monthly submission)
Data to be supplied by DHBs. For detailed information on reporting process please refer to Faster Cancer Treatment
Indicators: Business Rules and Data Definitions available from: www.nsfl.health.govt.nz/apps/nsfl.nsf/pagesmh/450
1 High-suspicion: means the person presents with clinical features typical of cancer, or has less typical signs and symptoms but the triaging clinician suspects that there is a high probability of cancer.
2 For the purposes of the FCT project, the term cancer is defined as the ICD10 primary diagnosis codes set out in
Appendix B of the Faster Cancer Treatment Indicators: Business Rules and Data Definitions available from: www.nsfl.health.govt.nz/apps/nsfl.nsf/pagesmh/450 .
3 A patient’s first treatment for cancer must be one that is publicly funded if it is to be included in FCT data reporting.
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Delivery of this measure supports the overarching outcomes for the health and disability system of ‘New
Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a p roductive economy’,
The faster cancer treatment health target takes a pathway approach to care, to facilitate improved hospital productivity by ensuring resources are used effectively and efficiently. DHBs working towards achievement of the target (performance level has yet to be set) against the health target supports public trust in the health and disability system; and that these services can be used with confidence.
Implementing the overall faster cancer treatment programme supports the overarching goal of Better,
Sooner, More Convenient Health Services for New Zealanders. Cancer treatment is provided across all
DHBs, although not all DHBs provide all services. This requires DHBs to collaborate across boundaries to ensure services are integrated and patients receive a seamless service.
Implementation of the faster cancer treatment health target requires existing capacity and resources to be maximised, this results in effective and efficient use of resources and supports the key planning consideration of value for money.
Actions to deliver improved performance in this focus area:
Actions to deliver improved performance in this focus area for 2014/15 include:

use the updated Business Rules and Data Definitions to ensure consistency of reporting

improve the quality of data (volume of patients, number of tumour types, types of first treatment) captured against the health target measure
 use the data to identify areas for system and process improve along the patients’ pathway and improve performance against the target

analyse the data to understand any differences in access or timeliness by ethnicity or geography.
Additional actions for 2014/15 and out-years could include:

review and re-design of the booking and scheduling of appointments for patients with a highsuspicion of cancer, including use of single point of referral to streamline referral route

implement fast-track access to all necessary diagnostic scans and investigations

develop rapid reporting and communication of results of diagnostic scans and investigations

review and re-design of the coordination of treatment processes and booking processes to ensure optimal use of capacity.
Detailed information is provided in the Ministry of Health’s Faster Cancer Treatment Indicators: Business
Rules and Data Definitions available from: www.nsfl.health.govt.nz/apps/nsfl.nsf/pagesmh/450.
Please refer to this document for information on the definitions, inclusions and data reporting processes.
For interpretation issues please refer to the
Ministry of Health’s
Faster Cancer Treatment Indicators:
Business Rules and Data Definitions available from: www.nsfl.health.govt.nz/apps/nsfl.nsf/pagesmh/450.
Alternatively contact the Ministry of Health’s cancer team via cancer_team@moh.govt.nz
Reporting required
Monthly supply of data (within 20 days of the end of the month) via secure file transfer protocol as outlined in the Ministry of Health’s Faster Cancer Treatment Indicators: Business Rules and Data
Definitions available from: www.nsfl.health.govt.nz/apps/nsfl.nsf/pagesmh/450.
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Quarterly supply of qualitative reporting through the quarterly reporting database as per the following table:
Quarter
Quarter 1
Quarter 2
Quarter 3
Quarter 4
For the time period
1 July – 30 September
1 October – 31 December
1 January – 31 March
1 April – 30 June
Rating:
Achieved
Partially Achieved
Not Achieved will apply, when for all of the three months under review, 85 percent of patients referred with a high suspicion of cancer waited 62 days or less to receive their first treatment (or other management) will apply when the DHB has improved its performance from the previous quarter and the narrative comment provided confirms the DHB has appropriate actions in place to reach the target. will apply when the DHB has not met the target for the quarter or the DHB has not improved its performance from the previous quarter and the narrative comment does not provide sufficient assurance that the DHB has the appropriate actions in place to reach the target.
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.
Target Champion – Dr Andrew Simpson National Clinical Director, Cancer
Summary information
All patients ready-for-treatment, wait less than four weeks for radiotherapy or chemotherapy.
Measures
Type:
Target
Output
All patients, ready-for-treatment, wait less than four weeks from decision-to-treat.
Reporting
Type: Data and exception report
Reporting frequency: Quarterly (monthly template submission)
Source data/template for reporting provided by: Data to be supplied by DHBs, template is on NSFL
Delivery against this measure supports the health and disability system outcome of ‘New Zealanders
living longer, healthier and more independent lives’, and the intermediate outcome of ‘the health and disability system and services are trusted and can be used with confidence’ .
Continued performance of the DHB against this measure, ensuring the timely access to cancer treatment for everyone needing it, will support public trust in the health and disability system; and that these services can be used with confidence. Through the intermediate outcomes the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives.
Radiotherapy treatment is provided in the six cancer centre DHBs requiring DHBs to collaborate across boundaries to support continued achievement of this measure for the DHB ’s domicile population.
Chemotherapy treatment is provided in almost all DHBs and requires collaboration across boundaries to ensure services are integrated and patients receive a seamless service.
Achievement of this measure requires existing capacity and resources to be maximised, this results in effective and efficient use of resources and supports the key planning consideration of value for money.
Actions to deliver improved performance in this focus area:
Actions to deliver improved performance in radiotherapy include:

