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29/11/2018
1
— AUSTRALASIAN REHABILITATION OUTCOMES CENTRE —SOCIAL AND SPATIAL DIMENSIONS OF ACCESS TO REHABILITATION
AOCPRM & RMSANZ 2018 AUCKLAND 21-24 NOVEMBER
AROC — 16 YEARS OLD AND GOING STRONG!!
• AROC was the brainchild of two well known and highly respected medical rehabilitation physicians, Ben Marosszeky and Garry Pearce.
• Established 1 July 2002 as a joint initiative of the whole Australian rehabilitation sector with support from key New Zealand providers– The Australasian Faculty of Rehabilitation Medicine (AFRM) is the auspice body– The Australian Health Services Research Institute (AHSRI) at the University of
Wollongong is the data manager and responsible for AROC’s day to day operations
• AROC, as the clinical quality registry and outcomes benchmarking arm of AFRM and the rehabilitation sector:– plays an important role in driving continued improvement in rehabilitation outcomes– contributes to the evidence underpinning the value of rehabilitation
• From a twinkle in Ben and Garry’s eyes all those years ago; today rehabilitation is leading the way in the measurement and benchmarking of outcomes
November 2018 2
29/11/2018
2
AROC PURPOSE
The purpose of AROC was established as, and continues to be:
• Develop a national benchmarking system to improve clinical rehabilitation outcomes for patients.
• Produce information on the effectiveness of interventions through the systematic collection of outcomes information in both the inpatient and ambulatory settings.
• Provide annual reports that summarise the Australasian data.
3
AROC COVERAGE – 292 INPATIENT SERVICES
North Island 25
South Island 14
AROC DATA, financial year 2018 4
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3
GROWTH IN AROC INPATIENT DATA
AROC DATA, financial years 1999-2018 5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2009(n=62,645)
2010(n=70,840)
2011(n=77,549)
2012(n=83,765)
2013(n=97,826)
2014(n=106,832)
2015(n=112,457)
2016(n=120,765)
2017(n=124,785)
2018(n=126,648)
2013(n=9,327)
2014(n=11,567)
2015(n=12,273)
2016(n=12,110)
2017(n=12,251)
2018(n=12,165)
AU NZ
Pro
po
rtio
n o
f ep
iso
des
dis
char
ged
eac
h y
ear
Stroke Brain Neuro Spine Amputee
Arthritits Pain Ortho fracture Ortho replacement Soft tissue injury
Other ortho Cardiac Pulmonary Burns Congenital
Other MultTrauma Developmental Re-conditioning/restorative
INPATIENT EPISODES BY IMPAIRMENT
OVER TIME BY COUNTRY
AROC DATA, financial years 2009-2018 6
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4
LOS & FIM CHANGE OVER TIME BY COUNTRY
7AROC DATA, financial years 2014-2018
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2014 2015 2016 2017 2018
Cas
emix
-ad
just
ed r
elat
ive
mea
n
Australia - Financial year
Casemix-adjusted relative mean FIM scoresCasemix-adjusted relative mean LOS
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2014 2015 2016 2017 2018
Cas
emix
-ad
just
ed r
elat
ive
mea
n
New Zealand - Financial year
GROWTH IN AROC AMBULATORY DATA
0
10
20
30
40
50
60
0
2,000
4,000
6,000
8,000
10,000
12,000
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Nu
mb
er
of
serv
ice
s
Nu
mb
er
of
ep
iso
de
s
Financial year of discharge
Episodes
Services
AROC DATA, financial years 2009-2018 8
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5
AMBULATORY EPISODES BY IMPAIRMENT OVER TIME
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2014 (n=8,351) 2015 (n=8,858) 2016 (n=9,424) 2017 (n=10,506) 2018 (n=10,893)
Proportion
of episodes
Re-conditioning
Developmental disability
Multiple trauma
Other disabling imp.
