Aboriginal and Torres Strait Islander Pilot Survey Report

Transcription

1 Aborigial ad Torres Strait Islader Pilot Survey Report South Australia Patiet Evaluatio of Hospital Services (PEHS) Survey February 2006 A-Louise Hordacre Beradette Hurst Ae Taylor Populatio Research ad Outcome Studies Uit South Australia Departmet of Health

2 This work is copyright. It may be reproduced ad the Populatio Research ad Outcome Studies (PROS) Uit welcomes requests for permissio to reproduce i the whole or i part for work, study or traiig purposes subject to the iclusio of a ackowledgmet of the source ad ot commercial use or sale. PROS uit will oly accept resposibility for data aalysis coducted by PROS uit staff or uder PROS uit supervisio. Published February 2006 by the South Australia Departmet of Health Populatio Research ad Outcome Studies (PROS) Uit, Health Itelligece, Health System Improvemet ad Reform PO Box 287 Rudle Mall 5000 South Australia, Australia Natioal Library of Australia Cataloguig-i-Publicatio: I accordace with the Copyright Act 1968 a copy of each book published must be lodged with the Natioal Library ad respective deposit libraries i each state. Prited : 1/02/2006

3 TABLE OF CONTENTS TABLE OF CONTENTS...I LIST OF TABLES...III LIST OF FIGURES...V KEY TO ABBREVIATIONS...VI EXECUTIVE SUMMARY... 1 OVERVIEW OF FINDINGS...3 CHAPTER 1 : BACKGROUND CONSULTATION AND DEVELOPMENT METHODOLOGY...8 CHAPTER 2 : PROFILE OF RESPONDENTS RESPONSE RATE SOCIO-DEMOGRAPHIC CHARACTERISTICS...16 CHAPTER 3 : PATIENT SATISFACTION OVERALL SCORES Socio-demographic characteristics AREA SCORES Coordiatio ad Cosistecy of Care Iformatio ad Commuicatio Betwee Patiet ad Service Provider Availability of People Carig for the Patiet Patiet s Ivolvemet i their Care ad Treatmet Access to the Hospital Meetig Persoal as Well as Cliical Needs Residetial Aspects of the Hospital PATIENT RANKING...36 CHAPTER 4 : PATIENT COMPARISONS ABORIGINAL AND TORRES STRAIT ISLANDER VS OVERNIGHT PEHS SURVEYS METROPOLITAN VS RURAL Residetial locatio Hospital locatio EMERGENCY VS NON-EMERGENCY ADMISSIONS AGE DIAGNOSES Priciple ad secodary diagoses I

4 4.5.2 Number of diagoses RACISM ABORIGINAL HOSPITAL LIAISON SERVICES SMOKING...50 CHAPTER 5 : OPEN QUESTIONS CENTRAL NORTHERN ADELAIDE HEALTH SERVICE NORTHERN & FAR WESTERN REGIONAL HEALTH SERVICE OTHER REGIONS...56 CHAPTER 6 : PROBLEMS AND POSITIVES PROBLEM RESPONSES SATISFACTORY RESPONSES...61 CHAPTER 7 : RECOMMENDATIONS FOR THE CARE OF ABORIGINAL AND TORRES STRAIT ISLANDER PATIENTS CHAPTER 8 : LESSONS AND RECOMMENDATIONS FOR SURVEY METHODOLOGY REVIEW COMPARABILITY CONSULTATION METHODOLOGICAL RECOMMENDATIONS...70 REFERENCES ATTACHMENT A: ABORIGINAL AND TORRES STRAIT ISLANDER PEHS SURVEY ATTACHMENT B: STATISTICAL TERMS AND REFERENCES ATTACHMENT C: ITEM RESPONSE FREQUENCIES II

5 LIST OF TABLES Table 1.1. Hospitals ad Regios Table 2.1. Number of participats withi reportable health service regios (uweighted), Aborigial ad Torres Strait Islader PEHS Table 2.2. Table 3.1: Table 3.2. Table 3.3. Table 3.4. Table 3.5: Table 3.6. Table 3.7. Table 3.8. Table 3.9. Table Table Table Table Table Table Table Table 4.1. Table 4.2. Table 4.3. Socio-demographic characteristics (uweighted), Aborigial ad Torres Strait Islader PEHS Overall satisfactio level by socio-demographic characteristics, Aborigial ad Torres Strait Islader PEHS Overall: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Coordiatio ad Cosistecy of Care items, Aborigial ad Torres Strait Islader PEHS Coordiatio ad Cosistecy of Care: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Iformatio ad Commuicatio betwee Patiet ad Service Providers items, Aborigial ad Torres Strait Islader PEHS Iformatio ad Commuicatio betwee Patiet ad Service Providers: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Availability of People Carig for the Patiet items, Aborigial ad Torres Strait Islader PEHS Availability of People Carig for the Patiet: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Patiet's Ivolvemet i their Care ad Treatmet items, Aborigial ad Torres Strait Islader PEHS Patiet s Ivolvemet i their Care ad Treatmet: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Access to the Hospital items, Aborigial ad Torres Strait Islader PEHS Access to the Hospital: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Meetig Persoal as well as Cliical Needs items, Aborigial ad Torres Strait Islader PEHS Meetig Persoal as Well as Cliical Needs: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Residetial Aspects of the Hospital items, Aborigial ad Torres Strait Islader PEHS Residetial Aspects of the Hospital: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Area score comparisos: Overight PEHS 2003 ad Aborigial ad Torres Strait Islader PEHS 2005 surveys Area score comparisos: Metropolita ad Rural patiets, Aborigial ad Torres Strait Islader PEHS Area score comparisos: Metropolita ad Rural hospitals, Aborigial ad Torres Strait Islader PEHS III

