BAY OF PLENTY DISTRICT HEALTH BOARD MĀORI HEALTH PLAN

2014/15

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Contents Overview

Abbreviations

Māori Population: Profile and Health Needs

National Indicators

Indicator 1: Accuracy of ethnicity reporting in PHO registers

Indicator 2: Percentage of Māori enrolled with PHOs

Indicator 3: Ambulatory sensitive hospitalisation rate (0­4, 45­64, 0­74 years)

Indicator 4: Full and exclusive breastfeeding rates at 6 weeks, 3 months, and 6 months

Indicator 5: Cardiovascular disease risk assessment rates (eligible population)

Indicator 6: Acute Coronary Syndrome

Indicator 7: Breast screening rates (50­69 years)

Indicator 8: Cervical screening rates (25­69 years)

Indicator 9: Percentage of hospitalised smokers provided with cessation advice

Indicator 10: Percentage of smokers enrolled in a PHO provided with cessation advice

Indicator 11: Percentage of infants fully immunised by eight months of age

Indicator 12: Seasonal influenza immunisation rates (65 years and over)

Indicator 13: Reduction in rheumatic fever rates

Indicator 14: Oral health

Indicator 15: Mental health

Local Indicators

Indicator 16: Asthma hospitalisation rate (0­14 years)

Indicator 17: Did­Not­Attend (DNA) rate for outpatient appointments

Appendix A – Methodology for Local Indicator Selection

References

Version 141003

This document is subject to ongoing updates. Readers are encouraged to refer to the BOPDHB website for the latest version of the plan.

Please direct correspondence related to this plan to george.gray@bopdhb.govt.nz

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Overview This plan describes Bay of Plenty District Health Board’s (BOPDHB) priorities in Māori health for the 2014­2015 year. This plan aligns with the requirements of the New Zealand Public Health and Disability Act (2000) which directs District Health Boards (DHBs) to reduce disparities and improve health outcomes for Māori. The format of this plan and the indicators listed within it follow the

guidelines given in the 2014/2015 Operational Policy Framework. This plan aligns with the BOPDHB’s Annual Plan (AP) and the Midland DHBs’ Regional Services Plan.

The Māori Health Plans of the past three years provided a foundation for BOPDHB to identify the leading causes of mortality and morbidity for Māori in our area. The plans also provided a focus for the DHB to coordinate activity and improvements with stakeholders. The 2014­2015 Māori Health Plan seeks to continue the positive momentum achieved to date and demonstrated through improvements in breast screening, asthma management, and rheumatic fever hospitalisations.

Over the coming year we will continue to take a population health approach on Māori health. We will continue to work with our partner organisations to address the primordial causes of health inequality, and work directly with our health sector stakeholders to address the indicators listed in this plan. As in the past, we will monitor progress through our Māori Health Plan Steering Group (MHSG); this quarterly forum comprises representatives from the various organisations involved in achieving the targets listed in this plan. The group includes representatives from primary care, secondary care, regional public health services, community providers, and the DHB.

The Māori Health Plan gives a one­year subset of actions and aspirational targets related to Māori health; longer term activities (2­5 years) to improve health for Māori and non­Māori are described in the 2014­2015 BOPDHB Annual Plan.

The methods used to determine the local indicators listed in this plan are summarised in Appendix A. Because the two local indicators listed in our previous plan remain significant areas of inequality, they have been retained for the 2014­2015 plan. We are pleased to see one of our locally developed indicators (oral health) elevated to a national indicator for 2014/15.

In addition to the Māori Health Plan Steering Group, quarterly performance results for the Māori Health Plan indicators will be disseminated to four key audiences. First, results will be submitted to the Board for review and discussion in the same manner that Annual Plan and Health Target results are presented. Second, quarterly performance reports will be reviewed by the DHB Runanga. Third, quarterly performance results will be presented at the DHB’s executive management meetings. These three dissemination groups represent both operational and governance levels of the organisation. Fourth, the DHB’s Māori Health Plan performance will be presented in the DHB’s Annual Report. We look forward to achieving the objectives described in this plan.

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Abbreviations

ABC An approach to smoking cessation requiring health staff to ask, give brief advice, and facilitate cessation support.

ACS Acute Coronary Syndrome

AP Annual Plan

ARF Acute rheumatic fever

ASH Ambulatory sensitive hospitalisation

BFHI Baby friendly hospital initiative

BOP Bay of Plenty

BOPDHB Bay of Plenty District Health Board

CME Continuing medical education

COPD Chronic obstructive pulmonary disease

CVD Cardiovascular disease

CVRA Cardiovascular risk assessment

DAR Diabetes annual review

DHB District Health Board

DHBSS DHB Shared Services

DMFT Diseased, Missing, or Filled Teeth

DNA Did not attend (used in the measurement of outpatient clinic attendance)

EBPHA Eastern Bay Primary Health Alliance

ENT Ear, nose and throat

GM General Manager

HbA1C Glycosylated haemoglobin

IGT Impaired glucose tolerance

IHD Ischaemic heart disease

ISP Independent service provider

ISDR Indirectly standardised discharge rate

MHSG Māori Health Steering Group

MOH Ministry of Health

NCHOD National Centre for Health Outcomes Development

NMO Nga Mataapuna Oranga (Primary Health Organisation)

NSU National Screening Unit

NZ New Zealand

NZHS New Zealand Health Survey

PHO Primary Health Organisation

POPAG Population Health Advisory Group

RR Rate ratio

WBOPPHO Western Bay of Plenty Primary Health Organisation

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Māori Population: Profile and Health Needs

1. Geographic Distribution BOPDHB’s population was 205,971 in the 2013 census (5% of New Zealand’s population). 26% of BOPDHB’s population identified as Māori compared with 14% nationally.15

BOPDHB comprises five territorial authorities. In 2013 the majority of the population were based in western areas, nearly 50% lived in Tauranga City with a tapering population count towards the east;

Absolute numbers of Māori reflect the total population’s pattern, tapering from west to east. However Māori make up a greater proportion of each district’s population toward the east.14

Table 1. Bay of Plenty (BOP) population distribution by territorial authority as at the 2013 Census.

District Western BOP Tauranga Whakatane Kawerau Opotiki Total Popn. 43,692 114,789 32,691 6,363 8,436 Māori (%) 18 17 43 62 61

2. Health Service Providers Key health service providers in BOPDHB include: Two public hospitals; Tauranga (349 beds) and Whakatane (110 beds);16 Three PHOs (enrolled 94% of the eligible Māori population and 97% of the non­ Māori in March 2014)17; Multiple local and national non­profit and private health and social providers.