Congenital deformity
Burns
Pulmonary
Cardiac
Ortho - others
Ortho - soft tissue injury
Ortho - replacements
Ortho - fractures
Pain
Arthritis
Amputee
Spinal cord
Neurological
Brain
Stroke
AROC DATA, financial years 2014-2018 9
SOCIAL AND SPATIAL DIMENSIONS
OF ACCESS TO REHABILITATION
IN AUSTRALIA AND NEW ZEALAND
10
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6
MEASURES OF SOCIAL AND SPATIAL DIMENSIONS USED
• GEOGRAPHIC LOCATION OF PATIENT AND REHABILIATION SERVICE– Australia: ABS Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA)
– New Zealand: Stats NZ Urban-Rural Index (URI)
• SOCIO-ECONOMIC DISADVANTAGE OF PATIENT AND REHABILIATION SERVICE– Australia: ABS Socio-Economic Indexes for Areas – Index of Relative Disadvantage (SEIFA-IRSD)
– New Zealand: Stats NZ Index of Relative Socioeconomic Deprivation (NZDep)
• DISTANCE PATIENT HAS TO TRAVEL TO REHABILITATION SERVICE– Australia and New Zealand: Determined using latitude and longitude of postcode
11
OBTAINING POSTCODE LEVEL DATA
• Australia: Data from the Australian Bureau of Statistics 2016 census was used. The ASGC-RA and SEIFA-IRSD provide measures mapped to Australian postcodes.
• New Zealand: Data from the Stats NZ 2013 census was used. The URI and NZDepdata (obtained from Otago University) provides measures mapped to meshblock(the smallest statistical area in NZ of ~80-100 people). Meshblocks are not directly mappable to NZ postcodes. To map to postcode geospatial data containing postcode and meshblock for each address in NZ was used (obtained from Koordinates). Meshblocks that crossed over postcodes were assigned the postcode with the most addresses. Postcode level data was obtained by weighting the data by the meshblock population – within each postcode the URI with the highest population and the median NZDep were identified and assigned to the postcode.
12
29/11/2018
7
GEOGRAPHIC LOCATION
• Australia: The ASGC-RA classifies postcodes into geographically similar categories, depending on the ‘remoteness’ of the area.– Major Cities of Australia
– Inner Regional Australia
– Outer Regional Australia
– Remote Australia
– Very Remote Australia
• New Zealand: The URI classifies meshblocks into geographically similar categories, based on measures of rurality. – Main Urban Area (population of 30,000 or more, e.g. cities)
– Secondary Urban Area (population of 10,000 to 29,999)
– Minor Urban Area (population of 1,000 to 9,999 )
– Rural Centre (population of 300 to 999 people)
– Other Rural
– Other (Inland Water, Inlet and Oceanic) 13
GEOGRAPHIC LOCATION
14
29/11/2018
8
WHERE ARE REHABILITATION SERVICES LOCATED
IN AUSTRALIA AND NEW ZEALAND
15AROC DATA, financial year 2018
0%
10%
20%
30%
40%
50%
60%
70%
80%
Major Cities ofAustralia /
NZ Main urbanare
Inner RegionalAustralia /
NZ Secondaryurban area
Outer RegionalAustralia /
NZ Minor urbanarea
Remote Australia/
NZ Rural Centre
Very RemoteAustralia /
NZ Other rural
Pro
po
rtio
n o
f se
rvic
es
Australia (n=252) New Zealand (n=39)Inpatient facilities:
0
10
20
30
40