6 Table 4.4. Table 4.5. Table 4.6. Table 4.7. Table 4.8. Table 4.9. Table Table C.1: Table C.2: Table C.3: Table C.4: Table C.5: Table C.6: Table C.7: LIST OF TABLES (CONTINUED) Area score comparisos: Emergecy vs No-Emergecy Admissios, Aborigial ad Torres Strait Islader PEHS Area score comparisos: Patiets aged 16 to 44, ad 45+ years, Aborigial ad Torres Strait Islader PEHS Proportio of patiets with specific diagoses, Aborigial ad Torres Strait Islader PEHS Area score comparisos: Patiets with up to 3, or 4+, recorded diagoses, Aborigial ad Torres Strait Islader PEHS Reasos give for Aborigial ad Torres Strait Islader patiet perceptio they were treated worse tha others (uweighted) Area score comparisos: Patiets who used, or did ot use the Aborigial Hospital Liaiso Service, Aborigial ad Torres Strait Islader PEHS Mai reaso give for ot stoppig smokig at the momet, Aborigial ad Torres Strait Islader PEHS Respose frequecies for Coordiatio ad Cosistecy of Care items, Aborigial ad Torres Strait Islader PEHS Respose frequecies for Iformatio ad Commuicatio betwee Patiet ad Service Providers items, Aborigial ad Torres Strait Islader PEHS Respose frequecies for Availability of People Carig for the Patiet items, Aborigial ad Torres Strait Islader PEHS Respose frequecies for Patiet's Ivolvemet i their Care ad Treatmet items, Aborigial ad Torres Strait Islader PEHS Respose frequecies for Access to the Hospital items, Aborigial ad Torres Strait Islader PEHS Respose frequecies for Meetig Persoal as well as Cliical Needs items, Aborigial ad Torres Strait Islader PEHS Respose frequecies for Residetial Aspects of the Hospital items, Aborigial ad Torres Strait Islader PEHS IV

7 Figure 1. LIST OF FIGURES Patiet satisfactio level by Area, Aborigial ad Torres Strait Islader PEHS Figure 2.1. Participatio ad eligibility rates Figure 3.1. Figure 3.2. Figure 3.3. Figure 3.4. Figure 3.5. Figure 3.6. Figure 3.7. Figure 3.8. Figure 3.9. Figure 4.1. Figure 4.2. Figure 4.3. Overall: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Patiet satisfactio level by Area, Aborigial ad Torres Strait Islader PEHS Coordiatio ad Cosistecy of Care: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Iformatio ad Commuicatio betwee Patiet ad Service Providers: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Availability of People Carig for the Patiet: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Patiet s Ivolvemet i their Care ad Treatmet: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Access to the Hospital: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Meetig Persoal as Well as Cliical Needs: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Residetial Aspects of the Hospital: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Compariso betwee Overight PEHS 2003 ad Aborigial ad Torres Strait Islader PEHS 2005 surveys Compariso betwee Metropolita & Rural patiets, Aborigial ad Torres Strait Islader PEHS Compariso betwee Metropolita & Rural hospitals, Aborigial ad Torres Strait Islader PEHS Figure 4.4. Compariso betwee Emergecy ad No-Emergecy Admissios, Aborigial ad Torres Strait Islader PEHS Figure 4.5. Figure 4.6. Figure 4.7. Comparisos betwee patiets aged 16 to 44, ad 45+ years, Aborigial ad Torres Strait Islader PEHS Comparisos betwee patiets with up to 3, or 4+ recorded diagoses, Aborigial ad Torres Strait Islader PEHS Comparisos betwee patiets who used, or did ot use the Aborigial Hospital Liaiso Service, Aborigial ad Torres Strait Islader PEHS V

8 KEY TO ABBREVIATIONS ANOVA CI FMC HMS ISAAC LMHS LOS N&FW NHS PEHS RAH RGH SE TQEH TSI Aalysis of Variace Cofidece Iterval Fliders Medical Cetre Hills Mallee Souther Itegrated South Australia Activity Collectio Lyell McEwi Health Service Legth of stay Norther ad Far Wester Noarluga Health Service Patiet Evaluatio of Hospital Services Royal Adelaide Hospital Repatriatio Geeral Hospital Stadard Error The Quee Elizabeth Hospital Torres Strait Islader VI

9 EXECUTIVE SUMMARY

10 Executive Summary The 2005 Aborigial ad Torres Strait Islader Patiet Evaluatio of Hospital Services (PEHS) survey presets satisfactio scores for a pilot sample of 60 adult patiets who idetified as beig of Aborigial or Torres Strait Islader descet ad received at least oe ight of care i the South Australia public hospital system i March Data were collected i May 2005 by meas of Computer Assisted Telephoe Iterviewig (CATI). Seve care ad service Areas have bee assessed (for descriptios see Sectio 1.2), with questios i these Areas coded to reflect the patiet s level of satisfactio from 0 (least satisfied/egative respose) to 100 (most satisfied/positive respose). The average of the resposes to the questios i each of the seve Areas provides a Area score, while the Overall score is the average of the seve Area scores. Areas with a score of 90 ad above have achieved a high level of satisfactio; this is see as the Gold stadard. Those with scores aroud 80 have a reasoable satisfactio level (but could improve), while Area scores aroud 70 reveal a level of satisfactio that warrats urget attetio. Key characteristics of the survey participats are as follows: 43.3 were males; 58.3 of participats were aged 45 years ad over (mea age of 48.1 years); 21.7 had completed secodary educatio; 26.7 were married or had a de facto parter, ad 28.3 had ever bee married; 58.3 of patiets had a icome of $20,000 or less; 50.0 of patiets were admitted through a emergecy departmet; 71.7 stayed oe to three days i hospital (mea LOS of 3.5 days); ad 43.3 reside i the metropolita area, however 56.7 atteded a metropolita hospital. The Overall satisfactio score for the 2005 Aborigial ad Torres Strait Islader PEHS survey was Although a higher level of satisfactio i males ad i oemergecy patiets approached sigificace, o sigificat differeces were foud for socio-demographic variables. Area scores are show i Figure 1, which presets the state satisfactio scores for each Area. This shows that satisfactio was highest i the Area assessig, Coordiatio ad Cosistecy of Care. State wide satisfactio was 2