3. Iwi within BOPDHB Multiple Iwi lie within or across BOPDHB’s borders including: • Ngai Te Rangi • Ngāti Ranginui • Te Whānau ā Te Ēhutu • Ngāti Rangitihi • Te Whānau ā Apanui • Ngāti Awa • Tūhoe • Ngāti Mākino • Ngāti Whakaue ki Maketū • Ngāti Manawa • Ngāti Whare • Waitahā • Tapuika • Whakatōhea • Ngāti Pūkenga

• Ngai Tai • Ngāti Whakahemo • Tūwharetoa ki Kawerau

4. Age Distribution of the Māori Population In 2013, BOPDHB’s over­65 population was proportionately larger than the national average (17.5% vs. 14.3%), with both BOP and national populations getting older. Other age categories are similar to the rest of the country;14

The BOPDHB Māori population is skewed towards younger age groups, one­third of Māori are aged under 15. Only 6% of Māori are aged over 6514

Table 2. Age distribution of the BOPDHB population as at the 2013 Census.14/15

Age Group 0­14 15­24 25­44 45­64 65­74 75+ Māori (%) 34 16 24 20 4 2 Non­Māori (%) 17 10 22 29 12 10

5. Population Growth Projections From 2006 to 2026 BOPDHB’s Māori population will grow by a greater amount (35.5%) than the local non­Māori/non­Pacific population (21.5%), and the national Māori population (29.9%).

14. Statistics New Zealand. District Health Board Area summary tables. Statistics New Zealand. [Online] 2014. http://www.stats.govt.nz/StatsMaps/Home/Maps/2013­census­map­ethnicity­as­a­percentage­of­total­population.aspx 15.Statistics New Zealand. Regional Summary Tables. Statistics New Zealand. [Online] 2014 http://www.stats.govt.nz/Census/2013­census/data­tables/population­dwelling­tables/bay­of­plenty.aspx 16. Bay of Plenty District Health Board. Hospitals. Bay of Plenty District Health Board. [Online] 2014. http://www.bopdhb.govt.nz/PatientInfo/TGAHospital.aspx.17. Ministry of Health. Primary Health Care. PHO Enrolment Demographics 20124Q1 (Juan­ March 2014). [Online] 2014. http://www.health.govt.nz/our­work/primary­health­care/about­primary­health­organisations/enrolment­primary­health­organisation

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6. Deprivation Distribution BOPDHB has more people in the two least deprived NZDep categories compared with the national average (21% versus 18%).15Deprivation increases toward the east of the DHB where Māori make up a greater proportion of the population. Over 60% of Māori in BOPDHB live in the three most deprived deciles.

7. Leading Causes of Avoidable Mortality and Hospitalisation The leading causes of avoidable mortality and hospitalisation are ranked below. Similar issues ranked highly for Māori and European/other populations locally and nationally 28.

Table 3. Leading causes of avoidable mortality and hospitalisation for BOPDHB 2006­200828

Avoidable Mortality BOPDHB NZ

Avoidable Hospitalisation BOPDHB NZ

1 CVD – IHD CVD – IHD 2 Lung cancer Lung cancer

Māori 3 Diabetes Diabetes 4 Road traffic injuries Road traffic injuries 5 Suicide & self harm Suicide & self harm

Respiratory infections Respiratory infections Dental conditions Dental Asthma Asthma Gastroenteritis ENT infx ENT infections Angina

1 CVD – IHD CVD – IHD

2 Road traffic injuries Suicide/self harm

Other 3 Suicide & self harm Lung cancer 4 Lung cancer Road traffic injuries 5 Colorectal cancer Colorectal cancer

Respiratory infections Respiratory infections Gastroenteritis Gastroenteritis Dental conditions ENT infections ENT infections Dental conditions Angina Angina

8. Health Service Utilisation

8.1 Primary Care – PHO Enrolment In December 2011 the highest number of Māori were enrolled with Eastern Bay Primary Health Alliance (EBPHA) (21,119 people), followed by Western Bay of Plenty PHO (WBOPPHO) (17,663), and finally Ngā Matapuna Oranga PHO (NMO) (8,188 people).17

Table 4. Enrolled populations in BOPDHB PHOs as at March 2014.17

PHO EBPHA WBOPPHO NMO Total Enrolees 45,476 145,502 11,068 Māori 21,119 17,663 8,188 Māori (%) 46 12 74

8.2 Secondary Care – Emergency Department Utilisation The 2011/12 New Zealand Health Survey (NZHS)29 reports that Māori adults are 1.7 times more likely to have used an emergency department (ED) than non­Māori at a national level. 21% of Māori adults used ED in the preceding 12 months, compared to 16% of Pacific, 13% of European and 9% of Asian adults (over 15 years of age). Māori children were also most likely to have used an ED (17%), compared to Pacific (15%), Asian (14%) and Europeans (13%). Emergency Department utilisation was also higher in BOPDHB for Māori (33.7%) than non­Māori (27.8%).

9. Social Determinants of Health Māori experience poorer education, income, unemployment, and housing outcomes than non­Māori. A selection of BOPDHB and national figures are listed below:

Table 6. Summary BOPDHB and national social determinants of health for Māori and non­Māori at the 2006 Census.10

BOPDHB NZ

Māori Non­Māori Māori Non­Māori

Gained Level 2 NCEA 41% 60% 42% 63%

Proportion on a low income (adults over 15 years) 27% 21% 24% 21%

Unemployment rate (adults over 15 years) 8.6% 3.6% 6.9% 3.3%

Proportion of adults who do not own their own home 64% 49% 66% 48%

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National Indicators Indicator 1: Accuracy of ethnicity reporting in PHO registers

Outcome we seek: Greater accuracy of ethnicity data in PHO enrolment databases.

How will we know if we have been successful?

Ethnicity data accuracy will increase as measured through implementation of the Ministry of Health’s primary care ethnicity data auditing tool.

Target: n/a ­ a target will be determined once baseline data has been collected

Māori: n/a

Non­Māori: n/a

What we are planning to do:

By 31 July 2014 Submit a proposal to the Ministry of health to obtain funding for the implementation of the primary care ethnicity data auditing tool.

By 31 July 2014 Participate in a forum with Te Tumu Whakarae members aimed at learning from DHBs who have already implemented the Ministry’s ethnicity auditing tool during 2013/14. The purpose of participation in the forum will be to learn what has worked well, what has not, and how BOPDHB can implement the tool in the most cost­effective way.

By 31 August 2014 Finalise the auditing tool implementation model which will be used based on available resources and feedback from other DHBs which have already implemented the tool. This step will be conducted in consultation with PHOs in BOPDHB to seek a collaborative approach to auditing tool implementation.

By 30 November 2014 Implement the ethnicity data auditing tool in BOPDHB in collaboration with PHOs.

By 31 January 2015 Report results of the initial primary care ethnicity data audit to the quarterly meeting of the Māori Health Plan Steering Group. This group comprises representatives from each of the PHOs in BOPDHB. This forum will be used to collaborate with the PHOs on ways to improve the baseline results. Audit results will be provided to all general practices in keeping with the current performance feedback activities already performed by PHOs.