50
60
70
80
90
100
Major Cities ofAustralia
Inner RegionalAustralia
Outer RegionalAustralia
RemoteAustralia
Very RemoteAustralia
Nu
mb
er
of
serv
ice
s
Australia Public (n=128) Australia Private (n=124)Inpatient facilities:
AU and NZ AU Public & Private
WHERE ARE REHABILITATION BEDS LOCATED
IN AUSTRALIA AND NEW ZEALAND
16AROC DATA, financial year 2018
0%
10%
20%
30%
40%
50%
60%
70%
80%
Major Cities ofAustralia /
NZ Main urbanare
Inner RegionalAustralia /
NZ Secondaryurban area
Outer RegionalAustralia /
NZ Minor urbanarea
RemoteAustralia /
NZ Rural Centre
Very RemoteAustralia /
NZ Other rural
Pro
po
rtio
n o
f b
ed
s
Australia (n=7,430) New Zealand (n=1,076)Inpatient rehab beds:
0
500
1,000
1,500
2,000
2,500
3,000
3,500
Major Cities ofAustralia
Inner RegionalAustralia
Outer RegionalAustralia
RemoteAustralia
Very RemoteAustralia
Nu
mb
er
of
be
ds
Australia Public (n=3,658) Australia Private (n=3,772)Inpatient rehab beds:
AU and NZ AU Public & Private
29/11/2018
9
WHERE DO PATIENTS RECEIVING REHABILITATION
LIVE IN AUSTRALIA AND NEW ZEALAND
17
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Major Cities ofAustralia / NZ
Main urban are
Inner RegionalAustralia / NZ
Secondaryurban area
Outer RegionalAustralia / NZMinor urban
area
RemoteAustralia / NZRural Centre
Very RemoteAustralia / NZ
Other rural
Pro
po
rtio
n o
f e
pis
od
es
AU (n=126,318) NZ (n=11,537)
AROC DATA, financial year 2018
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Major Cities ofAustralia
Inner RegionalAustralia
Outer RegionalAustralia
RemoteAustralia
Very RemoteAustralia
Pro
po
rtio
n o
f e
pis
od
es
Public (n=49,158) Private (n=77,160)
AU and NZ AU Public & Private
DO PATIENTS LIVE WHERE INPATIENT
REHABILITATION SERVICES ARE LOCATED
18
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Major Cities ofAustralia
(n=105,685)
Inner RegionalAustralia
(n=17,028)
Outer RegionalAustralia(n=2,872)
Remote Australia(n=80)
Very RemoteAustralia (n=2)
Australian facilities (episodes in 2018 = 125,667)
Pro
po
rtio
n o
f ep
iso
des
Major Cities of Australia Inner Regional Australia Outer Regional AustraliaRemote Australia Very Remote Australia
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NZ Main urbanarea (n=8,809)
NZ Secondaryurban area(n=1,070)
NZ Minor urbanarea (n=652)
NZ Rural Centre(n=0)
NZ Other rural(n=971)
New Zealand facilities (episodes in 2018 = 11,502)
Pro
po
rtio
n o
f ep
iso
des
NZ Main urban area NZ Secondary urban area NZ Minor urban areaNZ Rural Centre NZ Other rural
AROC DATA, financial year 2018
29/11/2018
10
VARIATION IN WHERE PATIENTS LIVE BY IMPAIRMENT
19
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Stro
ke (
n=9
,74
3)
Bra
in (
n=3
,11
3)
Neu
ro (
n=4
,447
)
Spin
e (n
=1,0
01)
Am
put
ee (
n=1
,450
)
Art
hrit
its
(n=3
90
)
Pai
n (n
=4,7
17
)
Ort
ho
fra
ctur
e (n
=19,
596
)
Ort
ho
rep
lace
men
t (n
=30,
874
)
Soft
tis
sue
inju
ry (
n=1
,548
)
Oth
er o
rth
o (n
=8,1
85)
Car
diac
(n
=3,9
01)
Pulm
ona
ry (
n=2
,51
6)
Oth
er (
n=8
47)
Mu
ltTr
aum
a (n
=1,1
50)
Re-
cond
itio