use information systems that provide information on prospective demand management allowing flexibility in management of workflow and scheduling

undertake lean-thinking reviews to identify areas where the workflow can be streamlined from
First Specialist Assessment (FSA) to start of treatment to ensure patients start treatment within four weeks

undertake regular process reviews to identify system bottlenecks and ensure processes can be put in place to minimise the bottlenecks and / or impact of bottlenecks on target achievement

continue to upgrade and replace capital in timely manner to ensure appropriate capacity is maintained

improve training and education opportunities to improve the skill mix of key workforce include radiation therapists, medical physicists and radiation oncologists
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
implement strategies to support recruitment and retention of key workforce.
Actions to deliver improved performance in chemotherapy include:

use information systems that provide information on prospective demand management allowing flexibility in management of workflow and scheduling

undertake lean-thinking reviews to identify areas where the workflow can be streamlined from
FSA to start of treatment to ensure patients start treatment within four weeks

undertake regular process reviews to identify system bottlenecks and ensure processes can be put in place to minimise the bottlenecks and / or impact of bottlenecks on target achievement

implement strategies to support recruitment and retention of medical oncology and haematology workforce.
Radiotherapy – DHB of service (Cancer Centre DHB) reports all patients by DHB of domicile
Completed monthly templates that measure the interval between the decision-to-treat and the patient beginning radiation treatment along with other related measures, are supplied on time and complete from the DHB of service (Cancer Centre DHB) as detailed in the reporting template located on the nationwide service framework library web site NSFL homepage: http://www.nsfl.health.govt.nz/ . Patients are identified by DHB of domicile.
Chemotherapy - DHB of service reports all patients by DHB of domicile
Completed monthly templates that measure the interval between the decision-to-treat and the patient beginning chemotherapy treatment along with other related measures, are supplied on time and complete from all DHBs where chemotherapy treatment has commenced (DHB of service) as detailed in the reporting template located on the nationwide service framework library web site NSFL homepage: http://www.nsfl.health.govt.nz/ . Patients are identified by DHB of domicile.
All DHBs – confirmation and exception reports
Provide a report confirming the DHB has reviewed the monthly wait time templates produced by the DHB of service or its own DHB where treatment commenced at that DHB for the quarter.
Where the monthly wait time data identifies:

any patients domiciled in the DHB waiting more than four weeks, due to capacity issues, and/or