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Indicator 2: Percentage of Māori enrolled with PHOs

Outcome we seek: Increased access for the Māori population to primary health care services.

How will we know if we have been successful?

100% of Māori in BOPDHB will be enrolled with a PHO.

Target: 100%

Māori (Jan­Mar 2014): 94%

Non­Māori (Jan­Mar 2014): 98%

What we are planning to do:

By 1 July 2014 Implement a five­point enrolment system (as used at Nelson­Marlborough DHB) to ensure enrolment of neonates (into PHO, oral health, hearing, immunisation (NIR), and Well Child Tamariki Ora services). This system will increase PHO enrolment rates for infants. Late enrolment has been identified as a barrier to full enrolment. PHO enrolment rates for Māori have been lower than non­Māori over the past three years. This intervention will help to increase enrolment rates for both adults and infants as it will provide an opportunity to check if parents are enrolled with a PHO along with infants. To be implemented through a collaboration between BOPDHB Funding & Planning and the three PHOs in the area. This intervention will impact both adult and infant enrolment rates.

By 30 September 2014 Calculate enrolment in BOPDHB territorial authorities by age, geography (east vs. western Bay of Plenty), and ethnicity to identify where enrolment gaps are located. Current enrolment demographics (numerator) will be compared with those from the 2013 census (denominator) to determine where enrolment gaps are located. This will help to target interventions to increase enrolment for the Māori population by identifying where high and low enrolment geographic areas are located. Interventions can then be tailored to reach people through relevant sites such as schools, community events, and workplaces. This activity will impact our understanding of where deficits in PHO enrolment rates for Māori are located. To be undertaken by the BOPDHB Performance Monitoring Team and Māori Health Planning and Funding Team.

By 31 October 2014 Develop and implement selected targeted initiatives to increase enrolment for Māori in PHOs over 2014/15. These interventions will be based on the geographic, and age gaps determined in the previous activity for the Māori population in BOPDHB. These interventions will be tabled and prioritised in collaboration with the three local PHOs using the quarterly Māori Health Plan Steering Group forum; this group includes representation from the three PHOs in BOPDHB. Selected interventions will be implemented between November­June 2014/15.

Monitor the impact of these initiatives through quarterly meetings of the Māori Health Plan Steering Group.

In addition to monitoring interventions, the Māori Health Plan Steering Group will monitor PHO enrolment rates on a quarterly basis.

Work with neighbouring Midland DHBs and PHOs to accurately gauge enrolment levels and improve enrolment in border areas (e.g. Murupara, Te Kaha, Waihi Beach).

By 30 November 2014 Complete an audit of ethnicity data accuracy in BOPDHB (see Indicator 1: Accuracy of ethnicity reporting in PHO registers). The audit will enable the Māori Health Planning and Funding Team to reconcile the impact of underreported or misclassified Māori ethnicity on reported PHO enrolment rates. Multiple studies have reported misclassification rates as high as 35%. 1 2

1 Bramley, Dale, and Sandy Latimer. "The accuracy of ethnicity data in primary care." Journal of the New Zealand Medical Association 120.1264 (2007). 2 Swan, Judith, Steven Lillis, and David Simmons. "Investigating the accuracy of ethnicity data in New Zealand hospital records: still room for improvement." New Zealand Medical Journal (2006).

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Indicator 3: Ambulatory sensitive hospitalisation rate (0-4, 45-64, 0-74 years)

Outcome we seek: Reduced ambulatory sensitive hospitalisation (ASH) rates among all age groups (0­4, 45­64, and 0­74 years) BOPDHB has estimated the cost of ASH to be $7 million per annum. The six most frequently seen ASH conditions account for 50% of all admissions. This local research has helped guide the development of a new intervention aimed at reducing ASH over 2014/15. This intervention is described in greater detail below.

How will we know if we have been successful?

Indirectly standardised ASH rates for Māori will be the same as those for the total population of New Zealand.

Targets (Māori): 0­4 years: 129 (% of the total national population indirectly standardised discharge rate) 45­64 years: 103 0­74 years: 116

Baseline Māori (year to Sep 2013):

0­4 years: 196 45­64 years: 152 0­74 years: 204

Baseline total population (year to Sep 2013):

0­4 years: 106 45­64 years: 108 0­74 years: 123

What we are planning to do:

By 31 May 2014 Complete the final service specification for a new acute demand intervention. The draft service specification has been developed with a focus on addressing ASH admissions and acute admissions in BOPDHB. It will be piloted by the largest PHO in the DHB (which serves 72% of the total population). The draft service specification aligns with the principles of proportional universalism – that is, there is a specific focus on the quintile 5 demographic (over 50% of Māori in BOPDHB were grouped in NZDep categories 8­10 at the 2006 census). This cohort will receive a free first appointment for any of the 25 ASH conditions. All subsequent appointments related to management will be free of charge (including prescriptions). The acute demand intervention will also assist with prevention. For example, patients who are seen in primary or secondary care for a pneumonia will be offered a free pneumococcal conjugate vaccination to reduce the likelihood of recurrence of this condition. The acute demand intervention will also feature a packages of care component. This approach is based on features of the packages of care community programme delivered by Canterbury DHB and Pegasus Health which has successfully reduced a range of avoidable hospital admissions. Package of care funding for quintile 5 patients will be provided for those who have experienced three or more hospital admissions in the past 12 months. Package of care funding will be support 1) the development of a patient care plan agreed with the patient, 2) a named care coordinator, 3) a focus on patient self­management, and 4) links to other community providers which may assist with condition management. The new acute demand intervention will fund primary care management of various acute conditions in all age groups. Conditions in the acute demand intervention which are especially relevant to ASH in the 0­4 year age group include upper respiratory and ear/nose/throat conditions (such as otitis media), cellulitis, and dermatitis/eczema. In parallel with the acute demand intervention BOPDHB will reduce admissions in the 0­4 year age group through other measures such as the five­point PHO enrolment process for newborn babies, increased preschool dental enrolment rates (see indicator 14), and increased immunisation rates by 8 months of age. These interventions address conditions found in the leading seven causes of ASH admissions in the 0­4 year age group in BOPDHB. The leading seven conditions account for 99% of all ASH admissions in the 0­4 year age group in BOPDHB. 3

3 Based on quarterly ASH data provided by the Ministry of Health. Last provided for the twelve months ending

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By 1 July 2014 Implement acute demand service intervention. The intervention will be deployed in BOPDHB in collaboration with the two public hospitals in the area, the three PHOs, GP clinics, and a range of other stakeholders.

By 31 July 2014 Educate general practitioners on the acute demand service and phase out the Coordinated Primary Options (CPO) programme. The new acute demand intervention supports primary care management of all 25 ASH conditions as opposed to the CPO programme which only funded primary care management of three ASH conditions. The CPO programme did not fund first appointments or related prescription costs.

By 31 July 2014 Deliver a Māori Health Excellence seminar focused on ASH. BOPDHB will deliver a seminar aimed at learning effective strategies to address ASH along with understanding limitations of the indicator. BOPDHB will provide seminar information to neighbouring Midland DHBs.

