Dr Simon TowlerDr Simon TowlerChief Medical OfficerChief Medical Officer
WA Department of HealthWA Department of Health
Dr Simon TowlerDr Simon TowlerChief Medical OfficerChief Medical Officer
WA Department of HealthWA Department of Health
MAKING THE DATA SPEAK!MAKING THE DATA SPEAK!
Just who is listening?Just who is listening?
MAKING THE DATA SPEAK!MAKING THE DATA SPEAK!
Just who is listening?Just who is listening?
What is your vantage What is your vantage point!point!
What is your vantage What is your vantage point!point!
Safe: avoid preventable injury from care
Effective: services based on scientific knowledge
Patient centered: respectful, responsive care
Timely: reducing waiting and harmful delays
Efficient: avoid waste (equipment, supplies, ideas)
Equitable: no variation due to ethnicity, gender, age, etc
Improving 21st CenturyImproving 21st CenturyHealth systemsHealth systems
Institute of Medicine
London Healthcare“A Framework for Action”
1/ Services focused on individual needs and choices
Provision should, wherever possible, be tailored to the particular needs of each individual.
Patients should feel in control of their care and be able to make informed choices.
London Healthcare“A Framework for Action”
2/ Localise where possible, centralise where necessary
Routine healthcare should take place as close to home as possible. More complex care should be centralised to ensure it is carried out by the most skilled professionals with the most cutting edge technology.
London Healthcare“A Framework for Action”
3 (a) Truly integrated care and partnership working, maximising the contribution of the entire workforce.
Better communication and co-operation is needed – between urgent and planned care, between health and social care – to stop people from falling through the gaps.
London Healthcare“A Framework for Action”
3(b) Truly integrated care and partnership working, maximising the contribution of the entire workforce.
Care should be multidisciplinary bringing together the valuable contributions of practitioners from different disciplines. The NHS should be committed to working in partnership with other organisations, including local government and the voluntary and private sectors.
London Healthcare“A Framework for Action”
4/ Prevention is better than cure.
Health improvement, including proactive care for people with long-term conditions, should be embedded in everything the NHS does. Close working with local authority partners is needed to help people stay mentally and physically healthy.
London Healthcare“A Framework for Action”
5/ A focus on health inequalities and diversity.
….., the most deprived areas of London, with the greatest health needs, need better access to high-quality healthcare.
London Healthcare
“A Framework for Action”
Partnerships to improve health.
The NHS has often made the mistake of thinking it can change healthcare outcomes on its own. It cannot. The NHS must work with its partners – the London boroughs, the Greater London Authority and the Mayor’s Office, the voluntary and private sectors, and the higher education sector – to implement this Framework.
Different viewpoints of what constitutes these outcomes
• The patient
• Carers and families
• Medical practitioners
• Other health professionals
• Management
• Politicians
Improving 21st CenturyImproving 21st CenturyHealth systemsHealth systems
Health information is being used by all these groups!
It is influencing their ideas about their own healthcare experience!
What is the quality of that information?
What is the depth of their understanding?
How is that information feeding back into the system?
“If governments, the professions and the community really want and expect a “better” health system, then it is time to start asking questions about resource allocation, in a spirit of transparency, with an explicit statement of values, and supported by a systematic and evidence-based framework. The answers have the potential to enhance the sustainability and quality of health care.”
Title: Identifying existing health care services that do not provide value for money
MJA Volume 190 March 2009 Elshaug et al
Health expenditure Health expenditure as % GDPas % GDP
Institute of Medicine0
2
4
6
8
10
12
14
16
18
1966 1976 1986 1996 2006
Australia
Austria
Belgium
Canada
Denmark
Finland
France
Germany
Iceland
Ireland
Japan
Luxembourg
Netherlands
New Zealand
Norway
Portugal
Spain
Sweden
Switzerland
United Kingdom
United States
By 2050
USA > 30
Most other countries 20Financial Times March 25 2009
USA
Australia
Advances in medical technology have brought large
benefits but have also been a major driver of increased
health spending in recent years. In many cases,
increased expenditure on new medical technologies
reflects improved treatment and a significant increase in
the number of people treated.
Productivity Commission Report
• This report identified that advances in medical
technology have been a major driver of the growth
in real health care expenditure and estimated that
the cost of technological change contributed 1.9 per
cent to the annual growth in real health care
expenditure of 5.3 per cent, or 36 per cent of the
annual growth in real health care expenditure from
1992-93 to 2002-03.
