ACTA Summit 2016 What we know about the health and economic benefit - PowerPoint PPT Presentation

ACTA Summit 2016 What we know about the health and economic benefit of trials and registries in Australia Dr Robert Herkes Clinical Director 24 November 2016 TRIM: D16-40837

Health and economic benefit of clinical quality registries and clinical trial networks? • The Australian Commission on Safety and Quality in Health Care • Atlas of clinical variation • National Safety and Quality Health Service Standards • Self improving health system • Australian cost benefit analysis of Clinical Quality Registries (CQR) • Prioritisation of Clinical Quality Registries • Australian cost benefit analysis of Clinical Trial Networks

The Long Room in the old library (1712) – Trinity College, Dublin (1592) (Doomsday Book 1086) (Oxford University 1096) 3

• Australian Government agency, jointly funded by all governments • Leads & coordinates national improvements in safety & quality of health care based on best available evidence • Aims to ensure that the health system is better informed, supported & organised to deliver safe & high quality care • Works in partnership with patients, consumers, clinicians, managers, policy makers & health care organisation • Aims to achieve a sustainable, safe & high-quality health system 4

Patient safety and quality • Australia’s health system generally performs well compared to other OECD countries • A significant proportion of Australian hospital admissions are associated with an adverse event • Reduction in the rate of adverse events and unwarranted variation – could potentially produce productivity savings, as well as direct benefits to patients • The economic benefits of improving patient safety and value are compelling • National data systems are not sufficient on their own to support improvements 1 Vital Signs (2015); 2 Health Policy Analysis (2013) 5

Commission work • National Safety & Quality Health Service Standards (NSQHS) • Pricing for safety and quality • Clinical Care Standards 6

National Safety & Quality Health Service Standards (NSQHS) • Commenced 2013 • National safety standards are designed to protect the public from harm and to reduce preventable adverse events • Focus on reducing high risk adverse clinical events • Mandated by COAG-HC • All public and private hospitals and day procedure centres Version 1 Version 2 7

The self improving health system 8

Measurement is foundational to advancing healthcare improvement Atlas of variation Clinical Clinical Trials Quality A robust safety and quality Registries monitoring system requires Incident HACs surveillance multiple measurements of patient safety Measurement Patient Clinical experience care and standard PROMs indicators SAMM/ PPH; NSQHS Standards NAUSP; CARAlert; NIMC Sentinel CHBOI Events 9

Australian Atlas of Healthcare Variation – Colonoscopy 10

How can clinical quality registries help? 11

What is a CQR? • Commission published a Framework for Clinical Quality Registries in 2010 • Clinical quality registries are organisations that systematically monitor the quality (appropriateness and effectiveness) of health care, within specific clinical domains, by routinely collecting, analysing and reporting health-related information • They provide severity of illness adjusted outcomes with peer comparisons to frontline clinicians, to allow peer comparison and improvement

What is a CQR?

What is a CQR?

What is a CQR? Patient survival Australia & Graft survival Australia & New Zealand primary New Zealand primary deceased donor deceased donor 1.00 1.00 0.75 0.75 2010-2014 0.50 0.50 2010-2014 2005-2009 2005-2009 2000-2004 2000-2004 0.25 0.25 1995-1999 1995-1999 1990-1994 1990-1994 1985-1989 1985-1989 0.00 0.00 0 10 20 30 0 10 20 30 Y e ars p ost tra nsplan t Y ears post transplant

CQR: Economic evaluation • Conservatively evaluated the economic impact of five clinical quality registries in Australia • Findings: • Significant net positive returns on investments and positive benefit to cost ratio • Substantial benefits, reflecting improvements to clinical practice and outcomes over time • Significant value for money, when correctly implemented and sufficiently mature 16

Selected CQRs Registry Hosted by Evidence of impact • Prostate cancer research international active surveillance (PRIAS) guideline compliance resulting in lower rates of unnecessary intervention • Positive need surgical margin reduction - better survival and avoided for Victorian Prostate Cancer Registry Monash University secondary therapy (Victorian PCR) • Earlier treatment • Reduced in-hospital mortality Victorian State Trauma Registry • Reduced average length of stay Monash University (VSTR) • Better longer term functional outcomes • ICU Standardised Mortality Rates Australia and New Zealand • Adverse events – (e.g. central line infection rates) Intensive Care Adult Patient • Rates of re-admission ANZICS Database • Length of stay in ICU (ANZICS APD) • Sepsis • Graft failure rate reduction over time Australia and New Zealand • Mortality Dialysis and Transplantation Royal Adelaide Hospital • Reduced rates of complications (e.g. peritonitis rates) Database • Changes in practices (e.g. shunt timing) (ANZDATA) Australian Orthopaedic • Reduction in arthroplasty revision rates Association National Joint • Early recall/removal from market of poorly performing prosthetic devices used in University of Adelaide joint replacement surgery Replacement Registry 17 (AOANJRR)

CQR: Economic evaluation results Current Evaluation (gross benefits) Extrapolation to full national coverage National Registry Period of analysis Benefit Cost BCR Benefit Cost Extrapolated BCR coverage Victorian PCR 2009-13 11% $5.2m $2.7m 2:1 $44m $8.9m 5:1 VSTR* 2005-13 25% $36m $6.5m 6:1 $147m $12m 12:1 ANZICS 2000-13 80% $36m $9.8m 4:1 $45m $11m 4:1 ANZDATA 2004-13 100% $58m $8.8m 7:1 $58m $8.8m 7:1 ≤2002 -14 AOANJRR $65m $13m 5:1 $13m 5:1 100% $65m *Crude estimate. Likely overestimate due to assumption of starting from zero coverage in other states. In reality, there is some existing coverage with different definitions of “major trauma” (BCR - Benefit-Cost Ratio) 18

CQR: Prioritised list of clinical domains • Application of the prioritisation criteria (and other elements) in the Framework, to create a prioritised list of clinical domains for potential development of national clinical quality registries • The process combined available data with the collective judgement of experts: • Shortlisted to identify a manageable list of diseases, conditions and interventions • Identified threshold criteria – prioritisation criteria essential to the successful functioning of a clinical quality registry • Applied threshold criteria to remove diseases, conditions and interventions not suitable for development • Grouped remaining diseases, conditions and interventions into clinical domains • Prioritised clinical domains against remaining prioritisation criteria. 1  2 3 19