nin
g (n
=32
,72
9)
Stro
ke (
n=1
,84
4)
Bra
in (
n=4
14)
Neu
ro (
n=2
14)
Spin
e (n
=201
)
Am
put
ee (
n=1
71)
Art
hrit
its
(n=4
0)
Pai
n (n
=21
4)
Ort
ho
fra
ctur
e (n
=3,8
34)
Ort
ho
rep
lace
men
t (n
=23
4)
Soft
tis
sue
inju
ry (
n=39
1)
Oth
er o
rth
o (
n=1
33)
Car
diac
(n
=10
9)
Pulm
ona
ry (
n=6
9)
Oth
er (
n=2
72)
Mu
ltTr
aum
a (n
=44
)
Re-
cond
itio
nin
g (n
=3,3
34
)
Australia New Zealand
Pro
po
rtio
n o
f e
pis
od
es
Major Cities of Australia Inner Regional Australia Outer Regional Australia Remote Australia Very Remote AustraliaNZ Main urban area NZ Secondary urban area NZ Minor urban area NZ Rural Centre NZ Other rural
AROC DATA, financial year 2018
IMPACT OF GEOGRAPHIC LOCATION ON LENGTH OF STAY
20
0
5
10
15
20
25
30
35
Maj
or C
itie
s o
f A
ustr
alia
Inn
er R
egio
nal
Aus
tral
ia
Ou
ter
Reg
ion
al A
ustr
alia
Rem
ote
Aus
tral
ia
Ver
y R
emot
e A
ustr
alia
NZ
Mai
n u
rban
are
a
NZ
Seco
ndar
y u
rban
are
a
NZ
Min
or u
rban
are
a
NZ
Ru
ral C
ent
re
NZ
Oth
er r
ura
l
2009 2014 2018
Ave
rag
e L
OS
(days
)
AROC DATA, financial years 2009, 2014, 2018
0
5
10
15
20
25
30
35
Maj
or
Cit
ies
of
Aus
tral
ia
Inn
er R
egio
nal
Aus
tral
ia
Ou
ter
Reg
ion
al A
ustr
alia
Rem
ote
Aus
tral
ia
Ver
y R
emo
te A
ustr
alia
Maj
or
Cit
ies
of
Aus
tral
ia
Inn
er R
egio
nal
Aus
tral
ia
Ou
ter
Reg
ion
al A
ustr
alia
Rem
ote
Aus
tral
ia
Ver
y R
emo
te A
ustr
alia
Treated at a public hospital Treated at a private hospital
29/11/2018
11
IMPACT OF GEOGRAPHIC LOCATION ON
CHANGE IN FUNCTION
21
0
5
10
15
20
25
30
Maj
or
Cit
ies
of
Au
stra
lia
Inn
er R
egio
nal
Au
stra
lia
Ou
ter
Re
gio
nal
Au
stra
lia
Rem
ote
Au
stra
lia
Ve
ry R
emo
te A
ust
ralia
NZ
Mai
n u
rban
are
a
NZ
Seco
nd
ary
urb
an a
rea
NZ
Min
or
urb
an a
rea
NZ
Ru
ral C
entr
e
NZ
Oth
er
rura
l
2009 2014 2018
0
5
10
15
20
25
30
Maj
or
Cit
ies
of
Au
stra
lia
Inn
er R
egio
nal
Au
stra
lia
Ou
ter
Re
gio
nal
Au
stra
lia
Rem
ote
Au
stra
lia
Ver
y R
emo
te A
ust
ralia
Maj
or
Cit
ies
of
Au
stra
lia
Inn
er R
egio
nal
Au
stra
lia
Ou
ter
Re
gio
nal
Au
stra
lia
Rem
ote
Au
stra
lia
Ver
y R
emo
te A
ust
ralia
Treated at a public hospital Treated at a private hospital
Ave
rag
e F
IM c
hange (
poin
ts)
AROC DATA, financial years 2009, 2014, 2018
SOCIO-ECONOMIC DISADVANTAGE
• Deprivation is a state of observable and demonstrable disadvantage relative to the local community or the wider society or nation to which an individual, family or group belongs (Townsend, 1987).
• Index interpretation: the lower the SEIFA and NZDep index scores the more disadvantaged an area.
• The SEIFA and NZDep scores from all postcodes were divided into population based quintiles to enable comparative analysis. – The quintiles represent five socioeconomic levels from low (most disadvantaged) through to high (least
disadvantaged), with each quintile representing approximately 20% of their national populationi.e. 20% of the population live in the lowest socioeconomic postcodes and 20% in the highest.
• Patients were assigned a socioeconomic category based on their postcode.
