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Regional Outcomes and Equity Report 2018/19

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Regional Outcomes and Equity Report 2018/19 Published May 2020 By the South Island Alliance Programme Office On behalf of the five South Island district health boards Telephone: +64 3 378 6631 PO BOX 639, Christchurch New Zealand 8140

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Table of Contents

Executive Summary .......................................................................................................... 5

Introduction ..................................................................................................................... 5 Equity for Māori .................................................................................................................................. 5 South Island Outcomes Framework .................................................................................................... 5 Priority Focus Areas ............................................................................................................................ 7 Potential data issues ........................................................................................................................... 7 Mental Health Key Performance Indicators (KPIs).............................................................................. 7

1. Measures Directory ................................................................................................... 8 Regional Goal A: Improved Health and Equity for all Populations with specific emphasis on Māori ............................................................................................................................................... 8 Regional Goal B: Improved Quality, Safety and Experience of Care ............................................... 8 Regional Goal C: Best value for Public Health System Resources .................................................. 8 Outcome 1: Improved environments to support health and wellbeing ......................................... 8 Outcome 2: People have increased access to planned care ........................................................... 8 Outcome 3: People wait less ........................................................................................................... 8 Outcome 4: People have prevented and/or delayed burden of long-term conditions .................. 8 Outcome 5: People have fewer or shorter episodes in care facilities ............................................ 9 Outcome 6: No wasted resource .................................................................................................... 9 Outcome 7: People are protected from harm or needless death .................................................. 9 Outcome 8: Death with dignity ....................................................................................................... 9

Priority Focus Areas .................................................................................................................. 9 1: First 1000 Days / Vulnerable Children ........................................................................................ 9 2: Acute Demand Management ...................................................................................................... 9 3: Advance Care Planning ............................................................................................................. 10 4: Mental Health and Addictions .................................................................................................. 10 5: Social Determinants of Health .................................................................................................. 10 6: Data into Information ............................................................................................................... 10

2. Measures .................................................................................................................... 11 A.1 Life expectancy at birth .............................................................................................................. 11 A.2 Amenable mortality rates ........................................................................................................... 12 A.3 Population who smoke ............................................................................................................... 14 A.4 Population who are obese .......................................................................................................... 14 A.5 Healthy birthweight - percent of small babies at term (37-42 weeks’ gestation) with birthweight under 10th centile ......................................................................................................... 15 A.7 Full or exclusive breastfeeding (3 months)................................................................................. 16 B.7 Access to primary care ................................................................................................................ 17 B.8 Workforce reflects the population ............................................................................................. 18 B.10 Patient Experience - National Patient Experience Survey ........................................................ 20 B.10a HQSC Quality dashboard ......................................................................................................... 24 C.11 Ambulatory Sensitive Hospitalisations (ASH) 0-4 year olds ...................................................... 26 C.12 Acute bed days .......................................................................................................................... 27 C.13 People 75+ living in their own home ........................................................................................ 28 1.16 Children’s oral health ................................................................................................................ 29 1.17 Percentage of population with diabetes................................................................................... 30 1.18 Mental wellbeing ...................................................................................................................... 31 1.19 Women screened for family violence during baby’s first year of life ....................................... 31 1.19a Well Child Tamariki Ora (WCTO) indicators ............................................................................ 32 2.22 People provided with an FSA within 4 months of referral (ESPI2) ........................................... 33

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2.23 People given a commitment to treatment and treated within 4 months of referral (ESPI5) ... 33 2.24 Ambulatory Sensitive Hospitalisations (ASH) among 45-64 year olds ...................................... 34 2.25 Access to Mental Health DHB Specialist Services ..................................................................... 37 3.29 Non-urgent Mental Health and AOD seen within 3 weeks ....................................................... 39 3.31 People wait no more than six weeks for CT scan and MRI scan ............................................... 40 3.33 Patients who receive an angiogram within 3 days (72 hours) of admission ............................ 41 3.35 Faster Cancer Treatment .......................................................................................................... 43 4.37 ‘Never Smokers’ among Year 10 Students ................................................................................ 45 4.38 Women Who Identify as Smokers Post-Natal ........................................................................... 46 4.39 People who have had a Cardiovascular Risk Assessment in the past five years ...................... 47 4.41 Women aged 50-69 who have had breast screen .................................................................... 48 4.43 Acute Mental Health Inpatient Pre-Admission Community Care ............................................. 49 4.43a Acute Mental Health Inpatient Post-admission Community Care .......................................... 49 5.50 Rate of Acute Medical Admissions to Hospital ......................................................................... 50 5.51 Acute Readmission Following Discharge .................................................................................. 51 5.54 Mental Health Average Length of Stay (ALOS) ......................................................................... 52 5.54a Acute Mental Health Discharges ............................................................................................. 52 5.54b Acute Mental Health Inpatient Readmission Rate ................................................................. 53 7.62 Population Aged 75+ Admitted to Hospital as a Result of a Fall .............................................. 54 7.63 Two and Five-year Olds Fully Immunised ................................................................................. 55 7.64 Over 65s Immunised Against Influenza .................................................................................... 57 8.72 Advance Care Planning (ACP) .................................................................................................... 58

Appendix 1: Mental Health - Overview of Regions .......................................................... 60

Appendix 2: WCTO indicator definitions ......................................................................... 61

Appendix 3: Measures matrix ......................................................................................... 63

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Executive Summary

Data in this report highlights that progress is being made in many areas. However, there is much more we could do, particularly to address inequity for Māori across the South Island.