Productivity Commission Report
1.98%
3.11%
4.50%
2.07%
4.55%
1.51%
3.04%
4.28%
2.79%
0.00%0.50%1.00%1.50%2.00%2.50%3.00%3.50%4.00%4.50%5.00%
WA is the
fastest growing State in
the nation
Population Growth Sept 2005 - Sept 2007*
GP workforce in WA
Itunes.lnk
Case study 1
2005-06 WA Metro GP FWE’s
11% less than the national average
WA Rural GP FWE’s
16% less than the national average
• You can imbed commercial videos or your own video movie in any slide ...
Distribution of General Practice in PerthDistribution of General Practice in Perth
PERTH
ROCKINGHAM
MANDURAH/PEELHH
HH
HH
HH
HH
HH
HH
FREMANTLE
ARMADALE
KELMSCOTT
Pink dots are GP PractisesPink dots are GP Practises
Population growth by SLA to 2016
0
5000
10000
15000
20000
25000
30000
Rockingham
(C)
Sw
an (C)
Cockburn (C
)
Mandurah (C
)
Wanneroo (C
) -S
outh
Wanneroo (C
) -N
orth-East
Arm
adale (C)
Wanneroo (C
) -N
orth-West
Gosnells (C
)
Inner city
Kw
inana (T)
Stirling (C
) - Central
Joondalup (C) -
North
Kalam
unda (S)
Stirling (C
) -C
oastal
Rem
ainder
Top 15 by population
0%
10%
20%
30%
40%
50%
60%
70%
80%
% g
row
th
Growth to 2016
% growth
Note overall metro growth rate is 17%
Population growth to 2016
Rockingham27000 additional people by 2016
30% growth
• You can imbed commercial videos or your own video movie in any slide ...
Distribution of General Practice in PerthDistribution of General Practice in Perth
HHROCKINGHAM
Population growth by SLA to 2016
0
5000
10000
15000
20000
25000
30000
Rockingham
(C)
Sw
an (C)
Cockburn (C
)
Mandurah (C
)
Wanneroo (C
) -S
outh
Wanneroo (C
) -N
orth-East
Arm
adale (C)
Wanneroo (C
) -N
orth-West
Gosnells (C
)
Inner city
Kw
inana (T)
Stirling (C
) - Central
Joondalup (C) -
North
Kalam
unda (S)
Stirling (C
) -C
oastal
Rem
ainder
Top 15 by population
0%
10%
20%
30%
40%
50%
60%
70%
80%
% g
row
th
Growth to 2016
% growth
Note overall metro growth rate is 17%
Population growth to 2016Cockburn
25000 additional people by 2016
30% growth
• You can imbed commercial videos or your own video movie in any slide ...
Distribution of General Practice in PerthDistribution of General Practice in Perth
HHROCKINGHAM
COCKBURN
What are GP’s doing?
BEACH data suggest that in the 12 months 2001–02,
people in Australia spent on average 83 minutes with
a GP per head of population.
This compares with about 56 minutes per head in New
Zealand and about 30 minutes in the United States
during the same period.
What are GP’s doing?
BEACH
The extent to which this affects health outcomes
for the populations is as yet unclear. However,
considering this high use of general practice
care, information about the problems dealt with
and how they are managed by GPs is essential.
Improving health systems
2nd
1st
2nd
Improving health systems
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
2003-04 2004-05 2005-06 2006-07
Year
ED A
tten
danc
es
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
9,000,000
GP A
tten
danc
es
Metro ED WACHS ED GP Attendances
GP attendances
have remained relatively
stable, ED attendance
(metro) growing at 6.2% per annum)
Services per July 2006 - May 100,000 pop
GP Attendances
NSW 3122 913503 35315 100129
VIC 6486 847737 30505 88771
QLD 6441 797695 70608 69215
SA 15989 865701 34315 99613
WA 2396 731812 27213 71454
TAS 2566 819081 10082 83156
ACT 906 674357 7575 72351
NT 2123 452029 12704 34852
Average 5444 841939 38931 86814
GP Services
Rates of ED presentation by area of residence (2004/05)
0 – 150 presentations
per 1000 population
310 - 402 presentations
per 1000 population
Public hospital activity is growing faster than the population
WA: Population Growth
AVERAGE LENGTH of STAYBy AGE GROUP and SEX
SEPARATIONS per 1000 POPULATION
by USUAL RESIDENCE
• Malcolm (1994):
“the overriding problem of hospitals, as organisational entities, is that they
fragment the continuum of care, the delivery of integrated services which
should be inclusive of both hospital as well as community-based care”.
Secondary
Hospitals
Upstream Downstream
SEPARATIONS per 1000 POPULATION by INDIGENOUS STATUS and AGE GROUP
Indigenous Australians as
percentage of all population, by
region
• The major weakness evident in the Western Australian health system is a lack of integration across its component agencies.
