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Hospital performance

Jenny Hargreaves Economics and Health Services Group AIHW

What is performance?
National Health Performance Framework
Chapter 9 in Australias Health 2010

National Healthcare Agreement Producti it! Commission"s report Public and Private Hospitals Report on Government Services A#HW"s Australian Hospital Statistics $ther iews

What is performance% Health &inisters" National Health Performance Framework

What is performance% C$A'"s National Healthcare Agreement


$utcomes
Hospital and related care
High (ualit!) appropriate) timel!

Patient e*perience
+uited to needs) informed) seamless) safe

+ustaina,ilit!
-espond) adapt

Progress measures
Waiting times) ad erse e ents) patient satisfaction

$utputs
-ates of ser ices) training positions

What is performance% Report on Government Services


Pu,lic hospitals) maternit! ser ices $utputs
.(uit!
access

.ffecti eness
access) appropriateness) (ualit! /safet!) responsi eness) capa,ilit!) continuit!0) sustaina,ilit!

.fficienc!

$utcomes

What is performance% Producti it! Commission"s Public and Private Hospitals


Australian 'o ernment re(uest for a report /pu,lished 1ecem,er 23390 on the relati e performance of pu,lic and pri ate hospital s!stems%
Hospital and medical costs
#ncluded measures of costs) producti it! and access

Hospital4ac(uired infections
#ncluded other safet! and (ualit! indicators

-ates of full! informed financial consent for pri atel! insured patients

What is performance% other iews


$nl! some statistical information is 5la,elled" as 5performance indicators" in those frameworks $ther statistics ma! ,e also iewed as measuring performance ,! stakeholders%
&inister -o*on highlighted num,ers of doctors and nurses in a speech to parliament last week A&A highlighted occupanc! rates in its Public Hospital Report Card /pu,lished in 23390 Adelaide Advertiser"s front page stor! on num,ers of people lea ing emergenc! departments ,efore ,eing seen ,! a doctor

What is performance? $ther than national6


Performance measurement for different purposes
local or state4le el management of hospitals funding agreements /pu,lic and pri ate hospitals0 accounta,ilit! or pu,lic reporting at the local or state le el

&easurement designed to support hospital (ualit! impro ement acti ities


Hospital ,enchmarking or comparison acti ities

Hospital performance indicators in Australias Health 2010


And some others from Australian Hospital Statistics 2008-0 ! C$A' reporting National Health Performance Framework%
.ffecti eness +afet! -esponsi eness Continuit! of care Accessi,ilit! .fficienc! and sustaina,ilit!

Comparisons% o er time) ,etween states7sectors7countries) considering e(uit!

.ffecti eness% Accreditation of hospitals

+afet!% Ad erse e ents treated in hospitals

+afet!% 8nplanned readmissions following surger! in pu,lic hospitals) 2339439 /C$A'0


Appendicectom! Cataract e*traction Prostatectom! H!sterectom! ?onsillectom! @ Adenoidectom! Hip replacement >nee replacement 3 3:; < <:; 2 2:; =

Readm issions per 100 separations

+afet!% Falls resulting in patient harm in hospitals /C$A'0


,! age group) and socioeconomic status) 233A439
<2

# "!

" 1!

1 0!

3 32B 2;BB B;CB Age group C;9B 9; or o er

0 1$ %o&est " # ' !$ Highest

Per <)333 hospitalisations

-esponsi eness
No indicators

Continuit! of care
No indicators

(ays ;3 B3 =3 23 <3 3

Accessi,ilit!% Waiting times for electi e surger! /C$A'0


$phthalmolog! .ar) nose and throat surger! $rthopaedic surger! '!naecolog!

&aDor cities

Eer! remote 'eneral +urger!


8rolog! Plastic +urger! Neurosurger! Eascular +urger! $ther Cardiothoracic surger! ?otal 3 <3 23 =3 B3 ;3 C3 A3

Cancer4related $ erall

)edian & aiting tim e *days+

Accessi,ilit!% .mergenc! 1epartment waiting times) 2339439 /C$A'0

Accessi,ilit!% -ates of ser ices% o ernight separations /C$A'0


2339439) international) socioeconomic comparisons
Separations per 1,000 population 293 2B3 233 <C3 <23 93 B3 3 +lo ak -ep: 8> &e*ico #reland #celand Netherlands New Fealand Australia +witGerland Hungar! +weden Norwa! Poland +pain 8+A
Separations per 1,000 population 233 <93 <C3 Pri ate hospitals Pu,lic hospitals All separations

CGech -ep:

'erman!

<23 <33 93 C3 B3 23 3

France
<HIow est

<B3

2 SES group

;HHighest

Accessi,ilit!% 1ifferential access to hospital procedures /C$A'0


#ndigenous rate ratio) 233A439J states) 2339439
Earicose eins) stripping and ligation ?onsillectom! +eptoplast! Prostatectom! &!ringotom! >nee replacement
#nguinal herniorrhaph! C!stoscop! Cataract e*traction 3 3:2 3:B 3:C Rate ratio 3:9 < <:2

National rate -ange of state7territor! rates

#nguinal herniorrhaph! H!sterectom!) females aged <;C9 Hip replacement Haemorrhoidectom! C!stoscop! Coronar! angioplast! Coronar! arter! ,!pass graft Cholec!stectom! Cataract e*traction

<3

Separations per 1,000 population

Access% -ates of ser ices% non4 acute care separations /C$A'0


Change in separations) 233B43; to 2339439
'eriatric e aluation and management Ps!chogeriatric care &aintenance care Pu,lic hospitals Palliati e care -eha,ilitation ?otal 4; -er cent change 3 ; <3 <; 23

Pri ate hospitals

.fficienc! and sustaina,ilit!% cost per casemi*4adDusted separation /C$A'0


.ost per casemi/$ad0usted separation *1+ 2;33 Non4medical la,our costs 2333

<;33

$ther recurrent costs

<333 &edical la,our costs ;33

3 233B3; 233;3C 233C3A 233A39 233939

.fficienc! and sustaina,ilit!% relati e sta! inde*


pu,lic) pri ate hospitals) 2339439
RSI <:B3 <:23 <:33 3:93 3:C3 3:B3 3:23 3:33 &edical +urgical $ther Pu,lic hospitals Pri ate hospitals All hospitals

What will ,e measured in 2323?


&ore safet! and (ualit!
against national clinical safet! and (ualit! standards Healthcare associated infections -eadmission and mortalit! rates Pressure ulcers $ther outcomes? Patient e*perience Waiting times after .mergenc! 1epartment care) for radiotherap! Ketter measures of comparati e ser ice use) eg against need Afforda,ilit! Appropriateness +ustaina,ilit!

C$A' indicators ,eing de eloped7proposed ,! C-C

$ther indicators associated with national health reform


Financial performance

What will ,e measured in 2323?


&ore for pri ate hospitals &ore for indi idual hospitals and hospital groups7networks Luarterl! rather than annuall! &ore timel!? 1eri ed from data linkage? 1eri ed from e4health?