BAY OF PLENTY DISTRICT HEALTH BOARD MĀORI HEALTH PLAN 2015/16

Transcription

1 BAY OF PLENTY DISTRICT HEALTH BOARD MĀORI HEALTH PLAN 2015/16

2 Summary of Indicator Performance 1 Legend: Target attained Within 10% of target 10-20% away from target Greater than 20% away from target The comparison population for Māori varies depending on the information provided by data suppliers. Change refers to the last quarter of publicly reported data. The trend column summarises data for the past 4 quarters in sparkline format. 1 Created with the trendly MHP performance improvement tool (beta version, 23 June 2015). 2 "2013 Census district health board tables." Feb < 1

3 Contents Overview... 3 Abbreviations... 4 Māori Population: Profile and Health Needs... 5 National Indicators... 7 Indicator 1: Accuracy of ethnicity reporting in PHO registers... 7 Indicator 2: Percentage of Māori enrolled with PHOs... 8 Indicator 3: Ambulatory sensitive hospitalisation rate (0-4, 45-64, 0-74 years)... 9 Indicator 4: Breastfeeding rates at 6 weeks, 3 months, and 6 months Indicator 5: Cardiovascular disease risk assessment rates (eligible population) Indicator 6: Acute Coronary Syndrome Indicator 7: Breast screening rates (50-69 years) Indicator 8: Cervical screening rates (25-69 years) Indicator 9: Smoking cessation in pregnancy Indicator 10: Percentage of infants fully immunised by eight months of age Indicator 11: Seasonal influenza immunisation rates (65 years and over) Indicator 12: Reduction in rheumatic fever rates Indicator 13: Oral health Indicator 14: Mental health Local Indicators Indicator 15: Asthma hospitalisation rate (0-14 years) Indicator 16: Did- Not- Attend (DNA) rate for outpatient appointments Appendix A Methodology for Local Indicator Selection Version Please direct correspondence about this plan to george.gray@bopdhb.govt.nz 2

4 Overview This plan describes Bay of Plenty District Health Board s (BOPDHB) priorities in Māori health for the year. This plan aligns with the requirements of the New Zealand Public Health and Disability Act (2000) which directs District Health Boards (DHBs) to reduce disparities and improve health outcomes for Māori and other New Zealanders. The format of this plan and the indicators listed within it follow the guidelines given in the 2015/2016 Operational Policy Framework. This plan aligns with the BOPDHB s Annual Plan (AP) and the Midland DHBs Regional Services Plan. The Māori Health Plans of the past three years provided a foundation for BOPDHB to identify the leading causes of mortality and morbidity for Māori in our area. The plans also provided a focus for the DHB to coordinate activity and improvements with stakeholders. The Māori Health Plan seeks to continue the positive momentum achieved to date. This plan is part of a continuous quality improvement framework in place at BOPDHB aimed at improving health outcomes for Māori and other New Zealanders. Other parts of this framework include the trendly web-based MHP monitoring tool which came online in June 2015 and the Māori Health Excellence Seminar series offered by livestream and delayed broadcast. In combination, these tools help us to identify current performance, implement effective interventions, and then monitor progress. As in the past, we will monitor progress through our Māori Health Plan Steering Group (MHPSG); this quarterly forum comprises representatives from the various organisations involved in achieving the targets listed in this plan. The group includes representatives from primary care, secondary care, regional public health services, community providers, and the DHB. The Māori Health Plan gives a one-year subset of actions and aspirational targets related to Māori health; longer term activities (2-5 years) to improve health for Māori and non-māori are described in the BOPDHB Annual Plan. The methods used to determine the local indicators listed in this plan are summarised in Appendix A. Because the two local indicators listed in our previous plan remain significant areas of inequality, they have been retained for the plan. We are pleased to see one of our locally developed indicators (oral health) elevated to a national indicator for 2014/15. 3

5 Abbreviations ABC ACS AP ARF ASH BFHI BOP BOPDHB CME COPD CVD CVRA DAR DHB DHBSS DMFT DNA EBPHA ENT GM HbA1C IGT IHD ISP ISDR MHPSG MOH NCHOD NMO NSU NZ NZHS PHO POPAG RR WBOPPHO An approach to smoking cessation requiring health staff to ask, give brief advice, and facilitate cessation support. Acute Coronary Syndrome Annual Plan Acute rheumatic fever Ambulatory sensitive hospitalisation Baby friendly hospital initiative Bay of Plenty Bay of Plenty District Health Board Continuing medical education Chronic obstructive pulmonary disease Cardiovascular disease Cardiovascular risk assessment Diabetes annual review District Health Board DHB Shared Services Diseased, Missing, or Filled Teeth Did not attend (used in the measurement of outpatient clinic attendance) Eastern Bay Primary Health Alliance Ear, nose and throat General Manager Glycosylated haemoglobin Impaired glucose tolerance Ischaemic heart disease Independent service provider Indirectly standardised discharge rate Māori Health Steering Group Ministry of Health National Centre for Health Outcomes Development Nga Mataapuna Oranga (Primary Health Organisation) National Screening Unit New Zealand New Zealand Health Survey Primary Health Organisation Population Health Advisory Group Rate ratio Western Bay of Plenty Primary Health Organisation 4