11 Executive Summary lowest i Patiet s Ivolvemet i their Care ad Treatmet ad i Availability of People Carig for the Patiet with both scores fallig below 70. Coordiatio & Cosistecy Iformatio & Commuicatio Availability of Care Ivolved i care Access to Hospital Meetig Needs Residetial Aspects Mea Figure 1. Patiet satisfactio level by Area, Aborigial ad Torres Strait Islader PEHS Overview of fidigs A participatio rate of 80 was achieved for this survey. However, it is of ote that a high umber of patiets could ot be cotacted for the iterviews. This appeared to be most marked i the remote areas, where telephoe umbers were ofte ot available, or telephoes wet uaswered. Aalyses to idetify systematic differeces betwee participats ad o-participats foud oly two differeces: patiets aged 45+, ad those with a priciple, or secodary, diagosis for heart disease were more likely to participate i the survey. The low umber of participats also impacted o the 3

12 Executive Summary survey s ability to aalyse data by health regio, both the Cetral Norther Adelaide ad the Norther ad Far Wester Health Regios had eough participats for reportig, however, results from the other regios have bee aggregated. Cosistet with previous PEHS surveys (Hordacre & Taylor, 2004; Hordacre, Taylor, & Hurst, 2004) patiets teded to have low satisfactio with their ivolvemet i their care ad treatmet, however, respodets i this survey also rated their satisfactio with the availability of care staff poorly. Aborigial ad Torres Strait Islader patiets rated their satisfactio i most Areas as lower tha Overight patiets, but it is of ote that they were ot sigificatly differet i their assessmet of access ad residetial facilities, suggestig that they are discerig i idetifyig areas of lower satisfactio. No-emergecy admissios were sigificatly more satisfied with a umber of Areas. We did ot idetify ay sigificat differeces betwee patiets from rural or metropolita residece, or based o attedace at a metropolita or rural hospital. Overall, eight (13.3) patiets respoded that they felt they had bee treated worse by hospital staff because they were Aborigial or Torres Strait Isladers, with five of these sayig they felt staff acted egatively or disrespectfully as a result. Eightee (30) patiets reported usig the Aborigial Hospital Liaiso Service, with aecdotal complaits made about access to this service. As a result of these fidigs the followig recommedatios are put forward: Improve commuicatio ad iformatio exchage betwee Aborigial ad Torres Strait Islader patiets ad service providers; Clarify roles ad expectatios of Aborigial Hospital Liaiso Officers; Improve codig of Idigeous status; ad Icrease the emphasis o discharge plaig procedures, icludig esurig the ivolvemet of the patiet. 4

13 CHAPTER 1 : BACKGROUND

14 Backgroud Quality improvemet is a importat issue i the health care system i Australia. The Commowealth ad South Australia govermets are committed to the developmet ad implemetatio of quality improvemet ad ehacemet practices which reward or promote high stadards i the delivery of public hospital services (Australia Health Care Agreemet betwee the Commowealth of Australia ad the State of South Australia ). The South Australia Hospitals Safety ad Quality Coucil was formed to oversee the process ad review progress with regard to the achievemet of state ad atioal priorities. I 2001, the South Australia Hospitals Safety ad Quality Coucil iitiated a South Australia Patiet Evaluatio of Hospital Services (PEHS) survey, for Overight patiets, to idetify key dimesios of care ad to measure patiet satisfactio withi these Areas. The procedures ad questios for this survey were based o the collectios that have bee i developmet i Wester Australia sice 1996 whe the Health Departmet of Wester Australia established the ogoig collectio of patiet evaluatios of hospital services through the use of mail self-complete questioaires ad Computer Assisted Telephoe Iterview (CATI) surveys. A umber of exclusio criteria were applied i the geeral Overight PEHS surveys. Of particular relevace, patiets idetifyig as beig of Aborigial or Torres Strait Islader descet were excluded, with the itetio of developig a specific survey for this populatio. The curret report details the methodology ad fidigs for the pilot South Australia Aborigial ad Torres Strait Islader PEHS survey. A Aborigial ad Torres Strait Islader-specific PEHS survey is critically importat for a umber of reasos. Research shows that South Australia Aborigial ad Torres Strait Islader people are two to four times more likely to be hospitalised tha o- Idigeous South Australias, a issue that is likely to be uderestimated (Australia Medical Associatio, 2003). Aborigial ad Torres Strait Islader Australias experiece a higher burde of disease, leadig to icreased hospitalisatio ad a lower life expectacy tha the rest of the populatio (Trewi & Madde, 2003). Importatly, it has also bee show that health outcomes improve whe the cosumer/patiet has a more positive experiece while receivig care or treatmet (Cosumer Focus Collaboratio, 2001). 6