The intention of this report is to establish a baseline dataset for regular reporting and update at regional level across a wide range of health specialties. It is also intended to assist with defining strategies and activities to address future activity and challenges, particularly in achieving equity.

We trust this report will initiate the generation of new ideas, innovation and problem-solving as together we seek to address challenges, with a strong focus on improving equity for Māori in the South Island.

Strategic Planning and Integration Team, South Island Alliance

Introduction

This report provides an annual overview of measures with data collated for our five district health boards (DHBs) across the South Island (SI), where data is available and definitions are consistent. Measures are reported against the South Island Outcomes Framework (Figure 1) and priority focus areas (2018-21), outlined in more detail below.

Interpretation of data is not provided, however some rationale from South Island Service Level Alliances (SLAs) and workstreams or business analysts has been included where relevant. The South Island Alliance (the Alliance) encourages a wide range of perspectives and interpretations of what stories the data are telling us.

Section 1 of this document (Measures Directory) lists the measures used in relation to the South Island Outcomes Framework and six priority focus areas. Section 2 (Measures) presents the data for each measure with background information and context where available.

Equity for Māori

Whilst we have progressed in some areas, data indicate there are many areas in which we could improve to reduce inequities between Māori and non-Māori and other groups in society.

Some measures in this report include data by Māori ethnicity and other ethnicities where these data are available. These are denoted by EQUITY MEASURE and also inform the Alliance’s regional reporting on equity.

South Island Outcomes Framework

The South Island Outcomes Framework (Figure 1) comprises three regional goals (top centre triangles, Figure 2) and eight outcomes (outer circles). Equity for Māori and other ethnicities is incorporated across all the goals and outcomes.

All measures, including further measures proposed, are listed in the matrix (Appendix 3). Some proposed measures have progressed and are included where available. The matrix demonstrates how measures contribute to each of our goals, outcomes and current priorities.

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Figure 1: South Island Outcomes Framework

Figure 2: Regional Goals

INDIVIDUAL

POPULATION SYSTEM

Improved quality, safety and experience of care

Best value for public health system resources

Improved health and equity for all populations

with specific emphasis on Māori

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Priority Focus Areas Six priority focus areas (Figure 3) were established for 2018-2021 to focus the Alliance work programmes on specific priorities. Measures for each were mapped from existing measures as listed in the Measures Directory (Section 1). Data from these measures provide indications on our progress in these areas. Figure 2: Priority Focus Areas 2018 – 2021

Potential data issues

Availability of recent data varies across measures dependant on the data source. Some data are provided by Canterbury DHB on behalf of the South Island Alliance for all SI DHBs.

Some disparities have been identified between datasets, generally related to summary level reporting (e.g. Trendly) versus source data provided by DHBs and/or Ministry of Health (MOH).

Throughout the document, small numbers in smaller DHBs, especially by ethnicity, should be interpreted with caution.

Mental Health Key Performance Indicators (KPIs)

The New Zealand Mental Health and Addictions KPI Programme provides a set of nationally comparable indicators of service performance reported by DHBs and non-government organisation (NGOs) intended to promote quality improvement practices at provider level.

MOH advises data quality issues were identified with the Programme for the Integration of Mental Health Data (PRIMHD) submitted by DHBs, including retrospective correction for prior periods, and recent period missing/low data. Please exercise discretion when interpreting and comparing DHB results.

Further information about the KPI Programme is available on the KPI Programme website www.mhakpi.health.nz or email [email protected]

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1. Measures Directory Regional Goal A: Improved Health and Equity for all Populations with specific emphasis on Māori

A.7 Breastfeeding EQUITY MEASURE

A.1 Life expectancy at birth EQUITY MEASURE

A.2 Mortality rates EQUITY MEASURE

A.3 Population who smoke

A.4 Population who are obese

A.5 Healthy birthweight EQUITY MEASURE

Regional Goal B: Improved Quality, Safety and Experience of Care

B.7 Access to primary care EQUITY MEASURE

B.8 Workforce reflects the population EQUITY MEASURE

B.9 Safety First indicators TBA

B.10 Patient Experience Survey

B.10a Quality dashboard

Regional Goal C: Best value for Public Health System Resources

C.11 Ambulatory Sensitive Hospitalisations (ASH) 0-4 year olds EQUITY MEASURE

C.12 Acute bed days EQUITY MEASURE

C.13 People 75+ living in own home

Outcome 1: Improved environments to support health and wellbeing

1.16 Children caries free age 5 EQUITY MEASURE

1.17 Population with diabetes

1.18 Mental wellbeing - community 1.19 Family violence screening during baby’s first year EQUITY MEASURE

1.19a Well Child Tamariki Ora (WCTO) indicators summary EQUITY MEASURE

Outcome 2: People have increased access to planned care

2.22 FSA within 4 months of referral (ESPI2)

2.23 Commitment to treatment and treated (ESPI5)

2.24 Ambulatory Sensitive Hospitalisations (ASH) 45-64 year olds EQUITY MEASURE

2.25 Access to Mental Health specialist services 0-19 EQUITY MEASURE

2.25 Access to Mental Health specialist service 20-64 EQUITY MEASURE

Outcome 3: People wait less

3.29 Referral for non-urgent Mental Health services

3.31 CT scan within 6 weeks

3.31 MRI scan within 6 weeks

3.33 Angiogram within 3 days EQUITY MEASURE

3.35 Faster cancer treatment: 62 day EQUITY MEASURE

3.35 Faster cancer treatment: 31 day EQUITY MEASURE

Outcome 4: People have prevented and/or delayed burden of long-term conditions

4.37 ‘Never Smokers’ among year 10 students

4.38 Women identify as smokers post-natal EQUITY MEASURE

4.39 Cardiovascular risk EQUITY MEASURE

4.41 Women aged 50-69 who have had breast screen EQUITY MEASURE

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4.43 Mental Health pre-admission community care