6 Māori Population: Profile and Health Needs 1. Geographic Distribution BOPDHB s population was 205,995 at the 2013 Census. 23% of BOPDHB s population identified as Māori (47,277 people) at the Census, compared with 14% nationally. 2 BOPDHB comprises five territorial authorities. In 2014 the majority of the population were based in western areas, 56% lived in Tauranga City with a tapering population count towards the east; Absolute numbers of Māori reflect the total population s pattern, tapering from west to east. However Māori make up a greater proportion of each district s population toward the east. Table 1. Bay of Plenty (BOP) population distribution by territorial authority. 3 District Western BOP Tauranga Whakatane Kawerau Opotiki Total Popn. 45, ,800 34,300 6,600 8,830 Māori Popn. 8,795 21,734 15,167 4,043 5,262 Māori (%) Health Service Providers Key health service providers in BOPDHB include: Two public hospitals; Tauranga (349 beds) and Whakatane (110 beds); Three PHOs (enrolled 93% of the eligible Māori population and 99% of non- Māori in quarter ); 4 Multiple local and national non-profit and private health and social providers. 3. Iwi within BOPDHB Multiple Iwi lie within or across BOPDHB s borders including: Ngai Te Rangi Ngāti Ranginui Te Whānau ā Te Ēhutu Ngāti Rangitihi Te Whānau ā Apanui Ngāti Awa Tūhoe Ngāti Mākino Ngāti Whakaue ki Maketū Ngāti Manawa Ngāti Whare Waitahā Tapuika Whakatōhea Ngāti Pūkenga Ngai Tai Ngāti Whakahemo Tūwharetoa ki Kawerau 4. Age Distribution of the Māori Population In 2014, BOPDHB s over-65 population was proportionately larger than the national average (17.5% vs. 14.3%), with both the BOPDHB and national populations getting older; The BOPDHB Māori population is skewed towards younger age groups, one-third of Māori are aged under 15. In comparison just 16% of non-māori are aged under 15; Only 7% of Māori are aged over 65, whereas 23% of non-māori are over the age of 65. Table 2. Age distribution of the BOPDHB population (projection for 2014 based on 2013 New Zealand Census). 5 Age Group Māori (%) Non-Māori (%) Population Growth Projections From 2006 to 2026 BOPDHB s Māori population will grow by a greater amount (35.5%) than the local non-māori/non- Pacific population (21.5%), and the national Māori population (29.9%) Deprivation Distribution BOPDHB has more people who live in the two most deprived NZDep categories compared with the national average (21% versus 18%). Deprivation increases toward the east of the DHB where Māori make up a greater proportion of the population. Over 60% of Māori in BOPDHB live in the three most deprived deciles. 7 2 "2013 Census district health board tables." Feb < 3 Statistics NZ infoshare, Population Estimates at 19/11/2014. Baseline 2013 Census 4 Ministry of Health. Primary Health Care. PHO Enrolment Demographics 2015Q1 (Jan- March 2015). [Online] Statistics New Zealand population projections, 2013 census baseline. 6 ibid. 7. Statistics New Zealand. Regional Summary Tables. Statistics New Zealand. [Online]

7 7. Leading Causes of Avoidable Mortality and Hospitalisation The leading causes of avoidable mortality and hospitalisation are ranked below. Similar issues ranked highly for Māori and European/other populations locally and nationally In 2011 age standardised mortality rates (WHO standard population) were per 100,000 population for New Zealand Māori and per 100,000 population for non-māori. 8 Table 3. Leading causes of avoidable mortality and hospitalisation for BOPDHB Avoidable Mortality BOPDHB NZ 1 CVD IHD CVD IHD 2 Lung cancer Lung cancer Māori 3 Diabetes Diabetes 4 Road traffic injuries Road traffic injuries 5 Suicide & self harm Suicide & self harm Avoidable Hospitalisation BOPDHB NZ Respiratory infections Dental conditions Asthma Gastroenteritis ENT infections Respiratory infections Dental Asthma ENT infx Angina 1 CVD IHD CVD IHD 2 Road traffic injuries Suicide/self harm Other 3 Suicide & self harm Lung cancer 4 Lung cancer Road traffic injuries 5 Colorectal cancer Colorectal cancer Respiratory infections Gastroenteritis Dental conditions ENT infections Angina Respiratory infections Gastroenteritis ENT infections Dental conditions Angina 8. Health Service Utilisation 8.1 Primary Care PHO Enrolment In Q the highest number of Māori were enrolled with Eastern Bay Primary Health Alliance (EBPHA) (21,227 people), followed by Western Bay of Plenty PHO (WBOPPHO) (18,146), and finally Ngā Matapuna Oranga PHO (NMO) (7,766 people). Table 4. Enrolled populations in BOPDHB PHOs as at Q PHO EBPHA WBOPPHO NMO Total Enrolees 45, ,059 10,780 Māori 21,384 18,296 7,820 Māori (%) Secondary Care Emergency Department Utilisation The 2011/12 New Zealand Health Survey (NZHS) reported that Māori adults are 1.7 times more likely to have used an emergency department (ED) than non-māori at a national level. 21% of Māori adults used ED in the preceding 12 months, compared to 16% of Pacific, 13% of European and 9% of Asian adults (over 15 years of age). Māori children were also more likely to have used an ED (17%), compared to Pacific (15%), Asian (14%) and European children (13%). Emergency Department utilisation was also higher in BOPDHB for Māori (33.7%) than non-māori (27.8%) New Zealand Deprivation Index The 2013 Census revealed that 65% of Māori Bay of Plenty Māori live in the three most deprived deciles, whereas only 5% of Māori live in the three least deprived deciles. In comparison, 36% of non-māori are found in the most deprived three deciles; 12% of non-māori are found in the least deprived three deciles Ministry of Health. Mortality 2011 online tables [online] ibid. 10 "Enrolment in a primary health organisation Ministry of Health, Wellington." 13 Feb < 11 "Emergency Department Use 2011/12 Ministry of Health NZ." Mar < department- use > 12 Atkinson, J. "NZDep2013 Index of Deprivation - University of Otago." < 6