• Planning has been isolated from clinical expertise and consequently implementation of plans and recommendations has been difficult
Deloitte Ross Tohmatsu 1991
London Healthcare
“A Framework for Action”
Clinical leadership.
The whole approach of this review has been to develop clinical support for our proposals. But it is easy to support principles for London, harder to support change in the hospital or locale where you work. Many clinicians understandably fear that change will affect their job satisfaction, their autonomy, their clinical reputation. To confront and assuage these fears, NHS London needs to indentify clinical champions to make the case for change.
Case study 2
What is evidence-based medicine is:What is evidence-based medicine is:
“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values”
- Sackett, et al 2001
Managing Disease
How well do we treat patients?
Between 16 to 50% of RBC transfusions in Australia may be inappropriate
“a failure of contemporary Australian transfusion practices to align with recommended best practice.”
Transfusion Variability in Austria
1,401 THR - patients transfused
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
15 12 13 16 9 3 1 7 2 11 4 6 5 8 14 10
Center No.
Huge inter-hospital variability of RBC transfusion rate for matched pts:16 – 84%
Gombotz H, Rehak P, Shander A, Hofmann A. Blood use in elective surgery: the Austrian benchmark
study. Accepted for publication February 14, 2007 in
Transfusion
AKH Linz Experience - Hip and Knee Replacement
0
10
20
30
40
50
60
70
80
90
100
1
% patients transfused
Baseline (2003)
Evaluation (2003)
Guidelines (2004)
Individual approach (2004-2005)
Plus preop treatment (2005)
Goal
Patient Blood
Management
AllogeneicTransfusion
Gombotz H. et al. Unpublished data.
Problems in Transfusion MedicineThe dramatially growing non-donating but blood using age cohort
The dramatially growing non-donating but blood using age cohort
The less growing donating age segment The less growing donating age segment
• Annual cost of the program• Total estimated annual savings
• Reduced product utilisation• Shorter hospital stays• Less work in transfusion laboratories• Less work in nursing units
• Enhanced patient satisfaction and safety
$1,800,000$14,950,000
Population 11.4 million (2001)
Freedman J, Luke K, Escobar M, et al. Experience of a network of transfusion coordinators for blood conservation(Ontario Transfusion Coordinators [ONTraC]). Transfusion 2007
60
98% 16% 22%0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Tra
nsfu
sio
n R
ate
in
Perc
en
t
1 2 3
Year
Perioperative Transfusion Rate (%) in Total Hip Replacement (Primary & Revision)
Fremantle Kaleeya Hospital
Perc
enta
ge
1989 1996 2002
The Blood Using Age Segment
<40yrs.40-69yrs.>70yrs. total0%
20%
40%
60%
80%1997 - 2006
1997 - 2016
Source: Compiled from WA Tomorrow
U/1,000
<40yrs. 40-69yrs. >70yrs.0
40
80
120
160
200
WA population growth until 2016 Transfused RBCs/1,000
Inhabitants
WA PublicHospitals
Unnecessary transfusion?
$340 per unit
A recent editorial in the New England Journal of Medicine (NEJM) estimated
that over $700 billion is wasted annually in the US health system. [i]
At first glance the statement seems extraordinary. By way of corroboration the
estimate in the NEJM is in line with an earlier estimate from the Health
Research Institute at PricewaterhouseCoopers published in their report, “The
price of excess – Identifying waste in health care spending” in which they
report a figure close to $1.2 trillion per year [ii].
Remarkably, this represents nearly 50% of the annual US expenditure on
healthcare!
[i] NEJM, 1……
[ii] PWC HRI ‘The price of excess”
Waste in healthcare spending
HEALTHPACT – Process
The business of health• Health is not just a “social good”• In Australia it is a business• There has been little work on the
interface between these two ideas• Different models exist• In WA, private operators provide
public health services• Australia is dependent upon
private sector in health.
The business of health
• Providing health care• Supporting policy and economic
review• Logistic development• Fostering innovation in
management• Working with providers on new
service models• Direct patient support• Improving clinician performance
Opportunities – reform is needed
• Enhancing patient and clinician participation
• Collecting and evaluating information
• Effective implementation
• Managing performance
• Adapting to the evidence
Key aims of policy and implementation
DATA is CENTRAL to this PROCESS!!
INFORMATION Management is Even More IMPORTANT
IMPLEMENTATION must be EVALUATED
Working in partnership
Improving health outcomes for WA
THANK YOU for YOUR ATTENTION
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