4.43a Mental Health post-admission community care

Outcome 5: People have fewer or shorter episodes in care facilities

5.50 Acute Medical Admissions

5.51 Acute readmission following discharge EQUITY MEASURE

5.54 Mental health average length of stay

5.54a Acute Mental Health discharges

5.54b Acute Mental Health readmission rate

Outcome 6: No wasted resource

No currently available measures. Planned measures include:

6.55 Did not attend rates TBA

6.57 Rescheduled surgery / dropped theatre lists TBA

6.60 Laboratory tests repeated TBA

C.15 Energy measure / carbon footprint TBA

Outcome 7: People are protected from harm or needless death

7.62 Hospital admissions 75+ result of a fall

7.63 5-year olds fully immunised EQUITY MEASURE


7.64 65+ immunised against ‘flu EQUITY MEASURE

Outcome 8: Death with dignity

8.72 Advance care plans draft and published

8.72 Advance care plans for Maori TBA EQUITY MEASURE

8.73 VOICES study TBA EQUITY MEASURE

8.74 Te Ara Whakapiri pathway TBA EQUITY MEASURE

Priority Focus Areas 1: First 1000 Days / Vulnerable Children

A.5 Healthy birthweight EQUITY MEASURE

1.16 Children caries free age 5 EQUITY MEASURE

1.19 Family violence screening during baby’s first year EQUITY MEASURE

4.38 Women identify as smokers post-natal EQUITY MEASURE



Sudden Unexpected Death in Infants (SUDI) is reduced - TBA

2: Acute Demand Management


2.24 ASH 45-64 year olds EQUITY MEASURE

5.50 Acute Medical Admissions

5.51 Acute readmission following discharge EQUITY MEASURE

7.62 Hospital admissions 75+ as result of a fall

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3: Advance Care Planning

8.72 Advance care plans draft and published

ACP uptake by Aged Care - TBA

ACP uptake by Māori – TBA EQUITY MEASURE

Number of patients with plans who have died during a specific time frame - TBA

4: Mental Health and Addictions

1.18 Mental wellbeing – community

2.25 Access to Mental Health specialist services 0-19 EQUITY MEASURE

2.25 Access to Mental Health specialist service 20-64 EQUITY MEASURE

3.29 Referral for non-urgent Mental Health services

4.43 Mental Health pre-admission community care

4.43a Mental Health post-admission community care

5.54 Mental health average length of stay

5.54a Acute Mental Health discharges

5.54b Acute Mental Health readmission rate

5: Social Determinants of Health

A.1 Life expectancy at birth EQUITY MEASURE Further measures in development by Public Health Partnership. Wellbeing measures (national only) available at https://wellbeingindicators.stats.govt.nz/ Further national measures available at https://www.stats.govt.nz/information-releases/wellbeing-statistics-2018 Canterbury Wellbeing Index measures https://www.canterburywellbeing.org.nz/

6: Data into Information

SS09: Improving the quality of identity data within the National Health Index (NHI) and data submitted to National Collections (TBA – in development by ISSLA)

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2. Measures A.1 Life expectancy at birth

EQUITY MEASURE

These data are an average across a range of variables. Life expectancy is the result of a range of social determinants of health such as living conditions, employment, income, working conditions, social supports and healthy behaviours. Health service provision is only one of the influences. Note that the dataset used is 2005-7 compared with 2012-14. This is the most recent dataset provided by Statistics NZ. ‘Subnational Period Life Tables: 2017–19’ is scheduled for release in 2020. The table indicates that the South Island region would achieve equity for Māori in the context of life expectancy at birth in 15 years (on average), compared to New Zealand taking 42 years to achieve the same outcome. There are a range of data challenges associated with this analysis. It should be viewed as being indicative of the level of progress made, acknowledging that such improvements are rarely linear in nature, and that the desired outcome may be challenged by the law of diminishing returns. Source: https://www.stats.govt.nz/information-releases/subnational-period-life-tables-201214

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A.2 Amenable mortality rates EQUITY MEASURE

This national system level measure (SLM) is generally accepted as having superseded ‘all-cause mortality rates.’

Amenable mortality deaths aged under 75 years, rates per 100,000 age standardised, by ethnicity

Note: rates are suppressed where there are fewer than 30 deaths.

Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate

Maori 16 … 10 … 19 … 10 … 23 …

Pacific 1 … 8 … 0 … 3 … 3 …

Non Maori, Non-Pacific 149 74.7 153 73.9 156 76.7 153 67.7 170 76.8

Maori 4 … 5 … 9 … 4 … 8 …

Pacific 0 … 2 … 5 … 0 … 0 …


Maori 45 136.0 55 157.6 63 171.0 73 178.4 62 155.9

Pacific 16 … 19 … 14 … 19 … 17 …


Maori 2 … 4 … 7 … 4 … 6 …

Pacific 1 … 2 … 2 … 0 … 0 …


Maori 33 149.6 30 130.4 42 175.9 43 173.5 44 167.9

Pacific 8 … 8 … 8 … 5 … 3 …


Maori 1171 211.1 1179 202.0 1185 196.1 1177 188.8 1260 195.1

Pacific 472 196.7 445 182.3 467 186.5 462 179.9 445 165.2


Southern

NZ

Nelson

Marlborough

West Coast

Canterbury

South

Canterbury

2015 20162012 2013 2014

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Amenable mortality SLM Outcome: Reduction in the number of avoidable deaths and reduced variation for population groups.