8 National Indicators Indicator 1: Accuracy of ethnicity reporting in PHO registers Target: Māori: Non-Māori: Greater accuracy of ethnicity data in PHO enrolment databases. Ethnicity data accuracy will increase as measured through implementation of the Ministry of Health s primary care ethnicity data auditing tool. n/a - a target will be determined once baseline data has been collected n/a n/a By 30 November 2015 By 31 December 2015 By 28 February 2016 By 28 February 2016 By 31 January 2016 Implement the ethnicity data auditing tool (EDAT) in 80% of BOPDHB s clinics in association with the three PHOs in the area. Collate EDAT scores and ethnicity data accuracy for 80% of clinics in BOPDHB. Facilitate sharing of best practice processes from high scoring clinics to others with low EDAT results within the three BOPDHB PHOs. Complete a register of clinic EDAT scores and performance in order to track implementation and repetition in 1-3 years (depending on initial results). Report results of the initial primary care ethnicity data audit to the quarterly meeting of the Māori Health Plan Steering Group. This group comprises representatives from each of the PHOs in BOPDHB. This forum will be used to collaborate with the PHOs on ways to improve the baseline results. Audit results will be provided to all general practices in keeping with the current performance feedback activities already performed by PHOs. 7

9 Indicator 2: Percentage of Māori enrolled with PHOs Increased access for the Māori population to primary health care services. 100% of Māori in BOPDHB will be enrolled with a PHO. Target: 100% Māori (Jan-Mar 2015): 93% Non-Māori (Jan-Mar 2015): 99% By 1 July 2015 Compare PHO enrolment (numerator) with the 2013 Census (denominator) to identify enrolment gaps stratified by geography, ethnicity, gender, and other variables. By 31 August 2015 Provide PHO enrolment deficit analyses to PHOs in BOPDHB in order to help PHOs target enrolment improvement initiatives to specific populations. Ongoing Track PHO enrolment on a quarterly basis. By 30 November 2014 Complete an audit of ethnicity data accuracy in BOPDHB (see Indicator 1: Accuracy of ethnicity reporting in PHO registers). The audit will enable the Māori Health Planning and Funding Team to reconcile the impact of underreported or misclassified Māori ethnicity on reported PHO enrolment rates. Multiple studies have reported misclassification rates as high as 35%. Ongoing Monitor indicator performance on a monthly basis through the Māori Health Planning and Funding Team. Monitor indicator performance on a quarterly basis through the Māori Health Plan Steering Group. 13 Bramley, Dale, and Sandy Latimer. "The accuracy of ethnicity data in primary care." Journal of the New Zealand Medical Association (2007). 14 Swan, Judith, Steven Lillis, and David Simmons. "Investigating the accuracy of ethnicity data in New Zealand hospital records: still room for improvement." New Zealand Medical Journal (2006). 8

10 Indicator 3: Ambulatory sensitive hospitalisation rate (0-4, 45-64, 0-74 years) Reduced ambulatory sensitive hospitalisation (ASH) rates among all age groups (0-4, 45-64, and 0-74 years) BOPDHB has estimated the cost of ASH to be $7 million per annum. The six most frequently seen ASH conditions account for 50% of all admissions. This local research has helped guide the development of an acute demand intervention aimed at reducing ASH over 2015/16 by testing subsidised primary care appointments and prescriptions for those presenting with ASH conditions. Targets (Māori): Baseline Māori (year to June 2015): Baseline total population (year to June 2015): Indirectly standardised ASH rates for Māori will be the same as those for the total population of New Zealand. 0-4 years: to be confirmed (TBC) years: TBC 0-74 years: TBC 0-4 years: 7,235/100, years: 5,214/100, years: 3,828/100, years: 4,496/100, years: 1,841/100, years: 1,875/100,000 By 31 July 2015 By 30 September 2015 By 31 July 2015 By 30 September 2015 By 31 July 2015 By 31 August 2015 Ongoing Contract with WBoP PHO (74% of BoP population) to provide primary care management of ASH conditions, in particular those ASH conditions which impact upon Māori including, management of pneumonia, heart failure, cellulitis, DVT and gastroenteritis in adults and skin infections and otitis media in children. Provision of nurse specialist and nurse practitioner in cardiology-led education for primary and community nurses to enable better management and reduced readmissions for patients with heart failure. WBoP PHO Health and Wellness community services plan to work in partnership with general practice to ensure patients with heart failure develop self-management plans. Provision of insulin-start education and ongoing management of insulin therapy. Toi Te Ora Public Health Unit provision of education to primary care health care professionals relating to management of skin infection in children. Provision of train the trainer packages to Hauora and Māori Health contractors, including those with BOPDHB Whanau Ora contracts, Tamariki Ora contracts, Korua Kuia contracts. These train the trainer packages include education from nurses, clinical pharmacists and community dietitians. The indicators listed above for ASH will be monitored for implementation via the indicator champion, the Māori Health Planning and Funding Team, and on a quarterly basis via the Māori Health Plan Steering Group. ASH indicator results will be tracked on a monthly basis through the Māori Health Planning and Funding Team. The Māori Health Plan Steering Group will track ASH indicator results on a quarterly basis. 9