15 Backgroud It has also bee reported that Australia health services do ot provide the same quality ad level of care ad services to Aborigial ad Torres Strait Islader patiets as they do to the maistream commuity (Australia Health Miisters' Advisory Coucil's Stadig Committee o Aborigial ad Torres Strait Islader Health Workig Party, 2004). Whilst differetials i quality ad services are thought to be due to a variety of reasos, icludig socio-ecoomic ad evirometal factors, less beig factors (e.g. racism, respect, limited cultural uderstadig ad poor commuicatio) also ifluece access to, ad quality of health care services. The challege, the, is to esure that the experieces of Aborigial ad Torres Strait Islader patiets are documeted ad at the forefrot of decisio-makig processes, whe determiig appropriate chages to health care policies ad procedures. Equally importat, is the ecessity to evaluate these chages ad esure that positive outcomes are achieved i terms of health outcomes ad improved cosumer satisfactio. The Aborigial ad Torres Strait Islader PEHS survey (the first statewide survey of its kid i Australia) will cotribute to the growig body of kowledge about the provisio of hospital care ad services i South Australia. More specifically, it will provide a opportuity for Aborigial ad Torres Strait Islader people to have a voice i the way care ad services are provided to them. Importatly, as a govermet iitiative, ad as part of the safety ad quality ageda, hospitals are expected to act o key fidigs from the survey. 1.1 Cosultatio ad developmet This pilot survey represets the developmet of methods ad protocols for a Aborigial ad Torres Strait Islader specific Patiet Evaluatio of Hospital Services (PEHS) survey. The developmet process has ivolved cosultatio with the Aborigial Health Coucil of South Australia Ic. (AHCSA) ad the South Australia Departmet of Health s Aborigial Health Divisio (AHD). Discussios at these meetigs focused o the cotet of the geeral Overight PEHS survey, ad the applicability of existig methodology. Based o these discussios, chages have bee made to reduce the size ad complexity of the survey. A 25 reductio i the umber of items has bee achieved usig Item Respose Theory (Baker, 1992), which retais the itegrity of the origial survey whilst reducig the umber of items (ad therefore 7

16 Backgroud the respodet burde). Factor aalysis was used to cofirm the required chages to the scorig system (resultig from the reductio of items). As part of the overall assessmet of the survey, chages were also made to reduce the complexity of its items. Additioal items have also bee icorporated i the survey to assess satisfactio with areas of specific cocer to the Aborigial ad Torres Strait Islader commuity. For further details regardig the developmet of this survey ad its methodology see Sectio Methodology This year s survey presets satisfactio scores for a sample of 60 eligible adult patiets who were idetified as beig of Aborigial or Torres Strait Islader descet ad received at least oe ight of care ad services i the South Australia Public Hospital system i March Iterviews were coducted i May 2005 by meas of a CATI survey (see Attachmet A). This report examies patiet demographic ad ecoomic backgroud ad their satisfactio with the followig Areas of hospital services: Coordiatio ad cosistecy of care; Access to the hospital (e.g. waitig for a admissio date ad beig able to get ito the hospital); Availability of people carig for the patiet; Iformatio ad commuicatio betwee patiet ad service providers; Patiet s ivolvemet i their care ad treatmet 1 ; Residetial aspects of the hospital (e.g. food, room/ward, toilet); ad Meetig persoal as well as cliical eeds. Questios i each of the seve service Areas have bee coded to reflect the patiet s level of satisfactio from 0 (least satisfied/egative respose) to 100 (most satisfied/positive respose). The average of the resposes to the questios i each of the seve Areas provides a Area score, while the Overall score is the average of the seve Area scores. From the Wester Australia experiece, it ca be cosidered that 1 Please ote that i previous PEHS reports this Area has bee labeled Patiet s right to be ivolved i their care ad treatmet. 8

17 Backgroud the Areas with a reported level of 90 ad above have achieved a high level of satisfactio, this is see as the Gold stadard. Those with scores aroud 80 have a reasoable satisfactio level (but could improve), while Area scores aroud 70 reveal a level of satisfactio that warrats urget attetio. This year, the survey icluded eligible Aborigial ad Torres Strait Islader patiets discharged from all South Australia public hospitals i March Hospitals ad regios are show i Table Patiets idetified for iclusio i the study met the followig criteria. They were required to: be idetified i the hospital system as beig of Aborigial or Torres Strait Islader backgroud; be a South Australia residet; be aged 16 to 80 years; have had at least oe overight stay i hospital; be discharged durig March 2005; ot have bee discharged to a ursig home or other istitutio; ad ot have a primary diagosis for materity, psychiatric, substace abuse, chemotherapy, radiotherapy or real dialysis. 2 Please ote that chages have bee made to hospital ames ad the regioal assigmet of some hospitals for this ad future surveys. All data show i this report are preseted by curret (correct as of Jue 2004) Health Regios ad Categories. 9

18 Backgroud Table 1.1. Hospitals ad Regios Health Regio Cetral Norther Adelaide Health Service Souther Adelaide Health Service No-affiliated metropolita Hills, Mallee & Souther (HMS) Wakefield Mid North Riverlad South East Eyre Peisula Norther & Far Wester (N&FW) Hospital Lyell McEwi Health Service (LMHS), Modbury, Royal Adelaide Hospital (RAH), The Quee Elizabeth Hospital (TQEH) Fliders Medical Cetre (FMC), Noarluga Health Service (NHS) Repatriatio Geeral Hospital (RGH) Kagaroo Islad MPS, Mallee (Karooda, Lameroo & Piaroo), Maum, Meigie, Mt Barker, Murray Bridge, Norther Adelaide Hills (Gumeracha & Mout Pleasat), South Coast (Victor Harbor), Strathalby, Tailem Bed Agasto, Balaklava & Riverto DHS (Balaklava & Riverto), Burra Clare Sowtow HS (Burra Burra, Clare & Sowtow), Eududa & Kapuda HS (Eududa & Kapuda), Gawler, Maitlad (CYP), Moota, Tauda, Yorketow (SYP), Wallaroo (NYP) Booleroo Cetre, Crystal Brook, Jamestow, Orroroo, Peterborough, Port Broughto, Port Pirie, Rocky River (Laura) Loxto, Remark, Riverlad Regioal HS (Barmera & Berri), Waikerie Bordertow, Kigsto (SE), Millicet, Mt Gambier, Naracoorte, Peola Cedua, Easter Eyre (Cleve, Cowell & Kimba), Lower Eyre (Cummis & Tumby Bay), Mid-West (Ellisto, Streaky Bay & Wudia), Port Licol Coober Pedy, Hawker Memorial, Leigh Creek, Marree, Oodadatta, Port Augusta, Quor, Roxby Dows, Whyalla, Woomera The methodology used closely follows that employed by the Overight ad Metal Health PEHS surveys sice 2001 (Hordacre & Taylor, 2004; Hordacre et al., 2004). The sample was draw from South Australia public hospital patiets discharged i March 2005, with eligible patiets idetified by hospital codig 3 of Idigeous status. Iitial cotact was made by Aborigial Hospital Liaiso Officers or Workers who were asked to iform patiets, durig their regular hospital visits i March, of the upcomig survey (they were provided with a flyer to facilitate this). Eligible patiets were the set a itroductory letter iformig them of the purpose ad timig of the survey, ad its cofidetiality. Additioally, they were provided with a 1800 phoe umber which ca be used to make queries, schedule a appoitmet or declie 3 It is recogized that the accuracy of recordig Aborigial or Torres Strait Islader status varies widely betwee hospitals, ad is more likely, tha other hospital data (admiistrative or cliical), to be iaccurate. Furthermore, accuracy has bee reported to icrease i areas with higher proportio of Idigeous residets (Aborigial ad Torres Strait Islader Health ad Welfare Iformatio Uit, 1999). 10