wait time standards were not met.
DHB of domicile must understand and report the resolution path being taken by the DHB of service where it does not provide radiotherapy or chemotherapy itself.
Interpretation issues
Wait times outside the acceptable treatment standard occur either when a service is facing capacity issues or when a patient chooses to wait for treatment or there are clinical reasons for delay. Where there are clearly identified reasons for delays that meet the defined delay code criteria, other than service capacity issues, the target will be treated as met.
Reporting required
Monthly supply of templates (within two weeks of the end of the month) and quarterly supply of confirmation and exception reports, as per the following table:
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Quarter
Quarter 1
Quarter 2
Quarter 3
Quarter 4
For the time period
1 July – 30 September
1 October – 31 December
1 January – 31 March
1 April – 30 June
The following achievement scale will be applied:
Rating:
Outstanding Performer will apply, at the end of the 12 month period, where all patients ready-fortreatment are treated within four weeks from decision-to-treat (excluding delays that meet the defined delay code criteria).
Achieved will apply, for all of the three months under review, where all patients readyfor-treatment receive treatment within four weeks from decision-to-treat
(excluding delays that meet the defined delay code criteria).
Partially Achieved
Not Achieved will apply, for two of the three months under review, where all patients readyfor-treatment receive treatment within four weeks from decision-to-treat
(excluding delays that meet the defined delay code criteria). will apply, for one month or more in the period under review, where some patients ready-for-treatment did not receive treatment within four weeks from decision-to-treat (excluding delays that meet the defined delay code criteria).
Note: Calculation of target achievement excludes Category D radiation patients.
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Target Champion – Pat Tuohy, Chief Advisor, Child and Youth Health
Summary information
Indicator: 90 percent of eight months olds will have their primary course of immunisation (six weeks, three months and five months immunisation events) on time by July 2014 and 95 percent by December 2014.
Measures Reporting
Type: Outcome Type: Mandatory
Target: Targets set in APs Reporting frequency: Quarterly
Source data/template for reporting provided by: Data supplied from Ministry from NIR
Delivery against this measure supports the health and disability system outcome of
‘New Zealanders living longer, healthier and more independent lives’ and the primary intermediate outcome of ‘Good health and independence are protected and promoted’.
Additional intermediate outcomes are ‘
A more unified and improved health and disability system’, ‘People receive better health and disability services’ and ‘The health and disability system and services are trusted and can be used with confidence’. This measure will also support delivery of the Minister of Health’s priorities of ‘ Strengthening the health workforce’ and ‘Speeding up the implementation of the Primary Health Care Strategy’.
Improved immunisation coverage leads directly to reduced rates of vaccine preventable disease, and consequently better health and independence for children. This equates to longer and healthier lives.
The changes which are required to reach the target immunisation coverage levels will lead to better health services for children, because more children will be enrolled with and visiting their primary care provider on a regular basis. It will also require primary and secondary health services for children to be better co-ordinated. These actions are leading to improved implementation of the Primary Health Care
Strategy, and the primary care workforce including maternity is better equipped to address the needs of children and families.
Training in immunisation provision, health education for parents, knowledge about vaccine preventable diseases and how to identify and provide services to high needs populations will generalise to a range of other child and family service areas.
Deliverable
Percentage of eligible children fully immunised at eight months of age – total DHB population,
Māori and Pacific
The Ministry will report coverage each quarter using the following NIR Datamart reports:
• NIR BC CI Overview - Milestone Ages DHB
• NIR BC CI Overview - Milestone Ages National
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The parameters for above reports will be:
The report date is the first day after completion of the quarter period:
• July to September Quarter - 1 October
• October to December Quarter - 1 January
• January to March Quarter – 1 April
• April to June Quarter – 1 July
The ‘Report Run’ date will be two weeks following the quarter to ensure that the complete quarter's data has been loaded on to the NIR datamart. This report will generally be run on working days between 10 th and 15 th of October, January, April and July.
The Ministry will report the 8 month milestone age from the ‘3 Months Final Dose’ tab.
The reports at both National and DHB level will be available to DHBs in both Excel and PDF format in the toolkit section. DHBs are expected to use this report for providing comments through the quarterly database.
Immunisation Coverage Targets
Immunisation coverage will be measured using the National Immunisation Register. A new eight month milestone report has been introduced to report on coverage. Achieving this target will require different rates of improvement for different populations, and some DHBs will have final immunisation coverage above or below the annual target depending on the active “opt-off” rate in their population. This target will be reported for Maori, Pacific (where relevant), and Other ethnic groups.
The national target is 90 percent of eight-month-olds have their primary course of immunisation at six weeks, three months and five months on time by July 2014 and 95 percent by December 2014. DHBs will be expected to set regional targets to meet these goals which there may be a range of individual
DHB targets. The Ministry does not intend to negotiate DHB targets with individual DHBs, but expects
DHBs within a region to negotiate target levels between themselves that will deliver the national target goals.
DHBs are expected to set targets that will reduce inequalities. All ethnic targets will be the same as the total population target. Individual DHBs should set targets with the aim of eliminating inequalities by
2015.
Assessing DHB Immunisation Coverage
Progress towards the health target will be assessed quarterly.
The target will be assessed based on three month ’s data for the previous quarter.
The assessment requirements for each quarter are set out below:
Table 1: Quarters 1, 2 & 3 assessment
Rating
Not Achieved
Explanation
Achieved* The DHB has reached the year’s total population immunisation coverage target for children eight months of age (as documented in the Annual
Plan).
Partially Achieved The DHB’s immunisation coverage has improved from the coverage at the start of the year and has made significant progress towards the target
(as documented in the Annual Plan).
The DHB’s immunisation coverage has not improved from the coverage at the start of the year and has not significantly progressed towards the target
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*From 2014/15 for all performance measures included in the Maori health plan this rating is applied when the
DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Maori population group, and the Pacific population group.
Table 2: Quarter 4 assessment
Rating
Outstanding
Performer
Achieved
Explanation
 The DHB has substantially exceeded the year’s immunisation coverage target for children eight months of age; and/or
 The DHB has reached the year’s immunisation coverage target for children eight months of age for: o the total population, and o the Maori population group, and where applicable o the Pacific population.
The DHB has reached the year’s total population immunisation coverage target for children eight months of age (as documented in the Annual
Plan).
Partially Achieved The DHB’s immunisation coverage has improved from the coverage at the start of the year and has made significant progress towards the target
(as documented in the Annual Plan).
Not Achieved The DHB’s immunisation coverage has not improved from the coverage at the start of the year and has not significantly progressed towards the target
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Target Champion – Karen Evison, National Programme Manager, Ministry of Health
Co-Target Champion – Dr John McMenamin, Clinical Advisor on Smoking in Primary Care
Summary information