11 Indicator 4: Breastfeeding rates at 6 weeks, 3 months, and 6 months Targets: Māori (Q4 2013/14): 16 Non-Māori (Q4 2013/14): Higher rates of breastfeeding for Māori infants at 6 weeks, 3 months, and 6 months. Māori infants will have attained breastfeeding rates consistent with the age-related targets set by the Ministry of Health in the Well Child Tamariki Ora Quality Improvement Framework % at 6 weeks (full or exclusive) 60% at 3 months (full or exclusive) 65% at 6 months (receiving breast milk) 62% at 6 weeks (full or exclusive) 51% at 3 months (full or exclusive) 58% at 6 months (receiving breast milk) 68% at 6 weeks (full or exclusive) 58% at 3 months (full or exclusive) 70% at 6 months (receiving breast milk) Breastfeeding has protective effects against a range of conditions including diabetes, overweight/obesity, dental caries, and respiratory infections. The factors influencing breastfeeding for Māori women have been identified in past research The barriers identified in the research include: difficulty establishing breastfeeding within the first six weeks; poor or insufficient professional support; perception of inadequate milk supply; and returning to work. The interventions listed below are aimed at addressing some of these factors by supporting initiation and delaying cessation of breastfeeding. 19 We will continue to achieve high initiation rates through continuation of the World Health Organization s Baby Friendly Hospital Initiative (BFHI) in BOPDHB hospitals. By 31 October 2015 Negotiate with relevant stakeholders in BOPDHB to implement the Baby Friendly Community Initiative (BFCI). By 31 July 2015 Review and prioritise recommendations from the evaluation of breastfeeding friendly spaces initiative in BOPDHB and Lakes DHB. By 30 June 2016 Progressively increase the number of accredited breastfeeding friendly public spaces in BOPDHB and Lakes DHB to 260 by June Breastfeeding friendly public spaces is the local implementation of elements of the BFCI. In particular, the program aims to increase the number and distribution of public spaces which are conducive to mother s needs for breastfeeding. A New Zealand based evaluation noted that the BFCI had the potential to raise breastfeeding rates and improve community support for breastfeeding. 20 This initiative may contribute to reduced disparities by increasing the acceptability of breastfeeding in public a perceived barrier for Māori women noted in past research. 17 By 31 December 2015 Establish a sustainable forum of breastfeeding stakeholders in the western Bay of Plenty (similar to that functioning in the eastern Bay of Plenty). Key activities of the group will be to establish a stocktake of breastfeeding promotion and support activities being performed by the various stakeholders, and then to integrate the 15 "The Well Child / Tamariki Ora Quality Improvement Framework." Mar < child- tamariki- ora- quality- improvement- framework> 16 Based on data supplied by Plunket. 17 Manaena- Biddle, H, J Waldon, and M Glover. "Influences that affect Māori women breastfeeding." Breastfeeding Review 15.2 (2007): Glover, Marewa et al. "Barriers to best outcomes in breastfeeding for Māori: mothers' perceptions, whānau perceptions, and services." Journal of Human Lactation 25.3 (2009): Dyson, Lisa, F McCormick, and Mary J Renfrew. "Interventions for promoting the initiation of breastfeeding." Cochrane Database Syst Rev 2 (2005). 20 Baby Friendly Community Initiative Evaluation May research/shore/projects/baby- friendly- community- initiative- evaluation.cfm 10

12 activities and breastfeeding targets of stakeholders. The forum will complete a work plan for the year. Areas to address will include improving the interface between lead maternity carers and Well Child Tamariki Ora services, integrating the roles of stakeholders, and providing more information to providers to educate and support mothers to continue breastfeeding. To be facilitated by BOPDHB Funding and Planning in collaboration with Toi Te Ora - Regional Public Health Service. By 31 December 2015 Implement a general practice based reminder system in collaboration with PHOs to remind staff to encourage breastfeeding at six-week and three month vaccination visits. Ongoing Monitor the breastfeeding indicator each month within the Māori Health Planning and Funding Team; on a quarterly basis through the Māori Health Plan Steering Group. 11

13 Indicator 5: Cardiovascular disease risk assessment rates (eligible population) Targets: Reduced cardiovascular disease mortality and morbidity through cardiovascular risk assessment (CVRA) and appropriate management. 90% of Māori in the eligible age group will have reached the national CVRA target by 30 June % of the eligible population will have had their cardiovascular risk assessed in the last five years. Māori (Q2 2014/15): 82% Non-Māori (Q2 2013/14): 90% In addition to tracking performance for the total population we will have a special focus on the Māori male year age group. By 1 July 2015 Have in place agreements with PHOs to fund the delivery of CVRA to eligible populations with an emphasis on High Needs patients. By 30 September 2015 Release an online learning module for improved CVRA performance to GP clinic staff based on the 2014 Māori Health Excellence Seminar on this topic. By 30 October 2015 Secure access to data for CVRA rates in the year age group. By 30 November 2015 Provide reporting to stakeholders categorised by PHO, ethnicity, gender, along with rates for the year Māori male subset. By 30 Sep 2015 By 31 Dec 2015 By 1 Jan 2016 Activities specific to EBPHA include: Develop reporting capability through BPI to separately track this cohort Workshops with GPs to identify ways of encouraging patient engagement Promote positive outcomes from CVD risk assessment including selfmanagement options By 31 July 2015 (ongoing) Monitor CVRA performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team. Monitor CVRA results on a quarterly basis through the Māori Health Plan Steering Group. This group involves representatives from the three PHOs and is used as a forum to review new initiatives implemented by primary care, and to plan other interventions. 12

