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

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

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

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

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

ObjectiveAustralians 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

Objectives Outcomes Progress

Measures

Output

Measures

PIs

Prevention 3 3 3 13

PHC 2 8 4 18

Hospital 1 4 1 17

Aged Care 1 2 5 9

Patient Experience

2 1 - 1(3)

Social Incl. 1 5 1 6

Sustainability 1 3 1 6

NHA Objectives/Outcomes/PIs

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

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?)

NHA reporting Table NHA.23.1

Selected potentially avoidable GP-type presentations to emergency departments, 2007-08 (number) (a), (b), (c)

          NSW Vic Qld WA SA Tas ACT NT Aust

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 23 766 1 957 773

Remoteness of residence (d)

Major cities 435 885 353 328 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

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

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)

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?

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

Thank you