The Commission Supporting the health and disability sector to - - PowerPoint PPT Presentation

Kupu Taurangi Hauora o Aotearoa

The Commission

Supporting the health and disability sector to deliver safe and quality health care to all New Zealanders Works with clinicians, health providers and consumers to:

• improve the quality and safety of services
• increase consumer engagement and participation

It’s about…

• ‘Shining a light’ on important quality and safety issues

through public reporting

• ‘Lending a hand’ through making expert advice, guidance and

tools available “Doing the right thing, and doing it right, first time”

Sector quality and safety outcomes

The New Zealand Triple Aim

• Building capability
• Supporting clinical leadership
• Building on the success of existing initiatives
• Sharing success stories

Driving quality improvement

• Medication Safety
• Infection Prevention and Control
• Reportable Events
• Consumer Engagement
• Mortality Review Committees
• Health Quality Evaluation

Our programmes Other focus areas

• Surgical Safety Checklist
• Trigger Tools
• Falls

falls healthcare-acquired infections medication surgery Sector capability & clinical leadership Information, analysis and evaluation Consumer engagement

Reducing harm from:

Our focus

Evidence tells us that with the right interventions:

• patient falls that result in fractures can be reduced by up to 30

percent

• CLAB rates can be reduced to fewer than one per 1000 bed days
• surgical complications can be reduced

by about a third

• potentially adverse drug events can be

reduced by a quarter

We know what works

• A campaign to reduce patient harm is under development
• It is led and coordinated nationally by the Commission, and led

and implemented locally by the sector

• Clinical and consumer champions will be the face of the campaign
• It focuses on reducing harm from:

– health care associated infections – surgery – medication – falls

• Register your interest and have input

into the campaign development: www.hqsc.govt.nz

Patient Safety Campaign

• Register for our newsletter and fortnightly email updates
• Contact us: info@hqsc.govt.nz

Our website: www.hqsc.govt.nz

Improvement starts with knowledge and clarity

• Well designed measures collect the right data,

in the right parts of the system, at the right time

• They help you understand what parts of the

system to change and how

Three key roles of measurement

• For UNDERSTANDING: to know how a system

works and how it might be improve

• For PERFORMANCE: monitoring if and how a

system is performing to an agreed improvement/performance/managerial state or level

• For ACCOUNTABILITY: allowing us to hold
• urselves up to patients, the government and

public to be openly scrutinised

Why measure?

• Stimulation of improvement
• Evaluation of what worked (or didn’t)
• Judgement of overall quality
• Prompting the important questions

Quality and Safety Markers

Aim to stimulate change in priority areas (process) but also demonstrate the benefit in reduced harm and saved $ (outcome)

• Answering the question of whether our interventions made any

difference is crucial for us.

• Completing projects successfully is not sufficient
• Need to measure IMPACT (were HQSC interventions taken up; what

changed in NZ healthcare as a result), and;

• OUTCOME (what harm was avoided, what health status was

improved, how much money was saved) (note this will usually have a

longer timescale)

Process and Outcome Measures

Outcome measures the voice of the consumer/patient

• What is the result?
• How is the system performing?

Process measures the voice of the workings of the system

• Are key changes being implemented in the system?
• Are the parts/steps in the system performing as

planned?

Quality and Safety Markers

• Process measures –

– practices that are shown to improve care and should (except for specific exclusions) always be undertaken – under the control of the provider – suitable for targets and league tables – therefore set a national threshold to be achieved with differential trajectories agreed between NHB and DHBs

• Outcome measures –

– outcomes that should be related to changed practice – harm avoided, cost reduced – not directly under the control of the provide so no targets or league tables used for these – contextualise process measures – quantify effects at a national level

Example QSM set for falls

Process markers

• Percentage of patients aged 75 and over that are given a falls risk assessment and

implementation of appropriate falls prevention. - proposed national threshold 95%

• Percentage assessments that result in a positive intervention to manage the risk of
• fall. (a subset used to contextualise the primary marker – no national threshold)

Outcome measures

• In hospital Fractured Neck of Femur (FNOF) per 1,000 admissions (age/sex

standardised).

• Mortality following in-hospital FNOF (actual lives lost and rate per 1,000

admissions).

• Additional occupied bed days (OBDs) and associated cost following in hospital

FNOF (actual OBDs and $s).

Quality Accounts

Quality Accounts require health care providers to give an account for the quality of their services in a similar way to financial accounts showing how an

• rganisation used its

money.

Quality Accounts: what are they?

• annual reports from service providers regarding the quality
• f the services provided, and how each provider is

progressing in quality improvement, the consumer experience and health outcomes.

• a mechanism that service providers are able to share their

successes, learning and future improvements with the public and the wider sector.

• designed to be published alongside annual financial

accounts to demonstrate the equal value and status of quality and safety.

Quality Accounts: who is it for?

The Atlas: what is it for?

• To prompt debate and raise questions about

health service use and provision amongst clinicians, users and providers of health services about why any differences (variation) exist, and to stimulate improvement through this debate

The Atlas: what is it?