95 percent of hospitalised patients who smoke and are seen by a health practitioner in public hospitals are offered brief advice and support to quit smoking

90 percent of enrolled patients who smoke and are seen by a health practitioner in General Practice are offered brief advice and support to quit smoking

Progress towards 90 percent of pregnant women who identify as smokers, at the time of confirmation of pregnancy in general practice or booking with a Lead Maternity Carer, being offered advice and support to quit smoking.
Measures
Target: Target agreed in
Annual Plans
Reporting
Source data/template for reporting provided by:
Type: Data & report
Reporting frequency: Quarterly

Hospital target data – supplied by DHBs

Primary care target data – supplied to the Ministry of Health through the PHO performance programme (PPP) system

Maternity target data – data source to be negotiated
All reporting templates will be supplied by the Ministry.
Delivery against this measure supports the health and disability system outcome of ‘New Zealanders living longer, healthier and more independent lives’, as well as the intermediate outcome of ‘a more unified and improved health and disability system’. The measure also supports the Government’s aspirational goal of a Smokefree New Zealand by 2025. Achieving a Smokefree New Zealand will mean that:

our children and grandchildren will be free from exposure to tobacco and tobacco use

the prevalence of smoking across all populations will be less than 5 percent

tobacco will be difficult to sell and supply.
At present, tobacco smoking places a significant burden on the health of New Zealander’s and on the
New Zealand health system. Tobacco smoking is related to a number of life-threatening diseases, including cardiovascular disease, chronic obstructive pulmonary disease and lung cancer. It also increases pregnant smokers ’ risk of miscarriage, premature birth and low birth weight, as well as their children’s risk of Asthma and Sudden Unexplained Death in Infants (SUDI).
Stopping smoking confers immediate health benefits on all people, and is the only way to reduce smokers’ risk of developing a smoking-related disease. Providing smokers with brief advice to quit increases their chances of making a quit attempt. The chance of that quit attempt being successful is increased if medication and/or cessation support are also provided. Most medications roughly double a smoker’s chance of quitting, but using medication in conjunction with a cessation support service (such as the Quitline or an Aukati KaiPaipa service) can increase a smoker’s chance of quitting by as much as four times.
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By ensuring that all health professionals are routinely providing their patients with advice and support to quit, DHBs, PHOs and midwives are helping to ensure that people receive better health and disability services, and live longer and healthier lives.
The following actions and activities are examples of initiatives that have had an impact on this measure in both hospital and primary care settings:

Mechanisms for capturing data are accessible and easy to use.