14 Indicator 6: Acute Coronary Syndrome Targets: Reduced cardiovascular disease mortality and morbidity through better management of acute coronary syndrome (ACS). Targets for ACS management will be attained by 30 June % of high-risk Acute Coronary Syndrome patients accepted for coronary angiography have it within 3 days of admission (Day of admission=day 0). 95% of patients presenting with Acute Coronary Syndrome who undergo coronary angiography have completion of ANZACS QI ACS and Cath/PCI registry data collection within 30 days. Baseline Māori: (Q2 2014/15) Baseline Non-Māori (European/Other group): (Q2 2014/15) 71% high-risk Acute Coronary Syndrome patients underwent coronary angiography within 3 days of admission (Day of admission=day 0). 100% (20/20) of patients presenting with ACS who underwent coronary angiography had ANZACS QI ACS and Cath/PCI registry data collected within 30 days. 83% of high-risk Acute Coronary Syndrome patients underwent coronary angiography within 3 days of admission (Day of admission=day 0). 92% of patients presenting with ACS who underwent coronary angiography had ANZACS QI ACS and Cath/PCI registry data collected within 30 days. Ongoing Maintain current performance on these indicators (BOPDHB has already reached the national targets for these two CV indicators for its Māori population). Ongoing Provide quarterly reporting to the MHPSG. If performance drops below national targets investigate the reasons for this change in consultation with the MHP cardiovascular champion. By 31 July 2015 (ongoing) Monitor indicator activity performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team in collaboration with the BOPDHB cardiac indicator champion. Monitor results on a quarterly basis through the Māori Health Plan Steering Group. 13

15 Indicator 7: Breast screening rates (50-69 years) Lower breast cancer morbidity and mortality among Māori women through better utilisation of the national breast screening programme for women aged years. 21 Screening rates for Māori women (50-69 years) in BOPDHB will have reached the national target of 70%. Target: 70% Baseline Māori: Baseline Non-Māori: 57.4% (24 months to 31 December 2014, year age group, National Screening Unit (NSU)) 68.9% (24 months to 31 December 2014, year age group, NSU) By 31 December 2015 Identify GP practices within BOPDHB with the highest Māori enrolments and lowest enrolment and/or screening rates (i.e eligible women not screened or underscreened) and aim to increase these by providing dedicated resource i.e. champions. Breastscreen Midland (BSM) GP data coordinator to identify practices by data match reports. Performance Measure: Numbers of Māori women who booked an appointment as a result of additional input eg an outward bound telephone call. Ongoing EBPHA will work with Breast Screen Midland (BSM), East Bay Radiology, Te Puna Ora o Mataatua, Whakatohea Health & Social Services and other key stakeholders to improve breast screening appointments and service delivery in the Eastern Bay of Plenty. Performance Measure: Increase in breast screening rates in EBoP Ongoing Independent Service Providers (ISPs) will increase participation in mobile breast screening units. Involvement in the enrolment of women, booking of appointments and providing support to service is likely to increase participation due to ISPs connectedness to their communities. Key activities to increase participation specifically in the Opotiki region will be: ISPs to be actively involved in key stakeholder meeting at least 3 months before mobile visit. Mobile Support Guidelines to be followed pre, during and post mobile (meetings, awareness, resources, evaluation, post mobile report) Promotion of breast screening through media campaign, advertising, BSA resources. Performance Measure: Use of mobile unit is optimized and an increase in screening from the previous mobile screening round. Ongoing BOPDHB will support collaborative working relationships between providers across the breast screening pathway by meeting every six months with relevant regional stakeholders. The stakeholders include Breast Screen Midland, PHO s, Radiology Provider, Independent Service Providers, and representatives from neighbouring DHBs. Standard agenda items include update on Midland screening coverage rates, progress against the Midland Breast Screening Regional Plan, the mobile screening unit schedule, issues and challenges, successes and an update from stakeholders. Performance Measure: Two regional hui held per annum and outcomes reported in NSU six-monthly reports. By 31 July 2015 (ongoing) Monitor performance on a monthly basis within the BOPDHB Māori Health Planning 21 It is acknowledged that the national breast screening program facilitated by the NSU provides coverage for women aged The BOPDHB Māori Health Plan 2014/15 refers to the year age group in keeping with existing performance reporting for this indicator. 14

16 and Funding team. Monitor screening performance on a quarterly basis through the MHSG. Performance Measure: Screening performance is monitored monthly and quarterly and key actions to lift performance are identified. 15