Rationale: About half the deaths under 75 years of age in New Zealand are classified as amenable according to the current code-list. These are ‘untimely, unnecessary’ deaths from causes amenable to health care.

Population measure: Deaths under age 75 years (‘premature’ deaths) from causes classified as amenable to health care. (There is currently a list of 35 causes - this list is being updated).

More information: https://nsfl.health.govt.nz/dhb-planning-package/system-level-measures-framework/data-support-system-level-measures/amenable

Source: National Service Framework Library via CDHB

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A.3 Population who smoke

Source: New Zealand Health Survey * Due to small survey numbers, many of the results included are not statistically significant.

A.4 Population who are obese

Source: New Zealand Health Survey* *Note that New Zealand Health Survey data has significant limitations due to small sample sizes and results should be interpreted with caution and only as a general indicator.

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A.5 Healthy birthweight - percent of small babies at term (37-42 weeks’ gestation) with birthweight under 10th centile

EQUITY MEASURE Most babies born in the South Island are a healthy weight, with a consistently better trend than the national average persisting over the last seven years. The difference between Māori and non-Māori babies born is difficult to interpret due to low numbers and data fluctuating, however the South Island is consistently at or below the national average. (Child Health Service Level Alliance)

*South Canterbury and West Coast suppressed – too few numbers to interpret. Data sourced from https://minhealthnz.shinyapps.io/maternity-clinical-indicator-trends/ and www.health.govt.nz/publication/new-zealand-maternity-clinical-indicators-2016

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A.7 Full or exclusive breastfeeding (3 months) EQUITY MEASURE

This indicator looks at the percentage of new-borns who are exclusively or fully breastfed at 3 months old for Jul – Dec 2018. Source: https://www.trendly.co.nz and www.nsfl.health.govt.nz/dhb-planning-package/well-child-tamariki-ora-quality-improvement-framework Note: There are data quality issues in the current and historical WCTO data collected. Users should exercise caution when making comparisons across different time periods. Refer to MOH data table for more information at https://nsfl.health.govt.nz/dhb-planning-package/well-child-tamariki-ora-quality-improvement-framework

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B.7 Access to primary care EQUITY MEASURE Percentage of population enrolled with a primary health organisation (PHO)

Source: http://www.health.govt.nz/our-work/primary-health-care/about-primary-health-organisations/enrolment-primary-health-organisation

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Māori enrolment

DHB Apr-Jun 2019 Māori

enrolment Additional enrolments

required to reach 90% target Target total enrolments

Nelson Marlborough 84.9% 819 14,418

Canterbury 81.8% 4,303 47,025

West Coast 80.5% 371 3,524

South Canterbury 81.0% 474 4,761

Southern 80.2% 3,308 30,236

Source: www.trendly.co.nz/Home/ViewReport

B.8 Workforce reflects the population DHB workforce who identify as Māori

EQUITY MEASURE

Per cent of staff with unknown / unrecorded ethnicity

DHB Mar-15 Mar-16 Mar-17 Mar-18 Dec-18 % Difference over 4 years

Nelson Marlborough 15.5% 14.4% 13.0% 8.0% 7.7% 7.8%

Canterbury 22.7% 16.9% 16.3% 17.4% 16.5% 6.2%

South Canterbury 7.8% 7.5% 7.5% 6.6% 6.2% 1.5%

Southern 7.4% 7.2% 6.6% 5.9% 5.6% 1.8%

West Coast 61.7% 58.2% 53.9% 53.9% 48.5% 13.3%

South Island 19.0% 15.6% 14.8% 14.4% 13.5% 5.4%

13.5% of the workforce (2362 people) recorded as ‘unknown’ ethnicity In December 2018.

19% of the workforce (3145 people) recorded as ‘unknown’ ethnicity in March 2015.

Source: http://centraltas.co.nz/strategic-workforce-services/health-workforce-information-programme-hwip/

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Māori workforce by professional group - by DHB and South Island. Assumptions:

Health Workforce Information Programme (HWIP) through Central TAS data is based on the DHB-employed staff only, quarterly workforce snapshot (i.e. not whole of sector)

This is a summary of the medical, midwifery and nursing data as well as the four largest Allied Health professions

The data is indicative only because of the unknown ethnicity (12.9% across the South Island)

For privacy reasons numbers below 5 are not reported (SI Workforce Development Hub)

Māori WorkforcePopulation in

current workforce

Māori in current

workforce

Population in

current workforce

Māori in current

workforce

Māori in workforce

(if = X% total

population)