Methods for referring patients to cessation support services are simple and succinct.

Services are able to monitor their progress towards the target on a regular basis.

Smokefree champions are in place within each ward, practice or service to provide motivation, education and support for the target.
Hospital target:
Each quarter, DHBs will be required to complete the template supplied by the Ministry (numerical and narrative sections must be completed). Local patient management systems will be used to capture the necessary data using the relevant ICD-10-AM codes (see table 1).
Table 1: Smoking related ICD-10-AM codes
Measurement of
Target
Hospitalised smokers
Advice and support
ICD Code ICD Definition
F17.1
F17.2
Z72.0
Z71.6
Mental and behavioural disorders due to use of tobacco, harmful use is assigned when a clearly documented relationship exists between a particular condition and smoking.
Mental and behavioural disorders due to use of tobacco, dependence syndrome is assigned only when a formal diagnosis of ‘tobacco dependence syndrome’ has been made.
Tobacco use, current is assigned if the patient has smoked tobacco within the last month and when there is insufficient documentation available to qualify the assignment of either F17.1 or F17.2.
Counselling for tobacco use disorder is assigned in addition to a tobacco status code when a health care worker has provided either advice to quit smoking and/or cessation therapy while the patient is in hospital.
- For completeness if Z71.6 coding exists in the absence of a code for hospitalised smoker, then apply code Z72.0.
Those DHBs that do not meet the 95 percent target for the quarter must provide the Ministry with an action plan detailing how they will improve their result, and must begin reporting their results to the
Ministry monthly.
Primary care target:
Each quarter, DHBs, in collaboration with their local PHOs, will be required to complete the template supplied by the Ministry. The Ministry will provide DHBs with their region’s primary care result once it has received the data from the PPP system.
Maternity target:
The Ministry is still searching for an appropriate data source to use in reporting on the maternity target.
Therefore, reporting requirements may change during the year. In the meantime, DHBs will be required to comment on the work they are doing to reduce the number of pregnant women who smoke in their region, as well as on the work they are doing to support their local midwives to provide advice and support to quit to their patients.
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Hospital target:
All adults who are:

aged 15 years and over

admitted to hospital either acutely or for elective procedures

admitted as an inpatient; and

identified as a current tobacco smoker at the time of admission (a current tobacco smoker is someone who has smoked within the last four weeks).
Explanation of terms
For the purpose of the hospital target a current smoker is someone who has smoked at all within the last four weeks. A facility is a place which may be a permanent, temporary or mobile structure, which health care users attend or are resident in, for the primary purpose of receiving health care or disability support services. This definition excludes supervised hostels, halfway houses, staff residences and rest homes where the rest home is the patient’s usual place of residence.
For the purposes of data collection for the hospital target, private hospitals are excluded. Therefore, the facility type includes, but is not limited to, public hospitals, psychiatric hospitals and drug and alcohol treatment facilities.
Primary care target:
All adults aged between 15 to 75 years who are enrolled in a PHO have been seen in General Practice in the last 15 months.
Maternity target:
All pregnant women aged 15 years and over. Further eligibility criteria will be announced once an appropriate data source has been found.
Quarterly reports must be submitted to the Ministry by the 20th of the month following the relevant quarter.
All DHBs are expected to maintain performance of 95 percent for the hospital target throughout 2014/15, and to meet the 90 percent primary care target by 30 June 2015. The achievement scale below will be applied to each of the target areas individually every quarter. Please note that DHBs will not be rated on their maternity target performance until an appropriate data source has been found.
Table 2: Health target achievement Scale
Rating Definition
Achieved*
Partial Achievement
Not Achieved
The DHB has met the percentage target for the quarter (ie, 95 percent for the hospital target and 90 percent for the primary care target).
The DHB has not met the percentage target, but has improved on its result from the previous quarter.
The DHB has not met the percentage target, and its result has dropped since the previous quarter.
*From 2014/15 for all performance measures included in the Maori health plan this rating is applied when the
DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Maori population group, and the Pacific population group.
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Target Champion – Karen Evison, Acting target champion
Summary information
Indicator:
90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years.
Measures Reporting
Type: CVD – Output Type: Data & exception
Target: Targets set in Annual Plans Reporting frequency:
Source data/template for reporting provided by:
CVD data provided by the Ministry from the PHO Performance
Programme (PHOPP)
Quarterly
Link to outcomes
Delivery against this measure supports the health and disability system outcome of ‘New Zealanders
living longer, healthier and more independent lives’, By increasing the percentage of people being checked and improving the ongoing management of their care, the DHB will impact the Ministerial priority of speeding up the implementation of the Primary Health Care Strategy by ensuring primary health care is better able to contribute to improved health outcomes. Consistent performance of the
DHB against this target, ensuring long-term conditions are identified early and managed appropriately, will help improve the health and disability services people received and aid in the promotion and protection of good health and independence. Through the intermediate outcomes the target contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives.
The following actions and activities are examples of initiatives that have a proven impact on this measure.

