Australian Atlas Of Healthcare Variation

Transcription

1 Australian Atlas Of Healthcare Variation 06 December 2016 Dr Anna Lewis and Ms Hayley Forbes

2 Australian Commission on Safety and Quality in Health Care Australian Government agency Leads & coordinates national improvements in safety & quality of health care based on best available evidence Aims to ensure that the health system is sustainable, better informed, supported & organised to deliver safe & high quality care

3 Commission s Priorities Patient Safety Partnering With Consumers Quality, cost and value Supporting health professionals to provide high quality care

4 Variation in Health Care Investigating variation is an action as part of the Commission s priorities regarding quality with a focus on appropriateness of care Large variations in health care use & clinical practice have been documented by researchers around the world for many years Raises issues about quality of care, health system efficiency & equity/access Important implications for health care and health policy

5 Variation in health care A proportion of this variation is termed unwarranted unrelated to patient need or preference may signal inappropriate care may signal ineffective use of resources Australia s health system generally performs well

6 Types of care in the context of variation Effective care procedures or activities with strong evidence of efficacy, proven value, no significant tradeoffs, benefits outweigh risks for almost all patients e.g. diabetic foot care Lower value care procedures or activities shown to be ineffective, no better than placebo or with no evidence showing effectiveness e.g. knee arthroscopy for degenerative disease

7 Types of care in the context of variation Care with different treatment options/uncertain marginal benefit individual patients/health care providers may evaluate risks & benefits of alternative care options differently cost or affordability factors supply-sensitive driven by availability of resources, equipment & workforce use of treatment/procedure extends beyond group in which benefit initially demonstrated

8 About the atlas Australian Atlas of Healthcare Variation Print copy Technical supplement Interactive METeOR specifications Series of work; second atlas in production and due for release in 2017

9 Australian Atlas of Healthcare Variation Launched November 2015 Documents health care variations with a focus on regional variation Provides suggestions on possible causes of variation through the clinical commentary Suggests ways to explore & reduce unwarranted variation

10 Development of the atlas Development with: Australian, state and territory governments Consumers, clinicians and their professional organisations, data experts clinical and consumer advisory group state and territory advisory group Final selection of data items reflects areas where there was: interest in the topic data available high volume, high cost /high risk high disease burden

11 Australian Atlas of Healthcare Variation Examines variation nationally in 36 healthcare interventions, grouped into 6 clinical themes: Antimicrobial dispensing Diagnostic interventions Surgical interventions Interventions for mental health & psychotropic medicines Opioid dispensing Interventions for chronic diseases

12 Australian Atlas of Healthcare Variation Presents healthcare use by residence of patient Region of residence is mapped at Statistical Area Level 3 (& SA 4) Local areas grouped by state/territory, remoteness & socioeconomic status Data are age-standardised

13 Australian Atlas of Healthcare Variation Data sources used: Admitted Patient Care National Minimum Data Set Medicare Benefits Scheme Pharmaceutical Benefits Scheme Produced by the Australian Commission on Safety and Quality in Health Care Analyses undertaken by the National Health Performance Authority Key findings and recommendations for action

14 Key findings Antimicrobial dispensing Very high rates of community antimicrobial use in Australia More than 30 million PBS prescriptions for antimicrobials were dispensed in Diagnostic interventions Fibre optic colonoscopies Very large variations in rates of fibre optic colonoscopies Highest rate area was 30x that of lowest rate area Lumbar spine CT scans 314,000 scans in Highest rate area was nearly 12x that of lowest rate area

15 Key findings Surgical interventions Knee arthroscopy in people aged 55 and over Hysterectomy & endometrial ablation Over 33,000 operations in Highest rate area was 7x that of lowest rate area Women in regional areas up to 5x more likely to undergo a hysterectomy or endometrial ablation than those living in metropolitan areas Cataract surgery Highest rate area 6.5x that of lowest rate area Opioid dispensing Nearly 14 million PBS prescriptions for opioid medicines dispensed in Highest rate area was 10x that of lowest rate area

16 Mental health & psychotropic medicines Key findings ADHD medicines More than 500,000 prescriptions dispensed in Highest rate area 75x that of lowest rate area Antidepressants Second only to Iceland in use of antidepressants among OECD countries Nearly 15 million prescriptions dispensed in to adults Highest rate area over 11x that of lowest rate area for adults and 43x for young people aged 17 and under Interventions for chronic disease In remote areas hospital admission rates for adults markedly higher than in metropolitan areas for heart failure, asthma and COPD, and diabetes-related lower limb amputation Australians have higher rates of asthma compared with other countries but hospitalisation rates are low

17 Interactive Atlas

18 Interactive Atlas Released November 2016 First interactive atlas complements/replicates design and structure of the hardcopy Adds functionality, particularly around the mapping Interactive mapping Local area pop-ups and comparison rates PHN and LHN boundary overlays

19 Hysterectomy and endometrial ablation

20 Interactive Atlas

21 Hysterectomy Second Atlas further analysis Heavy Menstrual Bleeding patient decision support tool Clinical Care Standard

22 Clinical Care Standard Heavy menstrual bleeding Draft CCS on HMB developed Recommendation from first Atlas Extensive consultation, now available for public consultation Feedback sought by 11 January

23 Knee Arthroscopy 55 years and over

24 Interactive Atlas

25 Osteoarthritis of the knee Patient decision aid Clinical care standard

26 The second Atlas Developed with: AIHW Australian, state and territory governments Consumers, clinicians and their professional organisations, data experts Topic Expert Groups Clinical and consumer advisory group State and territory advisory group Final selection of data items reflects areas where there was: interest in the topic available data high volume, high cost /high risk high disease burden

27 Atlas 2 Chapters Potentially Preventable Hospitalisations Maternity & Women s Health Surgery Cardiovascular Conditions

28 Atlas 2 Next Australian Atlas of Healthcare Variation will be released in 2017 Further information on the Australian Atlas of Healthcare Variation can be accessed at