17 Indicator 8: Cervical screening rates (25-69 years) Lower cervical cancer morbidity and mortality among Māori women through better utilisation of the national cervical screening programme for women aged years. 22 Cervical screening rates for Māori women will have reached the national target of 80%. Target: 80% Māori: Non-Māori: 62.0% (36 months to 31 December 2014, year age group, NSU) 83.4% (36 months to 30 September 2014, year age group, NSU) By 31 July 2015 Identify six GP practices (three in WBoP and three in EBoP) within BOPDHB who have a high eligible Māori population that have not been screened or under screened (not screened in the last 5 years) and aim to increase these by providing dedicated resource i.e. champions to contact these women and book them for a cervical smear. Performance Measure: Numbers of Māori women who booked an appointment as a result of additional input eg an outward bound telephone call. By 31 December 2015 Develop and circulate a clear set of instructions for each General Practice manager on how its Practice Management System MedTech32 should be set up so that the correct ethnicity is captured on the MedTech lab form. Performance Measure: Every GP clinic is circulated the information on how to capture ethnicity correctly for a cervical screening smear test. By 31 December 2015 EBPHA will work collaboratively with the Independent Service Provider- Te Puna Ora o Mataatua (TPOOM) to establish an effective e-referral process throughout the eastern Bay of Plenty. Performance Measure: Number of eligible Māori women who were referred and completed a cervical smear. By 31 July 2015 Nga Matapuna Oranga PHO will implement a cervical screening project based on a successful Hawkes Bay DHB model - Taku Wahine Puroto, entailing provision of outreach and after hours cervical screening services. Eligible women will also be encouraged to enrol and book a breast screening appointment at the time of screening. Performance Measure: Number of women screened as a direct result of the project. By 31 July 2016 Implement strategies as developed by the DHB Action Group (Colposcopy, ISPs, PHOs, Toi te Ora, BOPDHB Māori Health Plan Champion) to reduce number of colposcopy clinic DNAs for assessment and treatment. Strategies developed will aim to improve the timeliness and experience of colposcopy for Māori women. Performance Measures: Reduction in DNA rates. Ongoing BOPDHB will support collaborative working relationships between providers across the cervical screening pathway. Toi Te Ora will hold two regional hui per annum with Independent Service Providers, PHOs, Colposcopy Services and Planning and Funding portfolio managers to review progress against the BOP/Lakes Regional Cervical Screening Plan and consider new initiatives. DHB action group hui are held within the Bay of Plenty and Lakes districts to review 22 It is acknowledged that the national cervical screening program facilitated by the NSU provides coverage for women aged The BOPDHB Māori Health Plan 2014/15 refers to the year age group in keeping with the indicator guidance listed on page 154 of the 2014/15 Operational Policy Framework on the National Service Framework Library website. 16

18 progress, provide advice and assist resolution of any issues. Each action group includes Toi Te Ora, Independent Service Providers, PHOs, Colposcopy and Planning and Funding. Performance Measure: Two regional hui held per annum and outcomes reported in NSU six monthly reports. Three DHB Action Group hui held per annum and outcomes reported in NSU six monthly reports. 17

19 Indicator 9: Smoking cessation in pregnancy More Maori women who are smokefree at two weeks postnatal. The percentage of Maori women who were pregnant and were offered smoking cessation advice and support and who are smokefree at two weeks postnatal will increase over 2015/16 as a result of our efforts. Target: 95% Māori: Non-Māori: TBC TBC By 30 September 2015 Enhance referral processes and increase referral volumes from LMCs, DHB Maternity Services, Whanau Ora, Well Child Tamariki Ora (WCTO) services, community dentists etc to specialist smoking cessation providers such as Quitline, Aukati Kaipaipa, or PHO/General Practice services. Agency responsible: BOP Tobacco Control Coordination Service. By 31 December 2015 Continue to offer Innovate-provided smokefree training to LMCs and DHB midwives in BOP. Agency responsible: BOP Maternity Services. By 31 December 2015 (ongoing) Deliver ABC to pregnant women and young mothers at first registration with a midwife, two weeks post-partum and at 5 months well child check as these are trigger points where Maori women may be conducive/vulnerable to changes in smoking status. Agencies responsible : LMCs/GPs and WCTO providers. Ongoing Ensure that specialist smoking services for Maori pregnant women and young mothers offer smoking cessation services to partners and other whanau as well as the woman. Agencies responsible: All smoking cessation specialist services. By 30 September 2015 Consider carrying out ABC process at second and third notification appointments through DHB or private radiology services. Agency responsible: Planning and Funding, BOPDHB. By 31 July 2014 (ongoing) Monitor smoking cessation advice provision performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team. Monitor smoking cessation advice provision and smokefree rates at two weeks postnatal on a quarterly basis through the Māori Health Plan Steering Group. 18

20 Indicator 10: Percentage of infants fully immunised by eight months of age Reduced immunisation-preventable morbidity and mortality. 95% of Māori infants will be fully immunised by eight months of age (by 31 December 2014). Target: 95% Māori (Q2 2014/2015): 89% Non-Māori (Q2 2014/2015): 89% By 31 July 2015 Provide funding to support a media campaign promoting immunisation through utilisation of key clinical and other appropriate Immunisation champions, targeting specific community groups, ensuring key messages are heard. By 31 December 2015 Convene a Bay of Plenty Immunisation Provider s Forum to reassess effectiveness of existing strategies, identify areas where performance could be improved and progress opportunities to address specific areas of concern. By 31 July 2015 (Ongoing) Re-orientate focus of efforts from actual 8 month achievement against the Health Target to that of achieving fully immunised status for children by 6 months as an opportunity to influence attitudes and behaviours of parents/carers in respect to immunisation. By 31 July 2015 (Ongoing) Participate in local, regional and national forums that focus overall immunisation health target performance and information-sharing to support systems and service improvement where appropriate. By 31 July 2015 (ongoing) Monitor immunisation performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team and via the BOPDHB Funding and Planning immunisation champion. Monitor immunisation performance on a quarterly basis through the Māori Health Plan Steering Group. 19