22
29/11/2018
12
REHABILITATION SERVICES IN AUSTRALIA AND
NEW ZEALAND BY LEVEL OF SOCIAL DISADVANTAGE
23AROC DATA, financial year 2018
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
AU (n=252) NZ (n=39) POPULATION Public (n=128) Private (n=124)
Pro
po
rtio
n o
f se
rvic
es
High
4
Medium
2
Low(most disadvantaged)
(least disadvantaged)
SOCIAL DISADVANTAGE OF PATIENTS RECEIVING
REHABILITATION AUSTRALIA AND NEW ZEALAND
24AROC DATA, financial year 2018
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Australia (n=126,300) New Zealand (n=11,537) POPULATION Public (n=49,146) Private (n=77,154)
Country Australia
Pro
po
rtio
n o
f e
pis
od
es
High
4
Medium
2
Low(most disadvantaged)
(least disadvantaged)
29/11/2018
13
VARIATION IN LEVEL OF SOCIAL DISADVANTAGE
BY IMPAIRMENT
25
0%
20%
40%
60%
80%
100%
Stro
ke (n
=9,7
43)
Bra
in (n
=3,1
13
)
Neu
ro (
n=4
,44
7)
Spin
e (n
=1,0
01)
Am
pu
tee
(n=1
,450
)
Art
hri
tits
(n
=390
)
Pai
n (
n=4
,717
)
Ort
ho
fra
ctu
re (
n=1
9,5
96)
Ort
ho
re
pla
cem
ent
(n=3
0,8
74
)
Soft
tis
sue
inju
ry (
n=1
,548
)
Oth
er o
rth
o (
n=8
,18
5)
Car
dia
c (n
=3,9
01)
Pu
lmo
nar
y (n
=2,5
16)
Oth
er (
n=8
47)
Mu
ltTr
aum
a (n
=1,1
50
)
Re-
con
dit
ion
ing
(n=3
2,72
9)
Stro
ke (n
=1,8
44)
Bra
in (n
=414
)
Neu
ro (
n=2
14)
Spin
e (n
=201
)
Am
pu
tee
(n=1
71
)
Art
hri
tits
(n
=40)
Pai
n (
n=2
14)
Ort
ho
fra
ctu
re (
n=3
,83
4)
Ort
ho
rep
lace
men
t (n
=234
)
Soft
tis
sue
inju
ry (
n=3
91)
Oth
er o
rth
o (
n=1
33)
Car
dia
c (n
=10
9)
Pu
lmo
nar
y (n
=69)
Oth
er (
n=2
72)
Mu
ltTr
aum
a (n
=44)
Re-
con
dit
ion
ing
(n=3
,33
4)
Australia New Zealand
Pro
po
rtio
n o
f e
pis
od
es
High
4
Medium
2
Low
AROC DATA, financial year 2018
(most disadvantaged)
(least disadvantaged)
IMPACT OF SOCIAL DISADVANTAGE ON LENGTH OF STAY
26
0
5
10
15
20
25
30
Low 2 Medium 4 High Low 2 Medium 4 High
Australia New Zealand
2009 2014 2018
AROC DATA, financial years 2009, 2014, 2018
0
5
10
15
20
25
30
Low 2 Medium 4 High Low 2 Medium 4 High
Treated at a public hospital Treated at a private hospital
Ave
rag
e L
OS
(days
)
(most (least
disadvantaged) disadvantaged)
(most (least
disadvantaged) disadvantaged)(most (least
disadvantaged) disadvantaged)
(most (least
disadvantaged) disadvantaged)
29/11/2018
14
IMPACT OF SOCIAL DISADVANTAGE ON
CHANGE IN FUNCTION
27
0
5
10
15
20
25
Low 2 Medium 4 High Low 2 Medium 4 High
Australia New Zealand
2009 2014 2018
0
5
10
15
20
25
Low 2 Medium 4 High Low 2 Medium 4 High
Treated at a public hospital Treated at a private hospital
AROC DATA, financial years 2009, 2014, 2018
Ave
rag
e F
IM c
hange (
poin
ts)
(most (least
disadvantaged) disadvantaged)
(most (least
disadvantaged) disadvantaged)(most (least
disadvantaged) disadvantaged)
(most (least
disadvantaged) disadvantaged)
DISTANCE PATIENT HAS TO TRAVEL
• Distance between the patient’s home and the facility where they received rehabilitation was estimated using the geographical locators of longitude and latitude. – for both Australia and New Zealand longitude and latitude of postcodes were
obtained from AGGDATA (www.aggdata.com). Any postcodes missing longitude and latitude were then obtained using DISTANCESTO.COM (www.distancesto.com … Find Coordinates).