19 Backgroud ivolvemet i the survey. Attempts were the made to cotact all eligible patiets usig Computer Assisted Telephoe Iterview (CATI) methods ad employig Aborigial iterviewers 4. The CATI method esures that, where ecessary, at least 10 call-backs are made at differet times of day i a attempt to cotact the patiet. Iterview times ca also be scheduled at a time suitable for the patiet. I order to maitai cofidetiality, records are assiged a uique idetifier ad persoal details are deleted at the completio of the survey. Weightig was used to correct for the disproportioality of the sample with respect to the populatios of iterest. The weights reflect uequal sample iclusio probabilities ad compesate for differetial o-respose. The data were weighted by age, locatio (metro/coutry) ad geder to the eligible sample of adult ipatiets. This state weight was based o the weighted factor used for all eligible patiets (=161), ad provides the best estimate for the state (=60). The weightig of data results i occasioal roudig effects for the umbers. I all istaces the percetages should be the poit of referece rather tha the actual umbers of respodets. The percetages preseted i this report have bee processed o the figures pre-roudig. Statistical tests have bee employed to compare results. Cofidece itervals (CIs), idepedet samples t-tests ad oeway ANOVAs were used to compare differeces i mea satisfactio levels. Chi-square aalyses were employed to determie statistical sigificace of proportioal differeces betwee categories. A brief descriptio of the statistical terms employed i this report ad refereces for further iformatio ca be foud i Attachmet B. 4 The decisio was made to employ Idigeous iterviewers for the Aborigial ad Torres Strait Islader PEHS survey wherever possible. This was cosidered importat to esure that the iterviewer uderstood the iflueces of culture i a telephoe iterview with a Idigeous perso. It was also felt that hearig a Idigeous voice o the phoe may ecourage a higher respose. Additioally, where possible, male patiets were cotacted by a male iterviewer ad female patiets were cotacted by a female iterviewer. 11

20 Backgroud PAGE INTENTIONALLY BLANK 12

21 CHAPTER 2 : PROFILE OF RESPONDENTS

22 Profile of Respodets This report cotais the resposes from the 60 South Australia public hospital patiets who participated i the pilot Aborigial ad Torres Strait Islader PEHS survey i Table 2.1 shows the umber of survey participats from reportable regios 5. Table 2.1. Number of participats withi reportable health service regios (uweighted), Aborigial ad Torres Strait Islader PEHS Regioal groups (ATSI) Cetral Norther Adelaide Norther & Far Wester Other regios Total Cout Colum Respose rate There were 161 Aborigial ad Torres Strait Islader separatios recorded i the South Australia public hospital system i March 2005 that were idetified as eligible for the PEHS survey. Letters were set to the recorded postal address of all eligible patiets, ad where ecessary at least te attempts were made to cotact the patiets by telephoe. Of those who could be cotacted (=75) 6, a participatio rate of 80.0 was achieved. The participatio ad eligibility rates are show i Figure 2.1. Sixtee patiets were icorrectly idetified usig hospital records as eligible, with a umber of these ot Idigeous. Of ote, whilst o-idigeous patiets (who have bee icorrectly classified as Idigeous) ca be idetified upo cotact, it is ot possible to idetify the umber of Idigeous patiets excluded (due to icorrect classificatio as o-idigeous). Oly four patiets were uable to participate as they were o-eglish speakig, however, this is likely to reflect our iability to cotact patiets i the more remote regios where patiet telephoe umbers were ot provided. 5 Please ote that due to small sample sizes all fidigs should be cosidered idicative. 6 This rate does ot iclude patiets who could ot be cotacted (or were uavailable) after te attempts; whose phoe umbers were icorrect or discoected; or those who had bee icorrectly idetified from hospital records as eligible. 14

23 Profile of Respodets Origial sample (=161) Eligible sample (=75, 46.6) Ieligible sample (=86, 53.4) Ieligibility reasos =22 (25.6), o-cotact after 10 attempts =9 (10.5), respodet uavailable =17 (19.8), phoe ot coected =21 (24.4), icorrect phoe umber =1 (1.2), umber for fax/modem =16 (18.6), icorrectly idetified COMPLETED INTERVIEWS (=60, 80.0) No-participatio (=15, 20.0) No-participatio reasos =3, refusal =4, o-eglish speakig =7, icapable/too ill =1, back i hospital Figure 2.1. Participatio ad eligibility rates. 15