By 31 July (ongoing) Monitor the impact of the acute demand service intervention. The performance and monitoring team in BOPDHB Funding and Planning will track admissions for ASH conditions before and after the intervention and report these to the Māori Health Planning and Funding General Manager. The data will be reviewed at the quarterly Māori Health Steering Group meetings.

By 30 June 2015 Improve the accuracy of ASH data and the calculation methodology for the indicator in collaboration with Te Tumu Whakarae, the Ministry of Health, and the Health Quality & Safety Commission. This approach will help to adjust for artefactual differences in ASH rates which are due to differences in hospital resources such as Emergency Department Observation Units.

By 31 August 2014 Link the Kaupapa Māori Advanced Nursing programme with the Whakatane Hospital Emergency Department in an effort to increase condition management options for rurally based patients in the eastern Bay of Plenty and reduce the likelihood of presentation to hospital.

By 30 June 2015 Implement a kaupapa Māori community based cardiac rehabilitation programme. This intervention will help to reduce ASH related to cardiovascular disease.

Ongoing Monitor the ASH indicator on a monthly basis through the Māori Health Planning and Funding Team. Monitor the ASH indicator on a quarterly basis through the Māori Health Plan Steering Group.

December 2013.

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Indicator 4: Full and exclusive breastfeeding rates at 6 weeks, 3 months, and 6

months

Outcome we seek: Higher rates of breastfeeding for Māori infants at 6 weeks, 3 months, and 6 months.

How will we know if we have been successful?

Māori infants will have attained breastfeeding rates consistent with the age­related targets set by the Ministry of Health in the Well Child Tamariki Ora Quality Improvement Framework. 4

Targets: 68% at 6 weeks (full or exclusive) 54% at 3 months (full or exclusive) 59% at 6 months (full, exclusive, or partial)

Māori (Q2 2013/14): 66% at 6 weeks (full or exclusive) 44% at 3 months (full or exclusive) 55% at 6 months (full, exclusive, or partial)

Non­Māori (Q2 2013/14): 73% at 6 weeks (full or exclusive) 58% at 3 months (full or exclusive) 64% at 6 months (full, exclusive, or partial)

What we are planning to do: The factors influencing breastfeeding for Māori women have been identified in past research. The barriers identified in the research include: difficulty establishing 5 6

breastfeeding within the first six weeks; poor or insufficient professional support; perception of inadequate milk supply; and returning to work. The interventions listed below are aimed at addressing some of these factors by supporting initiation and delaying cessation of breastfeeding. We will continue to 7

achieve high initiation rates through continuation of the World Health Organization’s Baby Friendly Hospital Initiative (BFHI) in BOPDHB hospitals. We will support new mothers with access to lactation consultants and will monitor utilisation throughout the year. Breastfeeding after returning to work will be supported through childcare centres providing greater support for breastfeeding and a higher number of workplaces and public spaces providing environments supportive to breastfeeding. These interventions are described below.

Ongoing Ongoing measurement of the proportion of mothers in different ethnic groups who are breastfeeding at discharge from BOPDHB delivery units.

Ongoing Measure utilisation of lactation consultants by maternal ethnicity.

By 31 July 2014 Complete an evaluation of the breastfeeding friendly spaces initiative in BOPDHB and Lakes DHB. The evaluation will assess the experiences of organisations with the initiative and determine the level of support for breastfeeding which has been provided. The research will examine individual, environmental, and organisational support for breastfeeding which have been provided, along with barriers to breastfeeding. To be completed by Toi Te Ora ­ Regional Public Health Service.

By 31 July 2014 Complete a needs assessment for breastfeeding support with eight early childhood education services in BOPDHB (including home based, play centre, and kindergarten services). Assess the capacity of centres to support mothers who wish to utilise child care services but also wish to continue breastfeeding. This information will be used to assist education services to improve their support for breastfeeding. To be completed by Toi Te Ora ­ Regional Public Health Service.

By 31 December 2014 Establish a sustainable forum of breastfeeding stakeholders in the western Bay of Plenty (similar to that functioning in the eastern Bay of Plenty). Key activities of the

4 "The Well Child / Tamariki Ora Quality Improvement Framework ." 2013. 12 Mar. 2014 <http://www.health.govt.nz/publication/well-child-tamariki-ora-quality-improvement-framework> 5 Manaena-Biddle, H, J Waldon, and M Glover. "Influences that affect Maori women breastfeeding." Breastfeeding Review 15.2 (2007): 5. 6 Glover, Marewa et al. "Barriers to best outcomes in breastfeeding for Māori: mothers' perceptions, whānau perceptions, and services." Journal of Human Lactation 25.3 (2009): 307-316. 7 Dyson, Lisa, F McCormick, and Mary J Renfrew. "Interventions for promoting the initiation of breastfeeding." Cochrane Database Syst Rev 2 (2005).

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group will be to establish a stocktake of breastfeeding promotion and support activities being performed by the various stakeholders, and then to integrate the activities and breastfeeding targets of stakeholders. The forum will complete a work plan for the year. Areas to address will include improving the interface between lead maternity carers and Well Child Tamariki Ora services, integrating the roles of stakeholders, and providing more information to providers to educate and support mothers to continue breastfeeding. To be facilitated by BOPDHB Funding and Planning in collaboration with Toi Te Ora ­ Regional Public Health Service.

By 30 June 2015 Increase the number of accredited breastfeeding friendly public spaces in BOPDHB and Lakes DHB by 26 ­ from 124 at 30 June 2014 to 150 by 30 June 2015 (the number of breastfeeding friendly accredited spaces was 118 at the end of February 2014). To be completed by Toi Te Ora ­ Regional Public Health Service.

Ongoing Monitor the breastfeeding indicator on a quarterly basis through the Māori Health Plan Steering Group.

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Indicator 5: Cardiovascular disease risk assessment rates (eligible population)

Outcome we seek: Reduced cardiovascular disease mortality and morbidity through cardiovascular risk assessment (CVRA) and appropriate management.

How will we know if we have been successful?

90% of Māori in the eligible age group will have reached the national CVRA target by 30 June 2015.

Targets: 90% of the eligible population will have had their cardiovascular risk assessed in the last five years.

Māori (Q2 2013/14): 76%

Non­Māori (Q2 2013/14): 81%

What we are planning to do:

By 31 July 2014 Develop software to integrate cardiovascular risk assessment elements from general practice patient management systems (virtual­CVRA). Tool to be accessed from BPAC and implemented by clinics within all three PHOs in BOPDHB. CVRA rates stratified by PHO will be monitored on a quarterly basis by the Māori Health Plan Steering Group. Leading PHOs will share effective interventions with others in this forum. This forum is facilitated by the BOPDHB Māori Health Planning and Funding team.