• Straight line distance between the centre points of each pair of postcodes was used as an approximation of the distance.
• We acknowledge that the straight-line distance is likely to be underestimate of the patient’s actual travel distance however it was considered a suitable approximation.
28
29/11/2018
15
HOW FAR DO PATIENTS RECEIVING REHABILITATION
NEED TO TRAVEL IN AUSTRALIA AND NEW ZEALAND
29AROC DATA, financial year 2018
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Australia (n=56,653) New Zealand (n=136) Public hospital (n=17,993) Private hospital (n=38,660)
Country Australia
Pro
po
rtio
n o
f e
pis
od
es
more than 250km
up to 250km
up to100km
up to 50km
up to 30km
up to 20km
up to 15km
up to 10km
up to 5km
same postcode
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Stro
ke (
n=9
,66
7)
Bra
in (n
=3,1
02)
Neu
ro (
n=4
,407
)
Spin
e (n
=993
)
Am
pu
tee
(n=1
,44
7)
Art
hri
tits
(n=3
87
)
Pai
n (
n=4
,692
)
Ort
ho
fra
ctu
re (
n=1
9,4
70)
Ort
ho
rep
lace
men
t (n
=30,
742)
Soft
tis
sue
inju
ry (
n=1
,539
)
Oth
er o
rth
o (
n=8
,147
)
Car
dia
c (n
=3,8
80
)
Pu
lmo
nar
y (n
=2,5
03)
Oth
er (
n=8
42)
Mu
ltTr
au
ma
(n=1
,142
)
Re-
con
dit
ion
ing
(n=3
2,3
63
)
Stro
ke (
n=1
,88
4)
Bra
in (n
=42
7)
Neu
ro (
n=2
19)
Spin
e (n
=203
)
Am
pu
tee
(n=1
72)
Art
hri
tits
(n=4
1)
Pai
n (
n=2
19)
Ort
ho
fra
ctu
re (
n=3
,911
)
Ort
ho
re
pla
cem
ent
(n=2
37)
Soft
tis
sue
inju
ry (
n=4
00)
Oth
er o
rth
o (
n=1
38)
Car
dia
c (n
=11
0)
Pu
lmo
nar
y (n
=70
)
Oth
er (
n=2
76)
Mu
ltTr
aum
a (n
=45
)
Re-
con
dit
ion
ing
(n=3
,44
0)
Australia New Zealand
Pro
po
rtio
n o
f e
pis
od
es
more than 250km
up to 250km
up to100km
up to 50km
up to 30km
up to 20km
up to 15km
up to 10km
up to 5km
same postcode
VARIATION IN PATIENT TRAVEL DISTANCE BY IMPAIRMENT
30AROC DATA, financial year 2018
29/11/2018
16
PATIENT TRAVEL DISTANCES BY GEOGRAPHIC
LOCATION OF THE PATIENT AND COUNTRY
31AROC DATA, financial year 2018
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Major Citiesof Australia(n=95,339)
InnerRegionalAustralia
(n=22,245)
OuterRegionalAustralia(n=6,868)
RemoteAustralia(n=608)
Very RemoteAustralia(n=372)
NZ Mainurban area(n=8,435)
NZ Secondaryurban area(n=1,085)
NZ Minorurban area(n=1,160)
NZ RuralCentre(n=129)
NZ Otherrural (n=693)
Australia New Zealand
Pro
po
rtio
n o
f e
pis
od
es
more than 250km
up to 250km
up to100km
up to 50km
up to 30km
up to 20km
up to 15km
up to 10km
up to 5km
same postcode
PATIENT TRAVEL DISTANCES BY GEOGRAPHIC
LOCATION OF THE REHABILITATION SERVICE & COUNTRY
32AROC DATA, financial year 2018
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Major Cities ofAustralia
(n=105,507)
Inner RegionalAustralia
(n=16,996)
Outer RegionalAustralia(n=2,851)
Remote andVery Remote
Australia (n=82)
NZ Main urbanarea (n=8,904)
NZ Secondaryurban area(n=1,281)
NZ Minor urbanarea (N=653)
NZ Other rural(n=972)
Location of facility in Australia Location of facility in New Zealand
Pro
po
rtio
n o
f e
pis
od
es
more than 250km
up to 250km
up to100km
up to 50km
up to 30km
up to 20km
up to 15km
up to 10km
up to 5km
