1. A Health System for Future Generations: Health performance reporting and national performance indicators Dr David Filby HIMAA National Conference 2010 Health Information: The Golden Thread of Health Reform

2. National Reporting and Performance Indicators NHIA provides the basis for National infrastructure ( data dictionary, NMDS, DSS etc) Data elements, performance indicators and some limited number of benchmarks Range of national reporting e.g. –AIHW in AHS –C/W in SoPH –Prod. Commission in RoGS –AHMC NHPF through Australia’s health

3. New COAG arrangements Intergovernmental Agreement on Federal Financial Relations (IGA FFR): specifies regular reporting of all performance indicators and performance benchmarks to COAG National Healthcare Agreement (NHA): signed with IGA FFR outlines the goals of the health system specifies roles and responsibilities of governments within the health system Various National Partnership Agreements (NPA) Set performance targets and associated funding

4. Significant features include Focus on the achievement pf Outcomes and Objectives covering all the health system and both levels of government Performance benchmarks with associated funding rather than targets Independent and public reporting on progress indicators

5. What are the NHA objectives? Prevention: Australians are born and remain healthy Primary and community health: Australians receive appropriate high quality and affordable primary and community health services Hospital and related care: Australians receive appropriate high quality and affordable hospital and hospital related care Aged care: Older Australians receive appropriate high quality and affordable health and aged care services Patient Experience: Australians have positive health and aged care experiences which take account of individual circumstances and care needs Social Inclusion and Indigenous Health: Australia’s health system promotes social inclusion and reduces disadvantage, especially for Indigenous Australians Sustainability: Australians have a sustainable health system

6. Objective Australians receive appropriate high quality and affordable hospital and hospital related care Outcome Australians receive high quality hospital and hospital related care that is appropriate and timely. E.g. Hospital and related care: Output Rate of service provided by public and private per 1000 weighted population by patient type Progress measure Selected adverse events in acute and sub-acute care settings 38. Adverse drug events in hospitals 39. Healthcare-associated staphylococcus aureus (inc. MRSA) bacteraemia in acute hospitals 40. Pressure ulcers in hospitals 41. Falls resulting in patient harm 46. Outpatient occasions of service 45.Overnight separations 47. Non-acute care separations 48. Hospital procedures

7. ObjectivesOutcomesProgress Measures Output Measures PIs Prevention33313 PHC28418 Hospital14117 Aged Care1259 Patient Experience 21-1(3) Social Incl.1516 Sustainability1316 NHA Objectives/Outcomes/PIs

8. Indicator development issues Work to specify indicators and collection processes and prepare data quality statements Disaggregations required for many of the indicators Approved indicators for which no data is available Limited ability to supply for the reference year

9. Data quality information Data quality statements are produced for all National Agreement indicators Aspects of data quality described are: –Target/outcome; measure (computation); data sources –Institutional environment (who collected/ collated and under what authority?) –Relevance (does the measure reflect intent of indicator?) –Timeliness (how old is the data?) –Accuracy (are there errors I need to be aware of?) –Coherence (is the indicator consistent over time and with other reports?) –Accessibility (how do I access the data?) –Interpretability (what else do I need to know?)

10. NHA reporting Table NHA.23.1 Selected potentially avoidable GP-type presentations to emergency departments, 2007-08 (number) (a), (b), (c) NSWVicQldWASATasACTNTAust Indigenous status Indigenous 20 169 7 043 25 114 11 605 3 057 2 004 785 10 818 80 595 Other Australians 629 192 552 704 355 883 194 667 110 156 48 618 42 787 23 7661 957 773 Remoteness of residence (d) Major cities435 885 353 328 207185 106 328 105 058.. 43 396..1 251 180 Inner regional 193 558 163 902 99 415 64 942 4 852 24 511 51.. 551 231 Outer regional 16 429 41 185 44 428 29 673 1 596 24 710.. 21 440 179 461 Remote 2 125 633 14 069 2 823 670 1 255.. 9 314 30 889 Very remote 168.. 15 424 1 880 739 70.. 3 747 22 028

11. Reporting and Analysis Data via PC to CRC Data due by October so most is for the year before the reference year (or older) CRC Report on NHA –Data not timely –Too many indicators, too many gaps –Not enough outcome measures, too many input and output measures –Many targets are set for years later so trajectories needed to assess progress

12. Issues to be addressed Review of appropriateness and number of indicators against the framework Need to speed up data collection, inc. surveys Need to expand data collections into new areas Private sector information needed – different data flows and legislative arrangements And to do this we have to address Health information workforce Re-engineering of existing data processes Financial information needs to be audited Other reform requirements (e.g. ABF)

13. Some reflections (1) Health reform depends on high quality and timely data Focus on outcome indicators and critical process indicators that are closely linked to outcomes Focus on workforce and systems to support production of these data Be clear about policy objectives and who is accountable for what to whom Do the indicators measure progress/achievement of the objectives? Will achieving targets mean success?

14. Some reflections (2) Need for regular review/assessment – but some indicators change slowly It’s a long way between naming an indicator and agreeing on definitions and collection Ensure the debate not about the number but what it means Don’t just focus on those which bring $ Need timely data Data is expensive in $ and human resources

15. Thank you