The Health Roundtable CareTrack Australia Presenter: Natalie Hannaford Hospital Code Name: Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct

The Health Roundtable KEY PROBLEM  Evidence of poor compliance with clinical guidelines – this is limited to studies of single conditions  Community acquired pneumonia – use of PSI 5%; appropriate antibiotics – 18%  Low Back Pain – of almost 4000 presentations, more than a quarter were sent for imaging  Reflects care that is inappropriate, not cost effective and not in line with evidence or consensus based guidelines  Healthcare in Australia consumes nearly 10% of GDP, over $100 billion AUD per year.  No coordinated system available in Australia to measure, monitor and act on health care performance data 2

The Health Roundtable THE CARETRACK STUDY  AIM - Determine the percentage of healthcare encounters at which a sample of adult Australians received appropriate care in 2009 and 2010 in two Australian states  22 conditions – most common according to burden of disease, national health priority areas and studies of general practice activity and “Preventive Care”  522 clinical indicators developed from National and International guidelines and ratified by 45 experts  On site medical record review by trained surveyors  Developed a web based tool for onsite encrypted data collection 3

The Health Roundtable WHAT, WHO and WHERE  Surveyors assessed a total of 270, 052 healthcare encounters  of these were deemed eligible by the surveyors  deemed ineligible by software filtering  deemed ineligible by surveyors  1154 participants in the final sample.  225 healthcare providers - GP’s, hospitals and allied health professionals in regions across NSW and SA.  Metro, rural and remote 4

The Health Roundtable CARETRACK RESULTS 5

The Health Roundtable RESULTS  Australians received appropriate care at 57% of eligible healthcare encounters  For 39 practices or facilities with more than 300 encounters compliance ranged from 32% to 86%  The use of risk assessment tools is poor – overall compliance for four tools was 1% (AUSDRISK, ABCD2, PSI or CURB 65)  Condition compliance ranged from 90% for CAD to 13% for alcohol dependence  Inadequate documentation of information in medical records limits the results of this study 6

The Health Roundtable LESSONS LEARNT  Measuring care processes is a useful way of monitoring compliance or otherwise for common conditions and/or certain aspects of care  Standard documentation in medical records is lacking – vast amounts of data are missing – what was really done?  Highlights gaps in “translating the evidence” into everyday practice (i.e. not embedded). Provides an opportunity for more work in this area  More effective use of electronic information systems provides a major opportunity for improving care.  Gaining access to medical records in this country involves a lot of work……. 7