Hospitals Jenny Hargreaves

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Hospital performance Jenny Hargreaves Economics and Health Services Group AIHW

Transcript of Hospitals Jenny Hargreaves

Page 1: Hospitals Jenny Hargreaves

Hospital performance

Jenny Hargreaves Economics and Health Services Group

AIHW

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What is performance?• National Health Performance Framework

– Chapter 9 in Australia’s Health 2010• National Healthcare Agreement• Productivity Commission’s report Public and

Private Hospitals• Report on Government Services• AIHW’s Australian Hospital Statistics• Other views

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What is performance: Health Ministers’ National Health Performance Framework

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What is performance: COAG’s National Healthcare Agreement• Outcomes

– Hospital and related care• High quality, appropriate, timely

– Patient experience• Suited to needs, informed, seamless, safe

– Sustainability• Respond, adapt

• Progress measures– Waiting times, adverse events, patient satisfaction

• Outputs– Rates of services, training positions

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What is performance: Report on Government Services• Public hospitals, maternity services• Outputs

– Equity• access

– Effectiveness• access, appropriateness, quality (safety, responsiveness,

capability, continuity), sustainability

– Efficiency• Outcomes

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What is performance: Productivity Commission’s Public and Private Hospitals

• Australian Government request for a report (published December 2009) on the relative performance of public and private hospital systems:– Hospital and medical costs

• Included measures of costs, productivity and access– Hospital-acquired infections

• Included other safety and quality indicators– Rates of fully informed financial consent for privately

insured patients

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What is performance: other views

• Only some statistical information is ‘labelled’ as ‘performance indicators’ in those frameworks

• Other statistics may be also viewed as measuring performance by stakeholders:– Minister Roxon highlighted numbers of doctors and

nurses in a speech to parliament last week– AMA highlighted occupancy rates in its Public

Hospital Report Card (published in 2009)– Adelaide Advertiser’s front page story on numbers of

people leaving emergency departments before being seen by a doctor

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What is performance? Other than national…• Performance measurement for different

purposes– local or state-level management of hospitals– funding agreements (public and private hospitals)– accountability or public reporting at the local or

state level• Measurement designed to support hospital

quality improvement activities– Hospital benchmarking or comparison activities

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Hospital performance indicators in Australia’s Health 2010• And some others from Australian Hospital Statistics

2008-09; COAG reporting • National Health Performance Framework:

– Effectiveness– Safety– Responsiveness– Continuity of care– Accessibility– Efficiency and sustainability

• Comparisons: over time, between states/sectors/countries, considering equity

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Effectiveness: Accreditation of hospitals

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Safety: Adverse events treated in hospitals

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Safety: Unplanned readmissions following surgery in public hospitals, 2008-09 (COAG)

0 0.5 1 1.5 2 2.5 3

Knee replacement

Hip replacement

Tonsillectomy & Adenoidectomy

Hysterectomy

Prostatectomy

Cataract extraction

Appendicectomy

Readmissions per 100 separations

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Safety: Falls resulting in patient harm in hospitals (COAG)by age group, and socioeconomic status, 2007-08

0

4

8

12

0–24 25–44 45–64 65–84 85 or overAge group

Per 1,000 hospitalisations

0

0.5

1

1.5

2

2.5

3

1-Lowest

2 3 4 5 -Highest

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Responsiveness• No indicators

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Continuity of care• No indicators

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Accessibility: Waiting times for elective surgery (COAG)

0

10

20

30

40

50

Major cities Very remote

Days

0 10 20 30 40 50 60 70

Total

Cardiothoracic surgery

Other

Vascular Surgery

Neurosurgery

Plastic Surgery

Urology

General Surgery

Gynaecology

Orthopaedic surgery

Ear, nose and throat surgery

Ophthalmology

Median waiting time (days)

Cancer-related

Overall

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Accessibility: Emergency Department waiting times, 2008-09 (COAG)

0

10

20

30

40

50

60

70

80

90

100

NSW Vic Qld WA SA Tas ACT NT Total

Per c

ent s

een

on ti

me

0

10

20

30

40

50

60

Min

utes

Proportion seen on time (%)

Median w aiting time to service delivery (minutes)

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Accessibility: Rates of services: overnight separations (COAG) 2008-09, international, socioeconomic comparisons

Separations per 1,000 population

0

40

80

120

160

200

240

280

Mex

ico

Spai

n

Net

herla

nds

UK

USA

New

Zea

land

Irela

nd

Aust

ralia

Icel

and

Swed

en

Switz

erla

nd

Nor

way

Hun

gary

Slov

ak R

ep.

Pola

nd

Cze

ch R

ep.

Ger

man

y

Fran

ce

0

20

40

60

80

100

120

140

160

180

200

1—Low est 2 3 4 5—Highest

Private hospitals Public hospitals All separations

Separations per 1,000 population

SES group

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Accessibility: Differential access to hospital procedures (COAG) Indigenous rate ratio, 2007-08; states, 2008-09

0 2 4 6 8 10 12

Cataract extraction

Cholecystectomy

Coronary artery bypass graft

Coronary angioplasty

Cystoscopy

Haemorrhoidectomy

Hip replacement

Hysterectomy, females aged 15–69

Inguinal herniorrhaphy

Knee replacement

Myringotomy

Prostatectomy

Septoplasty

Tonsillectomy

Varicose veins, stripping and ligation

Separations per 1,000 population

National rate

Range of state/territory rates

0 0.2 0.4 0.6 0.8 1 1.2

Cataractextraction

Cystoscopy

Inguinalherniorrhaphy

Rate ratio

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Access: Rates of services: non-acute care separations (COAG)Change in separations, 2004-05 to 2008-09

-5 0 5 10 15 20

Total

Rehabilitation

Palliative care

Maintenance care

Psychogeriatric care

Geriatric evaluation and management

Private hospitals

Public hospitals

Per cent change

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Efficiency and sustainability: cost per casemix-adjusted separation (COAG)

0

500

1000

1500

2000

2500

2004–05 2005–06 2006–07 2007–08 2008–09

Cost per casemix-adjusted separation ($)

Non-medical labour costs

Other recurrent costs

Medical labour costs

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Efficiency and sustainability: relative stay indexpublic, private hospitals, 2008-09

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

Medical Surgical Other

RSI

Public hospitals Private hospitals All hospitals

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What will be measured in 2020?• More safety and quality

– against national clinical safety and quality standards– Healthcare associated infections– Readmission and mortality rates– Pressure ulcers– Other outcomes?

• COAG indicators being developed/proposed by CRC– Patient experience– Waiting times – after Emergency Department care, for radiotherapy– Better measures of comparative service use, eg against need– Affordability– Appropriateness– Sustainability

• Other indicators associated with national health reform– Financial performance

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What will be measured in 2020?

• More for private hospitals• More for individual hospitals and hospital

groups/networks• Quarterly rather than annually• More timely?• Derived from data linkage?• Derived from e-health?