24 Profile of Respodets Pearso chi-square aalyses were coducted o hospital separatios data to determie whether there were ay systematic differeces betwee the 60 patiets who respoded to the survey ad the 161 i the origial sample. No differeces were foud betwee the sample ad respodets for geder, marital status, the source of their admissio referral (private practice, outpatiet, emergecy), the legth of their hospital stay, the regios (as reported i Table 2.1), patiets residig i the coutry or metropolita area, or hospitals situated i the coutry or metropolita area. Moreover, although umbers were small, there was o sigificat differece foud for patiets with priciple or secodary diagoses of diabetes, cacer or ijury, ad those without these diagoses. Notwithstadig, two sigificat differeces were foud ad are preseted below: Older patiets (45 years ad over) were more likely to participate i the survey tha the youger cohort; ad Patiets with priciple or secodary diagoses of heart disease were more likely to participate tha those without. 2.2 Socio-demographic characteristics Table 2.2 provides (uweighted) iformatio o the socio-demographic characteristics for the rage of South Australia hospital patiets who were iterviewed i the Aborigial ad Torres Strait Islader PEHS pilot survey. Key characteristics of the survey participats are as follows: 43.3 were males; 58.3 of participats were aged 45 years ad over (mea age of 48.1 years, rage years); 21.7 had completed secodary educatio; 26.7 were married or had a de facto parter, ad 28.3 had ever bee married; 58.3 of patiets had a icome of $20,000 or less; 50.0 of patiets were admitted through a emergecy departmet; 71.7 stayed oe to three days i hospital (mea LOS of 3.5 days, rage 1-24 days); ad 43.3 reside i the metropolita area, however 56.7 atteded a metropolita hospital. 16

25 Profile of Respodets Table 2.2. Socio-demographic characteristics (uweighted), Aborigial ad Torres Strait Islader PEHS Geder Age group Marital status Highest educatio Icome group Admissio Status LOS Source of referral Residetial locatio Hospital locatio Male Female 16 to 44 yrs 45+ yrs Married/ de facto Separated/ divorced/ widowed Never married Ukow Never/ Primary Some Secodary Completed secodary or higher Other $20,000 or lower More tha $20,000 Not stated/refused/do't kow Emergecy admissio No-emergecy admissio 1 to 3 days 4 to 7 days 8+ days Private medical practice Outpatiet departmet Casualty/ Emergecy Other Ukow Metropolita residece No-metropolita residece Metropolita hospital Coutry hospital Colum Colum Valid N Note. Please see Attachmet B for a descriptio of statistical terms 17

26 Profile of Respodets PAGE INTENTIONALLY BLANK 18

27 CHAPTER 3 : PATIENT SATISFACTION

28 Patiet Satisfactio 3.1 Overall scores Socio-demographic characteristics Table 3.1 shows the breakdow of South Australia Overall satisfactio scores by the socio-demographic characteristics of participats. Although the higher level of satisfactio i males ad i o-emergecy patiets approached sigificace, o sigificat differeces were foud. Table 3.1: Overall satisfactio level by socio-demographic characteristics, Aborigial ad Torres Strait Islader PEHS Geder Age group Marital status Highest educatio Icome group Admissio status LOS Source of referral Residetial locatio Hospital locatio Male Female 16 to 44 yrs 45yrs+ Married/ de facto Separated/ divorced/ widowed Never married Never/ Primary Some Secodary Completed secodary or higher $20,000 or lower More tha $20,000 Emergecy admissio No-emergecy admissio 1 to 3 days 4 to 7 days 8+ days Private medical practice Outpatiet departmet Casualty/ Emergecy Metropolita residece No-metropolita residece Metropolita hospital Coutry hospital N Mea SE Lower 95 CI Upper 95 CI The Overall satisfactio score for the 2005 Aborigial ad Torres Strait Islader PEHS survey i South Australia was The Overall scores for reportable health service regios ca be see i Figure 3.1 ad Table 3.2. There were o sigificat differeces observed. 20

29 Patiet Satisfactio Satisfactio level Cetral Norther Adelaide Norther & Far Wester Other regios Reportable Health Service Regios Figure 3.1.Overall: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Table 3.2. Overall: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Mea SE Lower 95 CI Upper 95 CI Reportable health service regios Cetral Norther Adelaide Norther & Far Wester Other regios Total: South Australia Area scores As previously metioed, a Area score cosists of the average of resposes to items asked about similar care ad service Areas. For example, the Area score for Coordiatio ad Cosistecy of Care cotais items about: time betwee use of the call system ad respose; coordiatio of care over a umber of visits; how complaits were dealt with; ad attetio to care from health care professioals. It is importat to ote that satisfactio scores are geerally skewed towards the high ed of the scale. Therefore, it should be recalled that the gold stadard, a high level of 21

30 Patiet Satisfactio satisfactio is idetified by a score of 90 or more. Scores aroud 80 are cosidered reasoable (but could improve), whilst scores aroud 70 are cause for cocer. Figure 3.2 presets the state wide satisfactio scores for each Area. This shows that the highest satisfactio levels were foud i five comparable Areas: Coordiatio ad Cosistecy of Care, Iformatio ad Commuicatio Betwee Patiet ad Service Provider, Access to the Hospital, Meetig Persoal as well as Cliical Needs ad Residetial Aspects of the Hospital. State wide satisfactio was lowest i Availability of People Carig for the Patiet ad Patiet s Ivolvemet i their Care ad Treatmet, with both scores fallig below 70. The followig sectios preset detailed results for each of the Area scores. Coordiatio & Cosistecy Iformatio & Commuicatio Availability of Care Ivolved i care Access to Hospital Meetig Needs Residetial Aspects Mea Figure 3.2. Patiet satisfactio level by Area, Aborigial ad Torres Strait Islader PEHS