Gap

CANTERBURY DHB 523,820 46,660 567,870 51,840 9.1%

Senior Medical Officers 536 * 595 7 54 47

Resident Medical Officers 469 7 541 17 49 32

Nursing 3387 >56 3541 78 322 244

Midwifery 141 0 137 6 12 6

Physiotherapist 135 * 138 * 13 9-12

Occupational Therapist 144 * 151 * 14 10-13

Dietitian 37 * 41 * 4 0-3

Social Worker 177 * 192 8 17 9

NELSON MARLBOROUGH DHB 144,320 14,645 150,770 15,980 10.6%

Senior Medical Officers 143 * 152 * 16 12-15

Resident Medical Officers 77 * 97 * 10 6-9

Nursing 767 18 761 40 81 41

Midwifery 47 0 43 * 5 1-4

Physiotherapist 40 0 37 * 4 0-3

Occupational Therapist 32 0 37 * 4 0-3

Dietitian 8 0 8 0 1 1

Social Worker 36 * 27 * 3 0-2

SOUTH CANTERBURY DHB - - 60,220 5,260 8.7%


Resident Medical Officers 21 * 25 * 2 0-1

Nursing 304 10 319 16 28 12

Midwifery 21 * 18 * 2 0-1

Physiotherapist 15 0 15 * 1 0

Occupational Therapist 12 0 14 * 1 0

Dietitian * * 5 * 0 0

Social Worker 8 * 9 * 1 0

SOUTHERN DHB 313,010 30,630 329,890 33,440 10.1%


Resident Medical Officers 270 >4 291 * 29 25-28

Nursing 1759 58 1774 71 179 108

Midwifery 73 * 74 * 7 3-6


Occupational Therapist 68 0 70 * 7 3-8

Dietitian 13 0 16 0 2 2

Social Worker 66 51 * 5 1-4

WEST COAST DHB 32,711 3,730 32,410 3,900 12.0%

Senior Medical Officers 35 * 32 * 4 0-3

Resident Medical Officers 15 0 11 * 1 0

Nursing 342 * 306 7 37 30

Midwifery 14 0 13 * 2 0-1

Physiotherapist 13 0 6 0 1 1

Occupational Therapist 7 0 8 0 1 1

Dietitian * 0 * 0 0 0

Social Worker 11 0 7 * 1 0

TOTAL SOUTH ISLAND 1,072,251 100,315 1,080,940 105,160 10%

Senior Medical Officers 1066 7 1144 15 111 96

Resident Medical Officers 852 18 965 23 94 71

Nursing 6559 151 6701 212 650 438

Midwifery 296 * 285 11 28 17


Occupational Therapist 263 * 280 7 27 20

Dietitian 65 * 72 * 7 3-6

Social Worker 298 10 286 15 28 13

As At March 2015 As at December 2018

* Data suppressed due to the low headcount (less than 5 but at least 1)

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B.10 Patient Experience - National Patient Experience Survey The Health Quality and Safety Commission designed a 20-item adult inpatient survey which began in August 2014. Patient experience measures are now routinely in place for hospitals. The survey runs quarterly in all district health boards and covers four key domains of patient experience. Each of the four domains as follows, include:

Communication: Questions answered, Explanations given, Doctor listened, Nurse listened, other listened, Side-effects explained.

Participation: Was involved, family was involved.

Coordination: Different things said, Discharge information.

Physical and emotional needs: Toilet, Pain, Respect, Kindness, Culture.

The survey is structured with an overall question to rate their overall experience of each domain using a 10-point scale, supported by between two and five questions from the Picker set to test specific aspects of the domains. A ‘free text’ box asks the respondent to give examples supporting their rating.

A selection of adult patients who spent at least one night in hospital are sent an invitation via email, text or post inviting them to participate in the national survey. The survey responses are anonymous unless patients chose to provide their contact details.

Further methodology available at: https://www.hqsc.govt.nz/assets/Health-Quality-Evaluation/PR/patient-experience-methodology-and-procedures-Jul-2014.pdf

Please note that response rates for this survey are generally low, as per the table below. Results should therefore be interpreted with caution. Response rate by DHB (per cent)

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B.10a HQSC Quality dashboard The Health Quality and Safety Commission (HQSC) introduced the ‘dartboard’ format to bring a range of quality measures together on the same scale. Six ‘slices’ of the dartboard correspond to six dimensions of quality: timely access, safety, effectiveness, patient centredness, equity and efficiency. Note equity and efficiency are in development and are not populated. The dashboard shows comparison of a DHB measurement with the national average for the current period. For each dimension, the best possible result is the centre of the dark green ‘bullseye’. The dashboard is best viewed interactively at https://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/quality-dashboards/dashboard-of-health-system-quality/ Measures illustrated in each dimension on the next page, are numbered as follows: Timely access (1) Percentage of patients waiting longer than the required timeframe for their first specialist

appointment (ESPI2) (2) Percentage of patients given a commitment to treatment but not yet treated within the required

timeframe (ESPI5) Safety (1) O/E ratio of postoperative DVT/PE cases in hospitals (2) Surgical site infection (SSI) rate per 100 hip and knee operations (3) Number of people aged 65 and over who received the ‘triple whammy’ per 1000 population (4) In-hospital falls causing FNOF per 100,000 admissions Effectiveness (1) Standardised acute hospital bed days per 1000 population (2) (Ambulatory sensitive hospitalisation (ASH) 0 – 4 year old admissions per 1000 population) (3) Percent of eligible patients who received mental health post-discharge community care (4) Age standardised amenable mortality rate per 1000 population Patient-centred (1) Inpatient experience survey communication domain, score out of 10 (2) Inpatient experience survey partnership domain, score out of 10 (3) Inpatient experience survey coordination domain, score out of 10 (4) Inpatient experience survey physical and emotional needs domain, score out of 10 Source: Health Quality and Safety Commission New Zealand, Atlas of Healthcare Variation – Dashboard of health system quality. For further information and to view interactively visit https://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/quality-dashboards/dashboard-of-health-system-quality/ Dashboard release date: 31 August 2019

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New Zealand Nelson Marlborough

West Coast

Canterbury

South Canterbury

Southern

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C.11 Ambulatory Sensitive Hospitalisations (ASH) 0-4 year olds This measure is a national system level measure (SLM) EQUITY MEASURE

Data from year to end March 2019 (Q3) iteration of ASH data, all conditions. Note: Only CDHB has sufficient Pacific population to provide data.