21 Indicator 11: Seasonal influenza immunisation rates (65 years and over) Reduced influenza morbidity through increased seasonal influenza vaccination rates in the eligible population (65 years and over). 75% of Māori in the eligible population will have received the seasonal influenza vaccination in the period January to July Target: 75% Māori (Q ): Non-Māori (Q ): 70% (High-needs population) 68% (Total population) May to 30 June 2015 (ongoing) Koroua/kuia health service providers will facilitate higher immunisation rates by: Facilitating education on the seasonal influenza vaccination for group attendees using IMAC-trained educators from the Māori Women s Welfare League; Providing free vaccination to group attendees using accredited local vaccinators. In parallel the three PHOs within BOPDHB will track vaccination rates by ethnicity and clinic to focus performance improvement for this indicator. This information will be monitored by the indicator champion. By 1 July 2015 (ongoing) A health education resource in te reo is prepared locally and used across all settings appropriate for Maori aged 65+ (there is no national resource in te reo). Experience has shown that Maori, particularly older Maori, prefer receiving health information in their own language and context. Feedback to be provided by educators on acceptability by Māori and whether it leads to increased vaccination rates, particularly amongst those who are vaccinated for the first time. By 1 July 2015 (ongoing) All Maori Women s Welfare League branches in the BOPDHB district are supported to promote influenza vaccination to Maori 65+ in their communities by receiving initial training and resources on influenza and the vaccine. Training to be provided by IMAC personnel in March/April 2015, who will report on training attendances. Impact measured by vaccinations delivered. By 31 Dec 2015 BOPDHB Planning and Funding will work with local PHOs to identify clinics willing to participate in a pilot project in early 2016 to test improved identification and recall systems/procedures for Māori clients within general practice for influenza immunisation. THE DHB will aim to work with clinics with a high proportion of Māori in the eligible age group. BOPDHB s Māori Health Planning and Funding Team will use the vaccination rates and PHO/clinic performance results from 2015 to plan more effective interventions for implementation in general practice in The interventions listed above will lead to better outcomes and reduced disparities by 1) increasing access to influenza vaccination in the Māori community, 2) improving the identification and recall of the eligible population in clinics with high Māori populations. By 31 July 2015 (ongoing) Monitor immunisation performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team and via the BOPDHB Funding and Planning immunisation champion. Monitor immunisation performance on a quarterly basis through the Māori Health Plan Steering Group. 20

22 Indicator 12: Reduction in rheumatic fever rates Target: Māori: Non-Māori: Reduced rates of acute rheumatic fever. The admission rate for an initial case of acute rheumatic fever in BOPDHB will reach the target for BOPDHB established by the Ministry of Health, as part of the national two thirds reduction in hospitalisations by per 100,000 per year (Total population crude rate, all ethnicities). This target results from a 55% reduction in the baseline rate of 3.8 per 100,000 per year (2009/ /12). Baseline rate: 3.8 per 100,000 per year (2009/ /12, BOPDHB total population rate, all ethnicities). Baseline performance data and targets are provided for the total population. Detailed actions are documented in the Bay of Plenty Rheumatic Fever Plan Key activities are described below: By 30 June 2016 Deliver 275 Healthy Homes System home assessments with intervention plans agreed by whanau and a range of interventions delivered against those plans. Quarterly target is 69 completed assessments delivered by BOPDHB s two subcontractors : Tauranga Community Housing Trust and Sustainability Options By 31 July 2015 (ongoing) Established rapid response clinics in Whakatane, Edgecumbe and Tauranga to provide easy access to sore throat assessment and treatment for 80% of 4-19 year old Maori (and Pacific) children and young people living in high deprivation quintile 5 areas. Ministry of Health funding provided for rapid response clinics in areas not currently served by school-based throat swabbing programmes.. Of the 41 cases of acute rheumatic fever aged 0-19 in the BOPDHB district in the six years from 2009 to 2014, 15 or 37% occurred in communities not covered presently by a schoolbased service. By 31 July 2015 (ongoing) Have loaded all retrospective cases of acute rheumatic fever on to the BOP rheumatic fever register operated by Rotorua Area Primary Health Services, and use the register to monitor and improve timeliness of injections given under the Bicillin programme. By 31 July 2015 (ongoing) Carry out systems failure analysis of all new notifications of acute rheumatic fever, and put into place all recommendations arising from that analysis. By 30 June 2016 Deliver actions for 2015/16 outlined in the BOP Rheumatic Fever Prevention Plan This plan will be reviewed during 2015/16 to update for initiatives and lessons learned from work undertaken to date. By 31 July 2015 (ongoing) Monitor performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team. Monitor screening performance on a quarterly basis through the Māori Health Plan Steering Group. 21

23 Indicator 13: Oral health Improved oral health outcomes for Māori children. 95% of Māori preschool children will be enrolled in a dental clinic. Target: 95% by June 2016 (90% by December 2015) Māori (December 2014): 61% Non-Māori (December 2014): 99% By 31 August 2015 Complete a comprehensive process map of the enrolment pathway in order to identify all barriers to oral health patient management along the pathway. To be completed by oral health champion, in association with 1) DHB Planning and Funding and MoH (data matching), 2) Community oral health services, 3) PHOs within BOPDHB. By 31 August 2015 Reconcile preschool PHO enrolments against the Titanium dental enrolment database. Identify any clusters of dental non-enrolment by hospital, geography, PHO, and ethnicity within the DHB. By 30 September 2015 Develop, prioritise, and implement interventions to increase Māori preschool dental clinic enrolment rates based on the assessment of patterns of non-enrolment described in the aforementioned activity. In parallel, identify gaps in the enrolment process and develop interventions to address these. By 31 July 2014 (ongoing) Monitor dental clinic enrolment performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team and via the BOPDHB Funding and Planning oral health champion. Monitor dental clinic enrolment performance on a quarterly basis through the Māori Health Plan Steering Group. 22