By 31 July 2014 Deliver a Māori Health Excellence Seminar focused on increasing CVRA results. The key speakers for this seminar have been booked and include a representative from the Ministry of Health (Dr Bryn Jones), one of the leading PHOs for CVRA in the country (Procare), the leading local PHO (WBOPPHO), and two GP clinics from within BOPDHB with the highest levels of CVRA for Māori (one mainstream clinic, and one Māori health provider primary care clinic). This initiative has involved collaboration between BOPDHB, local and national PHOs, and local general practice clinics.

By 30 September 2014 Investigate the delivery of non­GP clinic CVRA. This work involves surveying a selection of NGOs and investigating willingness to perform CVRA of their patient populations, along with assessing the technical requirements and capabilities of these providers. To be led by the BOPDHB Planning and Funding cardiac indicator champion.

By 30 September 2014 Once the feasibility of non­GP CVRA has been assessed the cardiac indicator champion will work with BOPDHB Māori Health Planning and Funding Portfolio Managers to determine which contracts can have CVRA added at their renewal point. The acceptability and safe of delivery of a traditionally clinical service by non­clinical services will be investigated. To be led by the BOPDHB Planning and Funding cardiac indicator champion in collaboration with Māori Health Planning and Funding portfolio managers. To be implemented by relevant community providers.

By 31 July 2014 (ongoing) Monitor CVRA performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team. Monitor CVRA results on a quarterly basis through the Māori Health Plan Steering Group. This group involves representatives from the three PHOs and is used as a forum to review new initiatives implemented by primary care, and to plan new interventions.

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Indicator 6: Acute Coronary Syndrome

Outcome we seek: Reduced cardiovascular disease mortality and morbidity through better management of acute coronary syndrome (ACS).

How will we know if we have been successful?

Targets for ACS management will be attained by 30 June 2015.

Targets: 70% of high­risk Acute Coronary Syndrome patients accepted for coronary angiography have it within 3 days of admission (Day of admission=Day 0). 95% of patients presenting with Acute Coronary Syndrome who undergo coronary angiography have completion of ANZACS QI ACS and Cath/PCI registry data collection within 30 days.

Baseline Māori: Jan­Mar 2014 for angiography data; Dec 2013­Feb2014 for forms data.

69.2% (18/26) high­risk Acute Coronary Syndrome patients underwent coronary angiography within 3 days of admission (Day of admission=Day 0). 100% (20/20) of patients presenting with ACS who underwent coronary angiography had ANZACS QI ACS and Cath/PCI registry data collected within 30 days.

Baseline Non­Māori: European/Other used as reference group, Jan­Mar 2014 for angiography data; Dec 2013­Feb2014 for forms data.

83.1% (74/89) of high­risk Acute Coronary Syndrome patients underwent coronary angiography within 3 days of admission (Day of admission=Day 0). 96.9% (93/96) of patients presenting with ACS who underwent coronary angiography had ANZACS QI ACS and Cath/PCI registry data collected within 30 days.

What we are planning to do:

By 31 October 2014 Develop systems to provide regular monthly reports for the two BOPDHB hospitals for this indicator. Reports will provide the percentage of ACS patients who undergo angiography within 3 days, along with the percentage of patients who have ANZACS QI ACS and Cath/PCI registry data collection within 30 days. Reports will be categorised by ethnicity. To be performed by the BOPDHB Planning and Funding Performance Monitoring Team, team in collaboration with the MHP cardiac indicator champion.

By 30 November 2014 DHBs with leading ACS management performance for Māori to be identified. Led by BOPDHB Planning and Funding MHP cardiac indicator champion.

By 30 November 2014 Midland Cardiac Network to facilitate performance reporting among Midland DHBs for ACS indicators. This reporting will help to identify the leading DHBs and facilitate process improvement within the region.

By 31 July 2014 (ongoing) Monitor indicator activity performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team in collaboration with the BOPDHB cardiac indicator champion. Monitor results on a quarterly basis through the Māori Health Plan Steering Group.

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Indicator 7: Breast screening rates (50-69 years)

Outcome we seek: Lower breast cancer morbidity and mortality among Māori women through better utilisation of the national breast screening programme for women aged 50­69 years. 8

How will we know if we have been successful?

Screening rates for Māori women (50­69 years) in BOPDHB will have reached the national target of 70%.

Target: 70%

Māori: 60% (24 months to 30 Nov 2013, 50­69 year age group, National Screening Unit (NSU))

Non­Māori: 68% (24 months to 30 Nov 2013, 50­69 year age group, NSU)

What we are planning to do:

By 31 July 2014 Determine current levels of enrolment in the breast screening programme categorised by GP clinic. Implement interventions to increase enrolment in these clinics. To be completed by BreastScreen Midland.

By 31 August 2014 Develop incremental enrolment targets for individual GP clinics based on current performance. To be completed by BreastScreen Midland.

By 31 August 2014 Identify women within BOPDHB who are enrolled on the breast screening programme but have not had screening completed within the required time period. Implement interventions to increase screening participation among this group (see below). To be completed by BreastScreen Midland.

By 31 July 2014 Ongoing

GP Liaison representative at Breastscreen Midland to provide breast screening independent service providers (ISPs) with monthly lists of those who do not attend screening appointments (DNA).

By 31 August 2014 ISPs to act as outreach services and navigators for BreastScreen Midland and provide individualised support for women requiring assistance with transport, health literacy, or cultural concerns associated with screening.

By 31 August 2014 ISPs to provide incentives to high­needs women to be screened (e.g. women who are screened will be entered into a prize draw for petrol or grocery vouchers). This activity will be delivered outside the conventional national screening awareness promotion campaign period.

Ongoing BOPDHB will work regionally by meeting every six months with regional stakeholders involved in the breast screening pathway. These stakeholders include Breast Screen Midland, radiology providers, independent service providers, and representatives from neighbouring DHBs. Agenda items includes update on Midland coverage, how we are progressing on the Breast Screening Regional Plan, the mobile screening unit schedule, issue/challenges and an update from stakeholders.

By 31 July 2014 (ongoing) Monitor indicator activity performance on a quarterly basis within the BOPDHB Māori Health Planning and Funding team. Monitor results on a quarterly basis through the Māori Health Plan Steering Group. This forum is used to seek regular presentations and personal reports from the BOPDHB MHP breast screening indicator champion.

8 It is acknowledged that the national breast screening program facilitated by the NSU provides coverage for women aged 45-69. The BOPDHB Māori Health Plan 2014/15 refers to the 50-69 year age group in keeping with existing performance reporting for this indicator.

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Indicator 8: Cervical screening rates (25-69 years)

Outcome we seek: Lower cervical cancer morbidity and mortality among Māori women through better utilisation of the national cervical screening programme for women aged 25­69 years. 9

How will we know if we have been successful?

Cervical screening rates for Māori women will have reached the national target of 80%.