• A web tool available through the Health Quality and Safety

Commission’s website

• Displays easy-to-use maps, graphs, tables and commentary

that highlight variations by geographic area in: – The provision and use of specific health services – Health outcomes

• Understanding and responding to variation information

helps improve health quality

www.hqsc.govt.nz/our-programmes/health-quality- evaluation/projects/atlas-of-healthcare-variation/

Richard Hamblin Director Health Quality Evaluation

Kupu Taurangi Hauora o Aotearoa

Quality Indicators

• Introducing the proposed indicator set
• Review each of the 11 ‘fast-track’ indicators
• Seeking your views on the indicator set as a

whole

What we seek to achieve

Provide robust information to support achievement and measure progress in the whole NZ healthcare system against delivery of the

• utcomes articulated in the NZ Triple Aim

framework

“the whole NZ healthcare system”

This is not about reporting at a local level, it’s not a quasi-performance management tool for local services We want in time to cover as much of the sector as possible

Our primary objective

Provide the public and the health and disability sector with a clear picture of the quality and safety

• f health and disability services in NZ as a whole,

including

– changes over time – (where possible) international comparisons

Services throughout the patient journey, across the health and disability sector

GOVERNMENT GOALS

New Zealanders live longer, healthier and more independent lives New Zealand’s economic growth is supported

NZ TRIPLE AIM OUTCOMES

Improved quality, safety and experience of care Improved health and equity for all populations Best value from public health system resources

SYSTEM LEVEL INDICATORS

Safety Patient experience

Effective

Equity Access/timeliness Efficiency

CONTRIBUTORY MEASURES

Organising principles

SYSTEM LEVEL INDICATORS

Safety Ö <Placeholder: measure of adverse events> Patient experience

Effective

Equity Access/timeliness Efficiency

Ö <Placeholder: measure of patient experience>

• 6. Amenable (preventable

mortality) Ö Placeholder: functional health outcomes scores

Ö Stratification of all measures across population groups Ö <Placeholder: PHC access, e.g. Ability to enrol with PHO or babies enrolled with PHO in first three months of life >

• 14. Health care cost

per capita

• 15. % GDP spent on

health care Ö <Placeholder: measure of workforce wellness>

CONTRIBUTORY MEASURES

• 1. Number of falls

resulting in harm in hospitals

• 2. Health care

acquired infections

• 3. Measure of surgical

harm

• 4. Measure of safe

medication management Ö <Placeholder: Pressure ulcers acquired in hospitals>

• 5. Cancellations of

elective surgery by hospital after admission

• 16. Hospital days

during last six months

• f life
• 12. % of eligible

population up to date with cervical screening

• 13. Age appropriate

vaccinations for 2 year olds Ö Stratification of all measures across population groups

• 7. Occupied bed-days for

people aged 75+ admitted 2

• r more times per year
• 8. Day case surgery turns

into unplanned and unexpected overnight stay

• 9. Hospital unplanned and

unexpected readmission %

• 11. Measure of CVD

management

Original suggested set

Ambulatory Sensitive Hospitalisation

• 10. Mental Health

Readmissions

SYSTEM LEVEL INDICATORS

Safety Ö <Placeholder: measure of adverse events> Patient experience

Effective

Equity Access/timeliness Efficiency

Ö <Placeholder: measure of patient experience>

• 6. Amenable (preventable

mortality) Ö Placeholder: functional health outcomes scores

Ö Stratification of all measures across population groups Ö <Placeholder: PHC access, e.g. Ability to enrol with PHO or babies enrolled with PHO in first three months of life >

• 14. Health care cost

per capita

• 15. % GDP spent on

health care Ö <Placeholder: measure of workforce wellness>

CONTRIBUTORY MEASURES

• 1. Number of falls

resulting in harm in hospitals

• 2. Health care

acquired infections

• 3. Measure of surgical

harm

• 4. Measure of safe

medication management Ö <Placeholder: Pressure ulcers acquired in hospitals>

• 5. Cancellations of

elective surgery by hospital after admission

• 16. Hospital days

during last six months

• f life
• 12. % of eligible

population up to date with cervical screening

• 13. Age appropriate

vaccinations for 2 year olds Ö Stratification of all measures across population groups

• 7. Occupied bed-days for

people aged 75+ admitted 2

• r more times per year
• 8. Day case surgery turns

into unplanned and unexpected overnight stay

• 9. Hospital unplanned and

unexpected readmission %

• 10. Mental health post-

discharge community care

• 11. Measure of CVD

management

Revised set

Individual measures Why? What are the results?

