Australian Atlas Of Healthcare Variation 21 March 2016 Dr Anne Duggan Senior Medical Advisor
Overview About variation in health care Australian Atlas of Healthcare Variation Contents Interpreting the graphs & maps Some findings Recommendations for investigation & action
Variation in Health Care Use Large variations in health care use & clinical practice have been documented by researchers in many countries for many years A proportion of this variation seems unwarranted unrelated to patient need or preference may signal inappropriate care May signal resource misallocation Raises issues of quality of care, health system efficiency & equity/access
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 or with no evidence showing effectiveness e.g. knee arthroscopy for degenerative disease
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
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
Development of the Atlas Developed with: Australian, state and territory governments Consumers, clinicians and their professional organisations, data experts Final selection of data items reflects areas where there was: interest in the topic data available high volume, high cost /high risk disease burden
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
Australian Atlas of Healthcare Variation Presents healthcare use by residence of patient Region of residence is mapped at Statistical Area Level 3 (& 4) Local areas grouped by state/territory, remoteness & socioeconomic status Data are age standardised
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
Fibre optic colonoscopy
Fibre optic colonoscopy
Fibre optic colonoscopy state & territory
Fibre optic colonoscopy remoteness & socioeconomic status
Fibre optic colonoscopy
Fibre optic colonoscopy
Fibre optic colonoscopy
Knee arthroscopy admissions 55 years and over
Cataract surgery 40 years and over
Lumbar spine surgery 18 years and over
Hysterectomy and endometrial ablation
Key Findings Antimicrobial dispensing Very high rates of community antimicrobial use in Australia More than 30 million PBS prescriptions for antimicrobials were dispensed in 2013 14 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 2013 14 Highest rate area was nearly 12x that of lowest rate area
Key Findings Surgical Interventions Knee arthroscopy in people aged 55 and over Hysterectomy & endometrial ablation Cataract surgery aged 40 years and over Over 33,000 operations in 2012 2013 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 Highest rate area 6.5x that of lowest rate area Opioid dispensing Nearly 14 million PBS prescriptions for opioid medicines dispensed in 2013 14 Highest rate area was 10x that of lowest rate area
Mental health & psychotropic medicines Key Findings ADHD medicines More than 500,000 prescriptions dispensed in 2013 14 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 2013 14 to adults 18 64 Highest rate area over 11x that of lowest rate area for adults 18 64 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
Key Findings Range across local areas per 100,000 Times difference (excluding outliers) Number per annum Anxiolytic medicines dispensing 65 years and over Antipsychotic medicines dispensing 17 years and under Antipsychotic medicines dispensing 18 64 years Antipsychotic medicines dispensing 65 years and over Attention deficit hyperactivity disorder medicines dispensing 17 years and under 6,193 to 80,445 4.0 1,265,996 306 to 6,895 7.1 104,697 2,076 to 39,544 3.2 2,582,447 8,043 to 57,130 2.4 919,026 382 to 28,642 7.3 544,218
Next steps Commission Further publications including interactive web Atlas Clinical Care Standards Patient Reported Outcome Measures Referred for review by other national bodies, MSAC, PBAC, states Shared decision making tools Review & implementation toolkit for PHCN s
Next Steps Clinical groups Health services and health networks Ensure education aligns with clinical guidelines & care standards Analyse reasons for variation at local level Promote better knowledge & use of shared decision making Develop local responses & priority action plans Promote use of guidelines & continued professional development in areas where high variation exists Monitor adherence to clinical care standards & guidelines
Atlas 2.0 Next atlas of healthcare variation will be released in early 2017 Further information on the Australian Atlas of Healthcare Variation can be accessed at http://www.safetyandquality.gov.au/atlas/