same postcode
29/11/2018
17
PATIENT TRAVEL DISTANCES BY LEVEL OF SOCIAL
DISADVANTAGE BY COUNTRY
33AROC DATA, financial year 2018
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Low(n=17,254)
2 (n=20,860) Medium(n=24,683)
4 (n=24,983) High(n=37,643)
Low(n=1,877)
2 (n=2,599) Medium(n=2,609)
4 (n=2,323) High(n=2,094)
Australia New Zealand
Pro
po
rtio
n o
f e
pis
od
es
more than 250km
up to 250km
up to100km
up to 50km
up to 30km
up to 20km
up to 15km
up to 10km
up to 5km
same postcode
(most (least
disadvantaged) disadvantaged)(most (least
disadvantaged) disadvantaged)
IN SUMMARY
• Patients mostly go to their local inpatient rehab unit
– SCI, BI and MMT patients travel further
• Patients attending rehabilitation are equally represented across all levels of socioeconomic backgrounds in NZ
– Australia has slightly more patients from less disadvantaged areas
• The more disadvantaged and the more remote an area is
– the greater the distance travelled to attend rehab
– the longer the length of stay
34
29/11/2018
18
AROC IN ACTION: BENDIGO HEALTH CRITICAL CARE
DATATHON (SEPTEMBER 2018)
35
AROC IN ACTION:BENDIGO HEALTH CRITICAL CARE DATATHON (SEPT’18)• First datathon covering the full patient journey — ED
admission to ICU to recovery in rehabilitation to community
– 140 Million records (Victorian public services only)
– patient linked data across 7 sources
• Data custodians agreed on anonymization rules before linkage
– most demographic information removed or rolled up (eg. age groups)
– all facility information removed
• Data linkage: Centre for Victorian Data Linkage (CVDL)
36
29/11/2018
19
AROC IN ACTION:BENDIGO HEALTH CRITICAL CARE DATATHON (SEPT’18)• AROC data
– 10 years of Victorian public services data (~170,000 episodes)
• Linked with– Dept. Health and Human Services Victoria
• VEMD (Emergency Department)• VINAH (Non-Admitted)• VAED (Admitted)• VCR (Victorian Cancer Registry)• HACC (Home and Community Care)
– ANZICS: Australia New Zealand Intensive Care Society• reported by contributing ICUs for benchmarking
37
AROC IN ACTION:BENDIGO HEALTH CRITICAL CARE DATATHON (SEPT’18)
• 18 teams looked at different topics, for example– Team CARDIAC ARREST looked at What happened next for the 52.1% of
patients that presented to ICU following a cardiac arrest and survived
– As intensivists, they wanted to know how many of their patients went on to have rehabilitation and what their outcomes looked like
– They were very surprised to learn most patients going on to rehabilitation showed improved function, were able to return home and very few die – this was an unexpected finding for them
– This team learnt just how beneficial rehabilitation is
38
29/11/2018
20
AROC IN ACTION:BENDIGO HEALTH CRITICAL CARE DATATHON (SEPT’18)
39
AROC CONTACT DETAILS
Australasian Rehabilitation Outcomes Centre (AROC)
Australian Health Services Research Institute (AHSRI)
iC Enterprise 1, Innovation Campus
University of Wollongong NSW 2522
Phone: +61 2 4221 4411
Email: aroc@uow.edu.au
Web: aroc.org.au
40
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