Hospitals Jenny Hargreaves
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Transcript of Hospitals Jenny Hargreaves
Hospital performance
Jenny Hargreaves Economics and Health Services Group
AIHW
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
What is performance: Health Ministers’ National Health Performance Framework
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
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
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
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
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
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
Effectiveness: Accreditation of hospitals
Safety: Adverse events treated in hospitals
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
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
Responsiveness• No indicators
Continuity of care• No indicators
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
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)
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
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
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
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
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
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
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?