Target: 80%

Māori: 64% (36 months to 30 Sep 2013, 25­69 year age group, NSU)

Non­Māori: 84% (36 months to 30 Sep 2013, 25­69 year age group, NSU)

What we are planning to do:

By 31 July 2014 Provide funding for free cervical smears for high­needs women in GP clinics. This is a collaborative venture between BOPDHB, the three PHOs in BOPDHB, and GP clinics.

By 31 August 2014 Provide free after­hours visits for women seen by independent service providers. ISPs which will deliver this service include Te Kupenga Hauora o Tauranga Moana in the western Bay of Plenty, and Te Puna Ora o Mataatua in the eastern Bay of Plenty.

By 31 August 2014 Provide funding to enable transport assistance for women seeking appointments with ISPs. BOPDHB will support the delivery of this service through Te Kupenga Hauora o Tauranga Moana, and Te Puna Ora o Mataatua.

By 31 July 2014 Ongoing

Review monthly GP clinic cervical screening performance results in an effort to evaluate new interventions introduced over the 2014/15 and also to identify the leading and trailing clinics. Monthly reports will help ISPs to identify clinics that require additional assistance contacting women and supporting attendance at cervical screening. Monthly reporting to be provided to BOPDHB Funding and Planning by Toi Te Ora Regional Public Health Unit.

By 31 August 2014 Educate GP clinics on the services provided by ISPs. These include culturally appropriate provision of cervical screening, and assistance with booking, transport, and follow­up. GP clinics may refer women to ISPs if cultural barriers to cervical screening or other issues are evident. Education to be provided by BOPDHB and ISPs.

By 31 July 2014 (ongoing) Monitor cervical screening performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team. Monitor cervical screening performance on a quarterly basis through the Māori Health Plan Steering Group.

9 It is acknowledged that the national cervical screening program facilitated by the NSU provides coverage for women aged 20-69. The BOPDHB Māori Health Plan 2014/15 refers to the 25-69 year age group in keeping with the indicator guidance listed on page 154 of the 2014/15 Operational Policy Framework on the National Service Framework Library website.

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Indicator 9: Percentage of hospitalised smokers provided with cessation

advice

Outcome we seek: Reduced smoking prevalence, morbidity, and mortality among the Māori population in BOPDHB.

How will we know if we have been successful?

The Health Target smoking cessation advice provision in secondary care target of 95% will consistently be attained. At least 95% of current smokers who are Māori will be provided with cessation advice whilst in BOPDHB’s hospitals. This activity contributes to BOPDHB’s efforts to reach a smoking prevalence of less than 5% by 2025. For additional activities refer to the BOPDHB Annual Plan.

Target: 95%

Māori (Oct­Dec 2013): 90%

Non­Māori (Oct­Dec 2013): 89%

What we are planning to do:

By 31 July 2014 (ongoing) Provide monthly performance reports to hospital ward managers and ward staff to maintain visibility of this indicator. Reports will display the performance of the individual hospital ward along with the indicator target and illustrate disparity between the two. Clinicians will be notified when smoking status for patients has not been stated in the patient’s clinical record, and when there is a failure to note or provide brief advice, and cessation support referral. Currently there is no significant ethnic disparity in cessation advice provision rates. However, when the gap between Māori and non­Māori is 5% or greater the Māori Health Plan Steering Group will implement corrective actions in collaboration with the provider arm representative on the group. These actions may include reviewing the cessation advice provision pathway to identify where smokers are lost to follow up, updating staff training, improving reporting to wards, and other actions.

By 31 July (ongoing) Track the training status of staff involved with assessing and recording patent tobacco use to ensure that key personnel are educated on cessation advice techniques, cessation providers, and equity issues. Where relevant, training will summarise tobacco use epidemiology in BOPDHB by ethnic group. Training will include basic cultural competency education such as offering those who identify as Māori the option of culturally relevant services such as Aukati KaiPaipa and Quitline’s Māori Advisers. 10

By 31 August (ongoing) Refine the cessation advice and follow­up pathway with primary care providers to ensure that integrated ongoing cessation support is provided beyond the hospital environment. Track cessation service use by ethnicity. Ongoing.

By 30 November 2014 Offer smoking cessation advice training to all hospital midwives and private lead maternity carers.

By 31 July 2014 (ongoing) Monitor smoking cessation advice provision performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team. Monitor smoking cessation advice provision on a quarterly basis through the Māori Health Plan Steering Group.

10 "Smoking cessation for Māori - BPJ 22 July 2009 - Bpac." 2013. 18 May. 2014 <http://www.bpac.org.nz/BPJ/2009/July/smoking.aspx>

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Indicator 10: Percentage of smokers enrolled in a PHO provided with cessation

advice

Outcome we seek: Reduced smoking prevalence, morbidity, and mortality among the Māori population in BOPDHB.

How will we know if we have been successful?

90% of patients who smoke and are seen by a health practitioner in primary care will be offered brief advice and support to quit smoking (Health Target). This activity contributes to BOPDHB’s efforts to reach a smoking prevalence of less than 5% by 2025. For additional activities refer to the BOPDHB Annual Plan.

Target: 90%

Māori (Oct­Dec 2013): 79% (High Needs population used as a proxy for Māori population)

Non­Māori (Oct­Dec 2013): 77% (total population)

What we are planning to do:

By 31 December 2014 Introduce software into general practice patient management systems in BOPDHB which facilitates weekly internal performance monitoring of smoking cessation advice provision. The software will provide performance monitoring categorised by patient characteristics such as ethnicity in order to avoid the creation of inequalities in this indicator. The software will provide an electronic referral function to streamline patient access to smoking cessation providers such as Aukati Kai Paipa.

By 30 September 2014 Establish a cessation champion within each general practice. The champion will be responsible for keeping smoking cessation a priority within the practice. Practice champions will be expected to educate practice staff on smoking cessation performance measures on a regular basis, and ensure that smoking status prompting tools are implemented and functional. At present the DHB does not have the capacity to develop a practice guideline for the Māori population, however, the DHB will work with PHOs to ensure that the practice cessation champions make health professionals aware of cessation services which may be culturally appropriate to some Māori health consumers such as Aukati KaiPaipa and Quitline’s Māori Advisers. 11

By 31 December 2014 Calculate ethnic differences in general practice presentations. Where these exist, work with the relevant PHO to offer smoking cessation advice through other means than waiting for a patient to present to general practice eg phone calls to patients to check on smoking status and offer cessation advice or referral to a cessation provider.

By 31 July 2014 (ongoing) Monitor smoking cessation advice provision performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team. Monitor smoking cessation advice provision on a quarterly basis through the Māori Health Plan Steering Group.

11 Ibid.

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Indicator 11: Percentage of infants fully immunised by eight months of age

Outcome we seek: Reduced immunisation­preventable morbidity and mortality.

How will we know if we have been successful?

95% of Māori infants will be fully immunised by eight months of age (by 31 December 2014).