• 1. Cancellation of elective surgery

by the hospital

Rationale:

• Provides insight into how close the system is

running to capacity

• It is a measure of patient experience that is

shown in other systems to be of importance to patients

Rates of operations cancelled after admission by year, 2008-2011

0% 1% 2% 3% 2008 2009 2010 2011 Rates of cancelled operations New Zealand Minimum Maximum

• 2. Deaths potentially avoidable

through health care

Rationale:

• Well tested and accepted as a whole-of-system

health outcome indicator

• Indicates the extent to which available

treatments are applied to diagnosed conditions

• Shows the potential for gain in health outcomes

Countries age-standardised amenable mortality rates for under 75 years

20 40 60 80 100 120 140 160 France Australia Italy Japan Sweden Norway Netherlands Austria Finland Germany Greece Ireland New Zealand Denmark United… United States Deaths per 100,000 population 1997/8 2006/7

NZ and Australian age-standardised amenable mortality rates by year 1997-2006

20 40 60 80 100 120 140 160 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Deaths per 100,000 population Australia New Zealand

Amenable deaths per 100,000 deaths in 2006 by gender and age group

200 400 600 800 1000 1200 0–14 15–24 25–44 45–64 65–74 Non-amenable mortality rate / 100,000 deaths Age groups (up to 75 years) Male Female

• 3. Occupied bed-days for people

aged 75+ admitted 2+ times per year

Rationale:

• Shown in both England and Scotland to be useful

proxy for the effectiveness of integration of primary, acute and long stay care

• Illustrates both effectiveness of avoiding

unnecessary admissions, and ability to “step down” to less intensive forms of care

Occupied bed-days (75+) and admitted 2+ time per 1000 population

500 1000 1500 2000 2500 2008/09 2009/10 2010/11 Occupied bed days associtaed with people aged 75+ admitted twice or more as an emergency Average Minimum Maximum

• 4. Day case surgery turns into

unplanned overnight stay

Rationale:

• Shows inconvenience to patients & disruption to planned

hospital flow

• May reflect an adverse incident in a procedure,

unrealistic expectations about which patients are suitable for day case surgery or some local factor

• Operates as both a prompt for further enquiry and a

judgement its own right, with both quality and efficiency dimensions

Day case overnight stay rate

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 2008/09 2009/10 2010/11 Day case overstay rate New Zealand average Minimum Maximum

• 5. Hospital unplanned and

unexpected readmission %

Rationale:

• Linked to complications from inadequate care
• Responsibility is placed with the initial

facility/DHB

% of hospital admissions followed by an unexpected readmission within 30 days of discharge

0% 2% 4% 6% 8% 10% 12% 14% 2007 2008 2009 2010 2011 Percentage of hospital admissions followed by unexpected readmission within 30 days of discharge All NZ Minimum Maximum

• 6. Eligible population up to

date with cervical screening

Rationale:

• Effectiveness of screening provides insight into

prevention and an indication of access to PHC services

• Early detection and treatment of cervical cancer

lowers the rate of premature mortality among women

% of eligible women aged 20-65 in 2010 up to date with cervical screening

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% All women aged 20-69 High need women aged 20-69 Percentage of eligible women up to date with cervical screening New Zealand Minimum Maximum

• 7. Age appropriate

vaccinations for 2 year olds

Rationale:

• Children who receive the complete set of age

appropriate vaccinations are less likely to become ill from certain diseases

• Effectiveness of immunisation provides perspective
• n prevention & an indication of access to PHC

services

Age appropriate vaccinations for 2 year olds All New Zealand

90%

Range across PHOs From 79% to 94%

Source: PHO Performance Programme March 2012

• 8. Healthcare cost per capita

(US$ PPP per capita) &

• 9. % of GDP spent on healthcare

Rationale:

• Measure of the costs of the whole system not of

differences in cost between DHB

• Way of comparing national expenditure with
• ther developed economies

Health care cost per capita (US$ PPP per capita)

1000 2000 3000 4000 5000 6000 7000 8000 9000 United States Norway Switzerland Netherlands Luxembourg Canada Denmark Austria Germany France Belgium Ireland Sweden Iceland United Kingdom Finland Italy Spain New Zealand Slovenia Israel Czech Republic Slovak Republic Korea Hungary Poland Estonia Chile Mexico Total expenditure on health, /capita, US$ purchasing power parity

Health care expenditure as a % of GDP

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 United States Netherlands France Germany Denmark Canada Switzerland Austria Belgium New Zealand Sweden United Kingdom Iceland Norway Ireland Italy Spain Slovenia Finland Slovak Republic Chile Czech Republic Israel Luxembourg Hungary Poland Estonia Korea Mexico Healthcare expenditure as % of GDP

• 10. Hospital days during

last six months of life

Rationale:

• Preferred that death be managed outside of the

hospital environment

• Improvements in the management of death

should be reflected in shorter average in- hospital care

Feedback so far...

Data- quality assurance

• Accuracy of data perceived as one of greatest

barriers

• Data sources used in first set are robust &

trusted

Patient experience

• Currently placeholder (system-level)
• Complex area, but a lot of work is happening
• DHBs currently working on service level measures
• Several options: informed consent measure, ADHB

patient experience survey, mental health KPI, patient satisfaction survey, etc.

• Rather do the job properly than rush it, work

planned for early 2013

Range of topics covered by first set

• Aiming towards integration (moving away from

primary/ secondary division)

• Broad coverage
• Will evolve overtime
• Possibility of including one contributory measure

from each part of the health & disability sector under each quality domain

Contact us Richard Hamblin richard.hamblin@hqsc.govt.nz DDI 04 901 6068 Gillian Bohm gillian.bohm@hqsc.govt.nz DDI 04 901 6047