31 Patiet Satisfactio Coordiatio ad Cosistecy of Care Satisfactio scores for the area of Coordiatio ad Cosistecy of Care area have bee calculated from the resposes to the survey questios preseted i Table 3.3 (item respose frequecies ca be foud i Attachmet C, Table C.1). The average of resposes to these items provides the Area score. Table 3.3. Coordiatio ad Cosistecy of Care items, Aborigial ad Torres Strait Islader PEHS Referece C29 C8 D13 D28 D29 D18 E4 E5 Questio wordig If you used the call system while you were i hospital, how log did it usually take before a urse came to ask you why you had called? Did ayoe ask you whether or ot you were curretly takig ay medicatio(s)? The coordiatio of your care over time if you had more tha oe visit was The way thigs were fixed if there was ay problem while i the hospital was The time you waited at discharge for ay prescriptio or medicatio was The way ay complaits were dealt with by the hospital was Regardig attetio by ursig staff to your care, for example, drips ad woud dressig, did you get Regardig the time doctors spet o your care ad treatmet, did you get I South Australia, Coordiatio ad Cosistecy of Care received a satisfactio score of Scores for reportable health service regios ca be see i Figure 3.3 ad Table 3.4. No sigificat differeces were foud. 23

32 Patiet Satisfactio Satisfactio level Cetral Norther Adelaide Norther & Far Wester Other regios Reportable Health Service Regios Figure 3.3.Coordiatio ad Cosistecy of Care: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Table 3.4. Coordiatio ad Cosistecy of Care: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Mea SE Lower 95 CI Upper 95 CI Reportable health service regios Cetral Norther Adelaide Norther & Far Wester Other regios Total: South Australia

33 Patiet Satisfactio Iformatio ad Commuicatio Betwee Patiet ad Service Provider Satisfactio scores for the area of Iformatio ad Commuicatio betwee Patiet ad Service Provider area have bee calculated from the resposes to the survey questios preseted i Table 3.5 (item respose frequecies ca be foud i Table C.2). The average of resposes to these items provides the area score. Table 3.5: Iformatio ad Commuicatio betwee Patiet ad Service Providers items, Aborigial ad Torres Strait Islader PEHS Referece C6 D10 D11 D26 D27 E21 E6 E7 E8 E17 Questio wordig Were you set ay iformatio o how to prepare for your hospital stay? The effort made by doctors to discuss the beefits ad risks of your treatmet was The way health care professioals respoded to ay cocers or commets about your treatmet was The way health care professioals explaied the outcome of your treatmet, procedure or surgery was The commuicatio betwee doctors, urses ad other health care professioals about your treatmet was Regardig the iformatio give to you about your plaed treatmet whe you got to the ward, did you get Regardig the iformatio about the purpose of the tests, did you get Regardig the iformatio about the results of the tests, did you get Regardig iformatio about medicatios, did you get Regardig iformatio o how to maage your coditio or recovery at home, did you get The Iformatio ad Commuicatio Betwee Patiet ad Service Providers satisfactio score for all hospitals was Scores for reportable health service regios ca be see i Figure 3.4 ad Table 3.6. There were o statistically sigificat differeces observed. 25

34 Patiet Satisfactio Satisfactio level Cetral Norther Adelaide Norther & Far Wester Other regios Reportable Health Service Regios Figure 3.4. Iformatio ad Commuicatio betwee Patiet ad Service Providers: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Table 3.6. Iformatio ad Commuicatio betwee Patiet ad Service Providers: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Mea SE Lower 95 CI Upper 95 CI Reportable health service regios Cetral Norther Adelaide Norther & Far Wester Other regios Total: South Australia

35 Patiet Satisfactio Availability of People Carig for the Patiet Satisfactio scores for the area of Availability of People Carig for the Patiet have bee calculated from the resposes to the survey questios preseted i Table 3.7 (item respose frequecies ca be foud i Table C.3). The average of resposes to these items provides the area score. Table 3.7. Availability of People Carig for the Patiet items, Aborigial ad Torres Strait Islader PEHS Referece C28 D5 D6 D25 E23 Questio wordig If you eeded some help to maage your recovery whe you got home (e.g. ursig care, or help with persoal care) did the hospital staff help you get it? The time you waited for a urse after usig the call system was The time you waited for a doctor if you asked to see oe was The way health care professioals (e.g. urses, physios) provided ay help you eeded (for example goig to the toilet) was Regardig access to ay extra support you eeded to aid your recovery, for example a support group, did you get The score for Availability of People Carig for the Patiet was the lowest reported at Scores for reportable health service regios ca be see i Figure 3.5 ad Table 3.8. There were o sigificat differeces foud. 27

36 Patiet Satisfactio Satisfactio level Cetral Norther Adelaide Norther & Far Wester Other regios Reportable Health Service Regios Figure 3.5. Availability of People Carig for the Patiet: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Table 3.8. Availability of People Carig for the Patiet: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Mea SE Lower 95 CI Upper 95 CI Reportable health service regios Cetral Norther Adelaide Norther & Far Wester Other regios Total: South Australia

37 Patiet Satisfactio Patiet s Ivolvemet i their Care ad Treatmet Satisfactio scores for the area of Patiet s Ivolvemet i their Care ad Treatmet have bee calculated from the resposes to the survey questios preseted i Table 3.9 (item respose frequecies ca be foud i Table C.4). The average of resposes to these items provides the area score. Table 3.9. Patiet's Ivolvemet i their Care ad Treatmet items, Aborigial ad Torres Strait Islader PEHS Referece C9 C10 C30 C14 C27 C19 E9 E11 E12 E22 F4 Questio wordig Were you asked about your dietary eeds whe you arrived o the ward? Did ayoe ask whether you had ay cultural or religious beliefs that might affect the way you were treated i hospital? If you eeded oe, did you have access to a iterpreter? Did the urse i charge of your care itroduce him or herself to you at each shift chage? Did the ursig staff let you kow whe a doctor would be comig so that you had a chace to thik about some questios? Did you feel that you could have refused to have studets (medical or ursig) preset durig your treatmet? Regardig time to cosider ay coset form you eeded to sig, was there Regardig the iformatio about your progress while i hospital, did you get Regardig iformatio give to your family or carers about your progress, did they get Regardig ivolvemet i decisios about your care ad treatmet, did you have Was your right to have a opiio respected? Patiet s Ivolvemet i their Care ad Treatmet was the secod lowest Area satisfactio score at Scores for reportable health service regios ca be see i Figure 3.6 ad Table No sigificat results were foud. 29