Target: 95%

Māori (Oct­Dec 2013): 87%

Non­Māori (Oct­Dec 2013): 87%

What we are planning to do:

By 1 July 2014 Implement a five­point enrolment system (as used at Nelson­Marlborough DHB) to ensure enrolment of neonates (into PHO, oral health, hearing, immunisation (NIR), and Well Child Tamariki Ora services). This system will improve our immunisation rates for infants at early milestones (six weeks, three months, five months). Late enrolment has been identified as a barrier to timely immunisation in the past. To be implemented through a collaboration between BOPDHB Funding & Planning and the three PHOs in the area.

By 30 June2014 Increase local NIR immunisation reporting frequency to all clinics to a weekly basis (reporting is currently monthly and up to one month in arrears for some clinics). This initiative will be implemented via the Immunisation Operational Working Group comprising representatives from the DHB, PHOs, and clinics.

By 1 July 2014 Implement a guideline for general practices to reduce referral time periods to outreach immunisation services. This pathway will engage outreach immunisation services at an earlier time and help to ensure parents have been contacted as soon as possible after a missed immunisation milestone. Will be facilitated by BOPDHB Planning & Funding immunisation champions. Parents who decline immunisation will continue to be referred to the outreach immunisation service within BOPDHB. This service provides education on the benefits of immunisation for those who have declined along with follow­up in future to check if parents have reconsidered their choice.

By 31 July 2014 (ongoing) Monitor immunisation performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team and via the BOPDHB Funding and Planning immunisation champion. Monitor immunisation performance on a quarterly basis through the Māori Health Plan Steering Group.

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Indicator 12: Seasonal influenza immunisation rates (65 years and over)

Outcome we seek: Reduced influenza morbidity through increased seasonal influenza vaccination rates in the eligible population (65 years and over).

How will we know if we have been successful?

75% of Māori in the eligible population will have received the seasonal influenza vaccination in the period January to July 2015.

Target: 75%

Māori (Jul­Sep 2013): 68% (High­needs population)

Non­Māori (Jul­Sep 2013): 70% (Total population)

What we are planning to do:

January to April 2015 Promote the seasonal influenza vaccination to Māori through the BOPDHB Communications Department, local newspapers, and initiatives implemented by Toi Te Ora – Regional Public Health Service.

January to July 2015 Work with primary care providers via PHOs to advocate for seasonal influenza immunisation for the Māori population. Encourage clinics to identify the eligible Māori population and invite this group to be immunised.

By November 2014 Advocate through Te Tumu Whakarae for DHBSS and the MoH to provide monthly reporting of seasonal influenza vaccination rates by ethnic group (Māori and non­Māori) during the Feb­July 2015 time period.

January to July 2015 Work with koroua/kuia health service providers to focus on immunisation for the over 65 year age group. Use the BOPDHB communications department to engage with koroua/kuia using culturally appropriate media.

By 31 July 2014 (ongoing) Monitor immunisation performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team and via the BOPDHB Funding and Planning immunisation champion. Monitor immunisation performance on a quarterly basis through the Māori Health Plan Steering Group.

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Indicator 13: Reduction in rheumatic fever rates

Outcome we seek: Reduced rates of acute rheumatic fever.

How will we know if we have been successful?

For 2014/15, the BOPDHB target is for hospitalisation rates for acute rheumatic fever to be 40% lower than the average over the last 3 years (measured by National Minimum Data Set).

Target: 2.3 per 100,000 per year (Total population crude rate, all ethnicities). This target results from a 40% reduction in the baseline rate of 3.8 per 100,000 per year (2009/10­2011/12).

Māori: Baseline rate: 3.8 per 100,000 per year (Total population crude rate, all ethnicities, 2009/10­2011/12).

Non­Māori: Baseline performance data and targets are provided for the total population.

What we are planning to do: Detailed actions are documented in the Bay of Plenty Rheumatic Fever Plan 2013­17. Key activities are described below:

By 1 July 2014 Enable access for BOPDHB clinicians to a register of rheumatic fever cases across Lakes and Bay of Plenty DHBs. The register will enable integration of case management by paediatricians, Medical Officers of Health, primary care providers, and nursing services.

By 30 September 2014 Track and monitor the length of time between hospital admission and notification to Medical Officer of Health to ensure the alignment and accuracy of NMDS and EpiSurv data along with accurate rate calculations for BOPDHB.

By 31 July 2014 (ongoing) Measure secondary prophylaxis rates and readmissions on a quarterly basis.

By 1 July 2014 (ongoing) Continue to deliver primary prevention through school­based throat swabbing in selected high incidence areas of the eastern Bay of Plenty.

By 1 July 2014 (ongoing) Continue to support primordial prevention through home insulation and heating projects in association with, private businesses, charitable trusts, and Toi Te Ora­Regional Public Health Service. These project will contribute to reduced household crowding and warmer dryer homes.

By 31 July 2014 (ongoing) Monitor admissions performance on a quarterly basis through the Māori Health Plan Steering Group.

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Indicator 14: Oral health

Outcome we seek: Improved oral health outcomes for Māori children.

How will we know if we have been successful?

70% of Māori preschool children will be enrolled in a dental clinic.

Target: 70%

Māori (Dec 2013): 54%

Non­Māori (Dec 2013): 93%

What we are planning to do:

By 31 August 2014 Complete a comprehensive process map of the enrolment pathway in order to identify all barriers to oral health patient management along the pathway. To be completed by oral health champion, in association with 1) DHB Planning and Funding and MoH (data matching), 2) Community oral health services, 3) PHOs within BOPDHB.

By 31 August 2014 Link children enrolled on PHO database with Titanium dental patient database (currently there are children enrolled on the PHO database who are not linked to a Titanium record). This will be achieved by removing the barriers to enrolment on the oral health database. To be completed by oral health champion, in association with 1) DHB Planning and Funding and MoH (data matching), 2) Community oral health services, 3) PHOs within BOPDHB.

By 31 August 2014 Determine additional oral health staff capacity required to accommodate new enrollees. Provider arm Chief Operating Officer Community oral health services.

By 30 September 2014 Link oral health enrolment process with key milestones in health consultation activities such as immunisation attendance and WCTO visits. This will provide additional opportunities to inform parents about oral health service enrolment and engage the child in the enrolment process.

By 1 July 2014 Implement a five­point enrolment system (as used at Nelson­Marlborough DHB) to ensure enrolment of neonates (into PHO, oral health, hearing, immunisation (NIR), and Well Child Tamariki Ora services). This system will improve our immunisation rates for infants at early milestones (six weeks, three months, five months). Late enrolment has been identified as a barrier to timely immunisation in the past. To be implemented through a collaboration between BOPDHB Funding & Planning and the three PHOs in the area.

By 31 July 2014 (ongoing) Monitor dental clinic enrolment performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team and via the BOPDHB Funding and Planning oral health champion. Monitor dental clinic enrolment performance on a quarterly basis through the Māori Health Plan Steering Group.