Strong collaboration and co-ordination between primary and secondary care;

Working with primary care to ensure that they have access to good data and can identify patients who need to be recalled for an appointment or need additional support to manage their health.

Community driven outreach programmes, including for example free CVD risk assessments offered at community events and workplaces, and promotion /education by people the target community identifies with. An example is PHARMAC’s One Hearts Many Lives programme.

Nurse-led support of diabetes self-management, and removal of identified barriers such as cost and time limited consultations.
Target Definition
The national target is 90% and was phased over 3 years. DHBs were required to achieve at least 60 percent by 30 June 2012, and at least 75 percent by 30 June 2013.
Deliverables definition
Each DHB must provide narrative comment for the indicator on the activities being taken to improve performance and achieve the target agreed through their Annual Plan. The narrative is to include specific activities undertaken for Maori and Pacific 1 populations.
Reporting period
1 The requirement to report about Pacific people applies only to those DHBs with high Pacific populations. These DHBs are:
Counties Manukau, Auckland, Waitemata, Waikato, Capital & Coast, Hutt Valley and Canterbury.
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Performance data for the CVD Risk Assessment indicator is to be reported quarterly.
The Ministry will provide summary data for the quarter. The data will be sourced from the PHO
Performance Programme provided by DHB Shared Services [a division of Central Regions' Technical
Advisory Service CRTAS].
Indicator:
Deliverables:
Cardiovascular Disease Risk Assessment (CVDRA)
Proportion of the eligible adult population that have had their CVD risk assessed in the last five years
Numerator: (Data source: PHO Performance Programme)
Count of enrolled people in the PHO within the eligible population who have had a
CVD risk recorded within the last five years
Denominator: (Data source: PHO enrolment register)
Count of enrolled people in the PHO who are eligible for a
CVD risk assessment .
The population eligible for CVDRA is as follows:

Males of Maori, Pacific, or Indian sub-continent* ethnicity aged 35-74 years at the end of the reporting period and enrolled with PHO

Females of Maori, Pacific, or Indian sub-continent* ethnicity aged 45-74 years at the end of the reporting period and enrolled with PHO

Males of any other ethnicity aged 45-74 years at the end of the reporting period and enrolled with PHO

Females of any other ethnicity aged 55-74 years at the end of the reporting period and enrolled with PHO
*the Indian sub-continent for this report is defined by the person enrolled with the PHO self-identifying as “Indian” ethnicity.
Expectations
The following achievement scale will be applied to the health target indicator:
Rating: Definition
Outstanding
Performer
Achieved**
Partially
Achieved
The DHB has met the target* for the total population, for Maori, and for
Pacific 1 populations.
The DHB has met the target* for the total population for the quarter.
The DHB has improved its performance from the previous quarter and the narrative comment satisfies the assessor that the DHB is on track to reach the target.
Not Achieved The DHB has not met the target* for total population for the quarter.
* see target definition above
**From 2014/15 for all performance measures included in the Maori health plan this rating is applied when the
DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Maori population group, and the Pacific population group.
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