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This is a national system level measure (SLM). Data to quarter 3 (March) 2018/19.

The measure is the rate calculated by dividing acute hospital bed days by the number of people in the New Zealand resident population. The acute bed days per capita rates are presented using the number of bed days for acute hospital stays per 1000 population domiciled within a DHB, age standardised.

Further information available at https://nsfl.health.govt.nz/dhb-planning-package/system-level-measures-framework/data-support-system-level-measures/acute

*Nelson Marlborough data incomplete for 2018/19

*

*

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C.13 People 75+ living in their own home

Results are presented against the PBFF population estimates for the year in question (i.e. the funded population) Source: MOH data via CDHB

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1.16 Children’s oral health EQUITY MEASURE

In line with the national trend, oral health status in the South Island is largely dependent on ethnicity and deprivation. These factors interact with accessibility to fluoridated water. Of the five DHBs only Southern DHB has public fluoridated water supplies, which reach 64.7% of the SDHB population.

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Canterbury is the only district with sufficient Pacific numbers to be statistically relevant. National Results from the Community Oral Health data on the Ministry of Health website: https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/oral-health-data-and-stats/age-5-and-year-8-oral-health-data-community-oral-health-service \

1.17 Percentage of population with diabetes

Population data from www.nzdotstat.stats.govt.nz Source: http://www.health.govt.nz/our-work/diseases-and-conditions/diabetes/about-diabetes/virtual-diabetes-register-vdr

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1.18 Mental wellbeing Mental health patients accessing community services within 7 days of discharge; an important element of suicide prevention. Source: https://www.mhakpi.health.nz/Data

MOH advise data quality issues were identified with PRIMHD data submitted by DHBs, including retrospective correction for prior periods, and recent period missing/low data. Please exercise discretion when interpreting and comparing DHB results.

1.19 Women screened for family violence during baby’s first year of life EQUITY MEASURE

This WCTO indicator looks at the percentage of new-borns and their mothers who have been screened for family violence at least three times during baby’s first year of life.

Women screened for family violence during baby’s first year of life, by region

Source: Based on WCTO data July 2017 to December 2018. Extraction March 2019. Results are subject to change due to on-going improvement work on data quality issues.

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1.19a Well Child Tamariki Ora (WCTO) indicators EQUITY MEASURE

The WCTO Quality Improvement Framework supports the Ministry of Health and the sector to improve the quality, effectiveness and reach of WCTO services. Data source and further detailed information on each indicator and DHB including Māori and non- Māori comparison charts are available at: https://nsfl.health.govt.nz/dhb-planning-package/well-child-tamariki-ora-quality-improvement-framework Appendix 2 outlines full indicator definitions and further information.

WCTO Six monthly report summary, May 2019

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2.22 People provided with an FSA within 4 months of referral (ESPI2) First Specialist Assessment (FSA) within 4-month timeframe - Elective Services Patient flow Indicators (ESPI).

2.23 People given a commitment to treatment and treated within 4 months of referral (ESPI5) Time between decision to treat and start of treatment is within 4 months.

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2.24 Ambulatory Sensitive Hospitalisations (ASH) among 45-64 year olds ASH admissions are also known as avoidable hospital admissions.

EQUITY MEASURE

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Source: DHB data from year to end Q3 2018/19 iteration of ASH data, all conditions. Note: Canterbury is the only district with sufficient Pacific population to provide relevant data.

ASH top 10 conditions

Further information including ASH over time and detailed charts illustrating ASH top 10 conditions, by DHB and ethnicity are available at https://nsfl.health.govt.nz/accountability/performance-and-monitoring/data-quarterly-reports-and-reporting/ambulatory-sensitive

ASH top 2 conditions

ASH aged 45 to 64 years, top 2 conditions by South Island DHB, 12 months to Dec 2018 are illustrated on the following page.

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ASH aged 45 to 64 years, top 2 conditions by DHB, 12 months to Dec 2018

Source: https://nsfl.health.govt.nz/accountability/performance-and-monitoring/data-quarterly-

reports-and-reporting/ambulatory-sensitive

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2.25 Access to Mental Health DHB Specialist Services EQUITY MEASURE

This measure counts people who have accessed DHB-funded specialist inpatient and outpatient services. It does not include access to NGO or primary care mental health services. The ‘Blueprint’ strategy (2012) predicated an access target of 3 per cent to mental health services. 0 - 19 year olds


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20 – 64 year olds

Source: Derived from the PRIMHD database, Ministry of Health.

Note: If a client's address changes from one DHB region to another during the period, they may be counted twice. As clients may have lived in more than one DHB during one period, the total of unique clients seen in New Zealand may also differ.


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3.29 Non-urgent Mental Health and AOD seen within 3 weeks People referred for non-urgent mental health and alcohol and other drugs (AOD), seen within three weeks. Some DHB data not available.

Source: DHBs via MOH

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3.31 People wait no more than six weeks for CT scan and MRI scan This measure shows access to timely diagnostics. Excludes access to urgent scans required for acute care to inform treatment.