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Indicator 15: Mental health

Outcome we seek: Appropriate rates of use of section 29 of the Mental Health Act (community treatment order).

How will we know if we have been successful?

To be determined in collaboration with the MoH.

Target: To be determined in collaboration with the MoH.

Māori (Jul 2012 to June 2013):

140 per 100,000 per year (74 clients) 12

Non­Māori (Jul 2012 to June 2013):

33 per 100,000 per year (53 clients)

What we are planning to do:

By 1 July 2014 Determine appropriate targets for the Māori and non­Māori populations in BOPDHB for this indicator. Refine data collection pathways to enable quarterly performance reporting.

Ongoing (every quarter) Review the data collected via PRIMHD in BOPDHB for the section 29 community treatment order. Check that this matches the manual DHB reporting to ensure accuracy of the reported collections. This involves clarity about standardised data collection points in the MHA process and mapping of the manual reporting in PRIMHD. To be completed by Mental Health and Addiction Services (DAMHS office and information systems analyst).

By 1 July 2014 Ongoing

Compare national data and data for BOPDHB on a quarterly basis in a clinician­led multidisciplinary forum and consider the variance and any clinical implications. Consider if this QA exercise might be usefully incorporated into the adult KPI programme. To be completed by BOPDHB Mental Health and Addiction Services and the Ministry of Health.

By 1 July 2014 Ongoing

Monitor indicator performance on a quarterly basis through the Māori Health Plan Steering Group.

By 31 May 2014 FInalise an indicator champion for this indicator.

By 1 July 2014 Finalise a range of actions aimed at attaining the negotiated targets for this indicator.

By 31 August 2014 Refine data collection pathways to enable quarterly performance reporting.

By 1 July 2014 Monitor indicator performance on a quarterly basis through the Māori Health Plan Steering Group.

12 Data provided by the Ministry of Health via the PRIMHD database, March 2013.

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Local Indicators Indicator 16: Asthma hospitalisation rate (0-14 years)

Outcome we seek: Lower hospitalisation rate for Māori with asthma aged 0­14 years

How will we know if we have been successful?

The asthma hospitalisation rate for Māori aged 0­14 years will be reduced to that of non­Māori.

Target: 432 per 100,000 per year

Māori (year to Jan 2014): 639 per 100,000 per year

Non­Māori (year to Jan 2014):

432 per 100,000 per year

What we are planning to do:

By 1 July 2014 Implement acute demand service intervention. This new intervention will be deployed in BOPDHB in collaboration with the two public hospitals in the area, the three PHOs, GP clinics, and a range of other stakeholders. This intervention will provide free appointments for selected conditions for the high needs population where ambulatory care would successfully avoid hospital admission. The intervention will also cover the costs of acute pharmaceutical requirements.

By 30 November 2014 Facilitate education sessions for primary care staff on asthma action plan development, acute and long­term management, and performance improvement. Contextualise the education with anonymised clinic performance feedback outlining pharmaceutical prescribing patterns in comparison with PHO averages and best practice recommendations.

By November 2014 Initiate a pilot project assessing the effectiveness of a community­based nurse to assist with asthma education, action­plan development, and medication review. To be facilitated by Ngā Matapuna Oranga PHO.

By 1 July 2014 Provide baseline and quarterly asthma hospitalisation figures to PHOs at quarterly Māori Health Steering Group meetings.

By 31 July 2014 (ongoing) Monitor asthma hospitalisations on a quarterly basis through the Māori Health Plan Steering Group.

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Indicator 17: Did-Not-Attend (DNA) rate for outpatient appointments

Outcome we seek: Lower did­not­attend (DNA) rates by Māori in outpatient appointments clinics.

How will we know if we have been successful?

The DNA rate for outpatient appointments for Māori will reach 5%.

Target: 5%

Māori (Jan 2014): 15.4%

Non­Māori (Jan 2014): 7.1%

What we are planning to do:

By July 2014. Report monthly DNA reports by ethnicity, service, and hospital location.

By December 2014.

Work with Te Tumu Whakarae and the DHB Chief Medical Officers forum to rank DNA performance and identify successful interventions used by leading DHBs to reduce DNA rates.

By December 2014.

Share performance improvement data, interventions, and results among BOPDHB stakeholders and other DHBs through Te Tumu Whakarae.

By November 2014. Identify strategies used by the Pacific Island Community Trust to reduce DNA rates for Pacific Island Peoples in BOPDHB over the past three years. Assess successful strategies for applicability to the Māori population.

By December 2014.

Fund a public health registrar to complete a service review, literature review, and gap analysis in order to identify DNA­reduction interventions suited to the needs of the Māori population in BOPDHB.

By November 2014.

Trial outreach outpatient clinics in areas with high DNA rates for Māori. The clinics will be sequentially introduced in Opotiki (May), Te Kaha (July), and Kawerau (October).

By 31 July 2014 (ongoing). Monitor DNA performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team and via the provider arm DNA champion. Monitor DNA performance on a quarterly basis through the Māori Health Plan Steering Group.

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Appendix A – Methodology for Local Indicator Selection

Local indicators were developed through a five-step process involving:

1. Identification of information sources; 2. Identification of leading health issues; 3. Ranking health issues; 4. Scoring the leading health issues; 5. Review and finalisation

1. Identification of Information Sources

External Information Sources

The most useful source of health needs information was a 2008 Health Needs Assessment completed by

the MOH. This document provided epidemiological summaries for a range of conditions stratified by age

gender, and ethnicity. Health service utilisation was also presented.

Internal Information Sources

Epidemiological and service utilisation reports were gathered from Toi Te Ora – Public Health Service,

Funding and Planning, and the DHB’s Population Health Advisory Group (PoPAG).

2. Identification of Leading Health Issues

Health conditions and service utilisation issues were collected in a spreadsheet if they met the following

criteria:

a) A statistically significant difference between Māori and non-Māori outcomes was present; b) There were high inequalities between Māori and non-Māori in BOPDHB (a rate ratio of 1.2 or

greater was used) – indicating worse health outcomes for Māori compared with non-Māori within the DHB;

c) There were high inequalities between Māori in BOPDHB and Māori nationally (a rate ratio of 1.2 or greater was used) – indicating worse health outcomes for Māori in BOPDHB than Māori in the rest of the country.

3. Ranking Health Issues

Rate ratios between Māori and non-Māori on BOPDHB were calculated. The list of health conditions and

service utilisation options were then ranked based on the size of the rate ratio – this gave a measure of

inequality within BOPDHB.

4. Scoring Health Issues

The issues with the highest rate ratios were scored against a list of indicator selection criteria developed

by the National Centre for Health Outcomes Development (NCHOD).

5. Review and Finalisation

The highest scoring options were reviewed by a public health physician from the regional public health

unit, before a set of three condition related indicators were finalised with the DHB’s PoPAG and the

General Manager Māori Health.

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