24 Indicator 14: Mental health Appropriate rates of use of Section 29 of the Mental Health Act (community treatment order). To be determined in collaboration with the MoH. Target: No targets set for 2015/16 Māori (July 2012 to June 2013): Non-Māori (July 2012 to June 2013): 140 per 100,000 per year (74 clients) per 100,000 per year (53 clients) By 31 August 2015 Identify variance in use of Section 29 across BOPDHB by establishing consistent data collection processes for this indicator. By 30 September 2015 Analyse the degree of variance in use of Section 29 within the DHB by reviewing the rationale for its use in samples of Māori patients seen by different practitioners in different parts of BOPDHB. Compare Māori and non-māori patients. By 30 October 2015 Report findings of analyses to practitioners and a clinically-led multidisciplinary mental health forum. Develop guidelines and regular auditing processes to support standardised application of Section 29 throughout BOPDHB. By 1 November 2015 (Ongoing) Monitor the impact of the implementation of guidelines and auditing processes. By 1 July 2015 (ongoing) Monitor indicator performance on a quarterly basis through the Māori Health Plan Steering Group. 23 Data provided by the Ministry of Health via the PRIMHD database, March

25 Local Indicators Indicator 15: Asthma hospitalisation rate (0-14 years) Target: Māori (year to May 2014): Non-Māori (year to May 2014): Lower hospitalisation rate for Māori with asthma aged 0-14 years The asthma hospitalisation rate for Māori aged 0-14 years will be reduced to that of non-māori. 398 per 100,000 per year 596 per 100,000 per year 398 per 100,000 per year By 1 July 2015 Implement acute demand service intervention. This new intervention will be deployed in BOPDHB in collaboration with the two public hospitals in the area, the three PHOs, GP clinics, and a range of other stakeholders. This intervention will provide free appointments for selected conditions for the high needs population where ambulatory care would successfully avoid hospital admission. The intervention will also cover the costs of acute pharmaceutical requirements. By 1 July 2015 Complete development of a query tool to report monthly asthma hospitalisations to BOPDHB hospitals. By 31 August 2015 Identify any individuals with high asthma hospitalisation rates and assess their needs. Ensure those who are regularly admitted and enrolled with a PHO. Link these individuals with support services such as asthma educators and healthy homes providers. By 31 August 2015 Assess the feasibility and impact of implementing the SMART asthma management programme in BOPDHB based on admission patterns and patient needs. 24 By 1 July 2015 Provide baseline and quarterly asthma hospitalisation figures to PHOs at quarterly Māori Health Steering Group meetings. By 31 July 2014 (ongoing) Monitor asthma hospitalisations on a quarterly basis through the Māori Health Plan Steering Group. 24 "SMART for Māori with Asthma - Asthma Foundation New..." Mar < content/uploads/2014/11/matireharwoodsmart.pdf> 24

26 Indicator 16: Did- Not- Attend (DNA) rate for outpatient appointments Lower did-not-attend (DNA) rates by Māori in outpatient appointments clinics. The DNA rate for outpatient appointments for Māori will reach 5%. Target: 5% Māori (month of December 2014): Non-Māori (month of December 2014): 15.9% 6.8% By December 2015 By February 2016 Ensure appointment information is provided in a way that meets patients literacy levels From partnerships with GPs and NGOs to support patients and outpatient clinic attendance By February 2016 Optimisation of administrative processes and systems to support timely scheduling and communnication processes By February 2016 By 31 July 2014 (ongoing). Understand and address where possible barriers that impact on attendance lie, with a special focus on three specialties that have the highest DNA rates. Monitor DNA performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team and via the provider arm DNA champion. Monitor DNA performance on a quarterly basis through the Māori Health Plan Steering Group. 25

27 Appendix A Methodology for Local Indicator Selection Local indicators were developed through a five- step process involving: 1. Identification of information sources; 2. Identification of leading health issues; 3. Ranking health issues; 4. Scoring the leading health issues; 5. Review and finalisation 1. Identification of Information Sources External Information Sources The most useful source of health needs information was a 2008 Health Needs Assessment completed by the MOH. This document provided epidemiological summaries for a range of conditions stratified by age gender, and ethnicity. Health service utilisation was also presented. Internal Information Sources Epidemiological and service utilisation reports were gathered from Toi Te Ora Public Health Service, Funding and Planning, and the DHB s Population Health Advisory Group (PoPAG). 2. Identification of Leading Health Issues Health conditions and service utilisation issues were collected in a spreadsheet if they met the following criteria: a) A statistically significant difference between Māori and non- Māori outcomes was present; b) There were high inequalities between Māori and non- Māori in BOPDHB (a rate ratio of 1.2 or greater was used) indicating worse health outcomes for Māori compared with non- Māori within the DHB; c) There were high inequalities between Māori in BOPDHB and Māori nationally (a rate ratio of 1.2 or greater was used) indicating worse health outcomes for Māori in BOPDHB than Māori in the rest of the country. 3. Ranking Health Issues Rate ratios between Māori and non- Māori on BOPDHB were calculated. The list of health conditions and service utilisation options were then ranked based on the size of the rate ratio this gave a measure of inequality within BOPDHB. 4. Scoring Health Issues The issues with the highest rate ratios were scored against a list of indicator selection criteria developed by the National Centre for Health Outcomes Development (NCHOD). 5. Review and Finalisation The highest scoring options were reviewed by a public health physician from the regional public health unit, before a set of three condition related indicators were finalised with the DHB s PoPAG and the General Manager Māori Health. 26