38 Patiet Satisfactio Satisfactio level Cetral Norther Adelaide Norther & Far Wester Other regios Reportable Health Service Regios Figure 3.6. Patiet s Ivolvemet i their Care ad Treatmet: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Table Patiet s Ivolvemet i their Care ad Treatmet: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Mea SE Lower 95 CI Upper 95 CI Reportable health service regios Cetral Norther Adelaide Norther & Far Wester Other regios Total: South Australia

39 Patiet Satisfactio Access to the Hospital Satisfactio scores for the area of Access to the Hospital have bee calculated from the resposes to the survey questios preseted i Table 3.11 (item respose frequecies ca be foud i Table C.5). The average of resposes to these items provides the area score. Table Access to the Hospital items, Aborigial ad Torres Strait Islader PEHS Referece C1 C2 C7 D24 D2 D3 D4 Questio wordig How log did you have to wait to be admitted to hospital after your doctor told you it was ecessary? Oce you got to the hospital, how log did you wait before you were take or set to your room or ward? Whe you got to the hospital, did you kow what you were supposed to do ad where you were supposed to go? The otice you received if your admissio date was cacelled or chaged was The time you waited to get ito hospital was The time you waited to be see by the admissios clerk was The time you waited before you were able to go to your ward or room after you had see the admissios clerk was The Access to the Hospital satisfactio score for the 2005 Aborigial ad Torres Strait Islader PEHS survey i South Australia was The scores for reportable regioal health services ca be see i Figure 3.7 ad Table No sigificat differeces were foud. 31

40 Patiet Satisfactio Satisfactio level Cetral Norther Adelaide Norther & Far Wester Other regios Reportable Health Service Regios Figure 3.7. Access to the Hospital: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Table Access to the Hospital: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Mea SE Lower 95 CI Upper 95 CI Reportable health service regios Cetral Norther Adelaide Norther & Far Wester Other regios Total: South Australia

41 Patiet Satisfactio Meetig Persoal as Well as Cliical Needs Satisfactio scores for the area of Meetig Persoal as well as Cliical Needs area have bee calculated from the resposes to the survey questios preseted i Table 3.13 (item respose frequecies ca be foud i Table C.6). The average of resposes to these items provides the area score. Table Meetig Persoal as well as Cliical Needs items, Aborigial ad Torres Strait Islader PEHS Referece B4 B8 B11 B12 B13 B14 B16 E15 E16 F5 F17 F18 F19 Questio wordig As a result of your hospital stay, did you get relief from the pai? As a result of your hospital stay, did [restrictio to your daily life] improve? Which of the followig situatios do you thik best applies to you at this time? Did you have ay uexpected complicatio(s)? Did [the uexpected complicatio(s)] require a doctor to arrage extra treatmet or medicatio? Which of the followig statemets best describes what your hospital did for you? Overall, how would you rate the health care provided by the hospital o this visit? Regardig the legth of time you stayed i hospital, was it Regardig the time give to prepare for your discharge, did you get Did you feel you were show respect while beig examied or iterviewed? Were the staff cosiderate ad polite to you? Did you feel that you could ask for iformatio if you felt axious about somethig? Did the hospital staff use low voices whe talkig or examiig so that others could t overhear? The state satisfactio score for Meetig Persoal as Well as Cliical Needs was Scores for reportable health service regios ca be see i Figure 3.8 ad Table No sigificat differeces were foud. 33

42 Patiet Satisfactio Satisfactio level Cetral Norther Adelaide Norther & Far Wester Other regios Reportable Health Service Regios Figure 3.8. Meetig Persoal as Well as Cliical Needs: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Table Meetig Persoal as Well as Cliical Needs: Reportable regios satisfactio scores, Aborigial ad Torres Strait Islader PEHS Mea SE Lower 95 CI Upper 95 CI Reportable health service regios Cetral Norther Adelaide Norther & Far Wester Other regios Total: South Australia

43 Patiet Satisfactio Residetial Aspects of the Hospital Satisfactio scores for the area of Residetial Aspects of the Hospital have bee calculated from the resposes to the survey questios preseted i Table 3.15 (item respose frequecies ca be foud i Table C.7). The average of resposes to these items provides the area score. Table Residetial Aspects of the Hospital items, Aborigial ad Torres Strait Islader PEHS Referece F2 F3 F12 G13 G14 G15 G16 G17 G18 G19 G20 G21 G22 Questio wordig Did you feel you could see visitors as much as you eeded/wated to? Was there screes (curtais) aroud the bed whe beig examied to esure privacy? Did you feel safe ad secure while i the hospital? Did you fid the hospital parkig Did you fid the sig postig to help you get aroud the hospital Did you fid the help provided to get ito the hospital (e.g. wheelchair) Did you fid the quality of the food to be Did you fid the rage ad appeal of the meus to be Did you fid the temperature of the food to be Did you fid the positio of the call for help butto to be Did you fid the comfort of your bed to be Did you fid the temperature i your room or ward to be Did you fid the storage for your persoal possessios to be Residetial Aspects of the Hospital received a state satisfactio score of Reportable health service regios scores ca be see i Figure 3.9 ad Table Statistically sigificat differeces were ot foud. 35