Source: DHBs via MOH

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3.33 Patients who receive an angiogram within 3 days (72 hours) of admission EQUITY MEASURE

The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry was designed to collect data on all coronary angiograms and percutaneous coronary interventions (PCI) and all acute coronary syndromes (ACS) managed with these invasive procedures. National performance targets have been agreed to support secondary clinicians to implement evidence-based guidelines through rapid diagnosis and treatment. Data collection enables identifying any gaps in equity and access and where to focus on quality improvement. South Island Summary by Ethnicity

Source: ANZACS Quality Improvement Register

6781 patients identified Acute Coronary Syndrome (3 years 2015-2018)

1.6% Pacific (109)

1.6% population 20+ identify as Pacific

89.5% European /Other (6066)

83.3% population identify as

European/Other

6.3% Māori (430)

7.4% population 20+ identify as Māori

2.6% Asian inc. Indian (176)

7.7% population 20+ identify as Asian

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New Zealand Acute Coronary Syndrome patients by region and ethnicity

South Island Acute Coronary Syndrome patients by ethnicity

For all ethnicities for the three years 2015-2018, the South Island region has exceeded other regions in meeting the 72-hour door to catheter lab target. Source: ANZACS Quality Improvement Register

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3.35 Faster Cancer Treatment EQUITY MEASURE

62-day: Patients who receive their first cancer treatment (FCT) or other management, within 62 days of being referred with a high suspicion of cancer. (Source: Southern Cancer Network)

*smaller DHBs may have small patient numbers that cannot be adequately represented as a sufficient sample size

**

** *

*

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31-day: Patients with confirmed cancer diagnosis who receive their first cancer treatment (FCT) or other management within 31 days of a decision to treat. (Source: Southern Cancer Network)

*smaller DHBs may have small patient numbers that cannot be adequately represented as a sufficient sample size

** *

*

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4.37 ‘Never Smokers’ among Year 10 Students South Canterbury do not use Action for Smokefree 2025 (ASH) data as the sample size was so small and the results varied significantly depending on which schools participated. Nelson Marlborough no longer use this measure.

Source: ASH, DHB data

Source: https://tcdata.org.nz/ASH%20data/ASH_03.html

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4.38 Women Who Identify as Smokers Post-Natal EQUITY MEASURE

Source: DHB data and https://minhealthnz.shinyapps.io/maternity-clinical-indicator-trends/

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4.39 People who have had a Cardiovascular Risk Assessment in the past five years EQUITY MEASURE

This was a health target until 2015/16, but is now part of PP20 (focus area 3). Revised guidelines do not currently have an electronic assessment tool. Source: DHB via MOH

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4.41 Women aged 50-69 who have had breast screen EQUITY MEASURE

Quarter 4 data for women aged 50-69 who have had breast screen once in the last two years.

Data source: https://www.nsu.govt.nz/health-professionals/breastscreen-aotearoa/breast-screening-coverage/dhb-quarterly-reports/june-2016

DHB Jan-Mar 2019 Additional reported rates

required to reach 70% target Target total

Nelson Marlborough 73.4% 0 -

Canterbury 70.4% 0 -

West Coast 67.7% 9 278

South Canterbury 61.1% 37 292

Southern 68.3% 42 1,743

Source: https://www.trendly.co.nz

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4.43 Acute Mental Health Inpatient Pre-Admission Community Care

Percentage of discharges from mental health and addiction service inpatient unit(s) for which a community service contact was recorded in the seven days immediately prior. Target is greater than or equal to 75 per cent. Nelson Marlborough data not available.

4.43a Acute Mental Health Inpatient Post-admission Community Care

Percentage of discharges from a mental health inpatient unit for which a community service contact was recorded within seven days. Target is greater than or equal to 90 per cent. Source: https://www.mhakpi.health.nz/Data/Data/Adult_Ending_2019_06_30 MOH advise data quality issues were identified with PRIMHD data submitted by DHBs, including retrospective correction for prior periods, and recent period missing/low data. Please exercise discretion when interpreting and comparing DHB results.

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5.50 Rate of Acute Medical Admissions to Hospital Based on WHO standardised population.

*incomplete reporting Source: DHBs via MOH

*

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5.51 Acute Readmission Following Discharge EQUITY MEASURE

Source: DHBs quarter 4 data. Methodology was updated in 2017/18.

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5.54 Mental Health Average Length of Stay (ALOS) Acute inpatient occupied bed nights for discharges. The average is the number of acute inpatient occupied bed nights, divided by the discharges.

*incomplete data

5.54a Acute Mental Health Discharges Per cent of discharges from acute mental health and addiction services inpatient unit(s) compared with the previous year.

Source: https://www.mhakpi.health.nz/Data/Data/Adult_Ending_2019_06_30 MOH advise data quality issues were identified with PRIMHD data submitted by DHBs, including retrospective correction for prior periods, and recent period missing/low data. Please exercise discretion when interpreting and comparing DHB results.

*

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5.54b Acute Mental Health Inpatient Readmission Rate Percentage of overnight discharges from mental health and addiction acute inpatient unit(s) that result in readmission within 28 days to the same organisation. Target is less than or equal to 10 per cent.

Source: https://www.mhakpi.health.nz/Data/Data/Adult_Ending_2019_06_30 MOH advise data quality issues were identified with PRIMHD data submitted by DHBs, including retrospective correction for prior periods, and recent period missing/low data. Please exercise discretion when interpreting and comparing DHB results.

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7.62 Population Aged 75+ Admitted to Hospital as a Result of a Fall

Results are presented against the PBFF population estimates for the specified year (i.e. the funded population). These results will include Māori from 2018/19 onwards. Source: DHB via MOH

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7.63 Two and Five-year Olds Fully Immunised EQUITY MEASURE

Immunisation coverage is measured at ‘milestone ages’ using National Immunisation Register (NIR) data. The milestone ages are six months, eight months, 12 months (one year), 18 months, 24 months (two years) and five years of age. Immunisation coverage is measured to identify groups at risk of vaccine-preventable diseases and to evaluate the effectiveness of programmes designed to increase coverage. This report includes the number of children at milestone age of two years and five years and who have completed their immunisations. Coverage figures include Pneumococcal vaccine.

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Source: http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data

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7.64 Over 65s Immunised Against Influenza

This measure records the number of individuals over 65 years of age who have completed their annual influenza immunisation. Census estimated population projections are used. Source: National Immunisation Register database via Ministry of Health.

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8.72 Advance Care Planning (ACP) Numbers of draft and published Advance Care Plans by DHB

Month of creation

DHB Drafts Prior to May 2019

May 2019 Published

May 2019 Draft

June 2019 Published

June 2019 Draft

July 2019 Published

July 2019 Draft

August 2019 Published

August 2019 Draft

NMDHB (1) 17 (1) 14 (1) 19 (2) 9 (4)

CDHB (21) 107 (4) 97 (1) 108 (1) 72 (4)

WCDHB (0) 0 (0) 3 (0) 1 (0) 0 (0)

SCDHB (3) 0 (5) 0 (0) 2 (2) 2 (5)

SDHB (10) 0 (2) 0 (8) 0 (26) 3 (19)

TOTALS (35) 124 (12) 114 (10) 120 (31) 87 (32)

Digital ACP launched May 2019 with NMDHB, WCDHB, SCDHB, SDHB commencing using for first time. CDHB used digital ACP since 2013 however transitioned to using SI ACP format May 2019. Hence the variance in total published to August 2019.

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Source: HealthOne via ACP Facilitator, Health of Older People SLA (HOPSLA)

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Appendix 1: Mental Health - Overview of Regions Source: www.mhakpi.health.nz/Data/Data/Adult_Ending_2019_06_30

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Appendix 2: WCTO indicator definitions

Indicator ID

Indicator Full Name

Indicator Short Name

Numerator Source

Denominator Source

Reporting Period

Data Compilation Date

Notes

01 Infants receive a referral to a WCTO provider by 28 days of age

WCTO Referral by 28 Days

WCTO WCTO Jul - Dec 2018

18 Mar 2019

Results are subject to change due to on-going improvement work on data quality issues

02 Infants receive WCTO core contact 1 before 50 days of age

WCTO Core Contact 1 before 50 Days


18 Mar 2019


03 Infants receive all WCTO core contacts in their first year of life

All WCTO Core Contacts Received by Age 1

WCTO WCTO Jan 2017 - Dec 2018

18 Mar 2019


04 Infants are exclusively or fully breastfed at two weeks

Breastfed at Two Weeks

MAT MAT Jan - Jun 2018

20 Mar 2019

Excludes 14% of data without status

05 Infants are exclusively or fully breastfed at discharge from LMC

Breastfed at LMC Discharge at 6 Weeks

MAT MAT Jan - Jun 2018

20 Mar 2019

Excludes 11% of data without status

06 Infants are exclusively or fully breastfed at three months

Breastfed at Three Months


18 Mar 2019


07 Babies who live in a smokefree household at WCTO 1st Core Contact (refer to SLM webpage)

Babies Living in Smokefree Homes

WCTO WCTO N/A 18 Mar 2019

Refer to the SLM webpage for further details

08 All women are screened for family violence at least three times during baby’s first year of life

Screened for Family Violence

WCTO WCTO Jul 2017 - Dec 2018

18 Mar 2019


09 All families are provided SUDI prevention information at a WCTO

SUDI Prevention Information Provided before 50 days


08 May 2019


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core contact before 50 days of age

10 Newborns are enrolled with a general practice by three months

Newborn Enrolled with GP

PHO NIR 2018/19 Q2 20 Mar 2019

There are data issues and limitations with this measure. However it has utility, as an interim measure, for improving newborn enrolment

11 Children aged 0-4 years are enrolled with the Community Oral Health Service

Children 0-4 Enrolled with Oral Health Service

DHB Reporting

Stats NZ 2017 Year 26 Oct 2018 Data can only be updated once per year

12 Average number of decayed missing and filled teeth in five-year-old children with caries are reduced

Reduce dmft in Five-Year-Old Children

DHB Reporting

DHB Reporting

2017 Year 22 Nov 2018

Data can only be updated once per year

13 Children are fully immunised for age at five years of age

Fully Immunised at Age 5

NIR NIR 2018/19 Q2 20 Mar 2019

14 B4SCs are started before children are 4½ years

B4SC Started before 4½

B4SC B4SC Jul - Dec 2018

20 Mar 2019

15 Children are at a healthy weight at four years

Children with Healthy Weight at Age 4


20 Mar 2019

16 Children with a BMI >98th percentile are referred

Children with BMI > 98th Percentile are Referred


20 Mar 2019

17 Children's well-being and resilience is supported

Children have Low SDQ-P Scores


20 Mar 2019

18 Children are referred when there is a concern for underlying mental health problems

Children with High SDQ-P Scores are Referred


20 Mar 2019

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Appendix 3: Measures matrix

regional outcomes and equity report 2018/19 › userfiles... · 2020-05-17 · 2 regional outcomes...

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