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DHB non-financial monitoring framework and performance measures 2016/17

2016/17

DHB non-financial monitoring framework and

performance measures

Update as at Sept 2016

Updates included February 2016

PP20: Improved management for long term conditions (CVD, Acute heart health, Diabetes, and Stroke) -Update to indicator title to include reference to acute heart health. Focus area 2 removal of reference to diabetes annual reviews. Focus area 3 inclusion of specific sub measure titled Indicator 2: Percentage of ‘eligible Māori men in the PHO aged 35-44 years’ who have had a CVD risk recorded within the past five years. Focus area 4 inclusion of reference to ANZACS-QI.

PP27: Supporting Vulnerable Children – change to indicator title, greater clarification provided in deliverable definition to clarify differences in expectations for DHBs with Children’s Teams versus other DHBs

PP29: Improving waiting times for diagnostic services - targets now included

SI4: Elective Services Standardised Intervention Rates - targets now included

OS8: Acute readmissions to hospital - clarification it is anticipated that the acute readmissions model will be begin to be implemented with data sharing in quarters one and two of 2016/17 and with more formal reporting by DHBs for quarters three and four of 2016/17.

Updates included April 2016

System Level Measures

The following System Level Measures (SLM) are introduced in 2016/17 (refer to page 3 for further details)ambulatory sensitive hospitalisations (ASH) rates for zero to four year olds – this SLM is included in existing measure SI1

new measure SI7 SLM total acute hospital bed days per capita – new measure SI8 SLM patient experience of care - combines the current DHB

hospital focused measure (DV4) with an additional section referencing primary care patient experience

new measure SI9 SLM amenable mortality rate new measure DV6 SLM youth access to and utilisation of youth appropriate health

services - developmental1


new measure DV7 SLM number of babies who live in a smoke-free household at six weeks post natal – developmental.

PP22 Delivery of actions to improve system integration –

This measure has been adjusted to include a requirement for jointly agreed (by district alliances) System Level Measure improvement plans, including improvement milestones, to be submitted to the Ministry as part of quarter one reports 2016/17. Assessment, and negotiations with DHBs as necessary, and approval of the improvement plans including improvement milestones by the Ministry will occur in quarter two 2016/17.

PP23: Improving Wrap Around Services – Health of Older People

Inclusion of additional deliverable re system integration, further detail re expectations of regional work in relation to dementia pathways, changes to falls and fracture prevention rehabilitation definition

SI6: IPIF Healthy Adult - Cervical Screening is removed as part of the changes made to include System Level Measures

OS10: Improving the quality of identity data within the National Health Index (NHI) and data submitted to National Collections -

Updates to definitions and achievement ratings for indicator 3 Focus area 2 (Assessment of data reported to the National Minimum Data Set (NMDS))

Updates included June 2016

SI1 ambulatory sensitive hospitalisations (ASH) – further clarification included regarding target setting in relation to the application the measure as an SLM and references in Annual Plans and Maori Health Plans.

PP28 Reducing Rheumatic fever – clarification that reporting for focus area 2 is expected to cover both cases of first episode and recurrent acute rheumatic fever.

Updates included Sept 2016 HS - Supporting delivery of the New Zealand Health Strategy (New deliverable) Each DHB is asked to provide one brief example (single dot point) per strategy theme each quarter, to highlight an action, initiative or activity delivered in the quarter. These highlights will be included on the DHB quarterly dashboards for sharing with the Minister.

PP26 - Rising to the Challenge update to deliverable re DHB Suicide prevention and postvention plans

PP28 - Reducing Rheumatic fever - Three new templates included - These templates replace all other reporting templates you may have used previously for PP28, CFA variation and CMS reporting and will be used for reporting against your contracts with the Ministry of Health as well as on progress in implementing your Rheumatic Fever Prevention Plans. This change means DHBs are no longer required to submit monthly reports.

DV4 text was missing from June version - update to replace (no change to previous requirements)

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2016/17 DHB non-financial monitoring framework Overview of changes to the measures proposed in the DHB monitoring framework for 2016/17 compared to 2015/16

Changes as signalled in DHB planning advice issued in December 2015 One measure included in the 2015/16 framework (PP24 Improving Waiting Times – Cancer

Multidisciplinary Meetings) has been removed in 2016/17.

Both the previous More heart and diabetes checks health target, and the hospital component of the Better help for smokers to quit health target have been incorporated into the accountability measures for 2016/17. The previous’ More heart and diabetes checks’ target has been incorporated into the existing PP20 measure, and a new measure (PP31) has been created for the Hospital component of the ‘Better help for smokers to quit health target’.

Four existing measures have new deliverables included as indicated in the overview table below. (PP20, PP26, PP28, SI2)

Two measures, SI1 Ambulatory sensitive (avoidable) hospital admissions and OS 8 Acute readmissions to hospital, have undergone significant review of their definitions with sector input. As at December 2015 the revision to the ASH measure have been finalised and are included in document. The revisions to the Acute readmissions measure will be made available as definitions are confirmed.

Update to include System Level Measures - May 2016

The Ministry has been working closely with the sector to co-develop a suite of System Level Measures that provide a system wide view of performance. These measures have evolved from an initial list of over 100 measures. The new measures engage the health sector more broadly (professions, settings and health conditions) than the previous measures.

The performance of individual clinicians and/or provider organisations, through health activities and processes, are measured by contributory measures. These individual groups must work as one team to improve system level performance. The System Level Measures for introduction in 2016/17 also resonate with the care closer to home, people powered and smart system themes of the Strategy.

The System Level Measures rely on the contribution of a wider group of providers. 2016/17 focuses on the contributions and performance of DHBs and PHOs. The contribution of the wider groups will be implemented over the next 18 months as the Ministry and the DHBs include System Level Measures in a wider range of contracts.

The four new System Level Measures to be implemented from 1 July 2016 are:

Ambulatory Sensitive Hospitalisation (ASH) rates per 100,000 for 0 – 4 year olds (ie Keeping children out of the hospital)

Acute hospital bed days per capita (ie Using health resources effectively) Patient experience of care (ie Person centred care) Amenable Mortality rates (ie Prevention and early detection)

The following two System Level Measures will be developed during 2016/17 including definitions and identification of data sets:

Number of babies who live in a smoke free household at six weeks post natal (ie Healthy

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start) Youth access to and utilisation of youth appropriate health services (ie Teens make good

choices about their health and wellbeing).

System Level Measures have nationally consistent definitions and will be reported nationally. Contributory measures will have nationally consistent definitions and data sets but will be selected locally and do not need to be reported nationally.

More information about system level and contributory measures is available from the Health Quality Measures Library from 30 May 2016 (www.hqmnz.org.nz). A measures guidance document explaining the concept of system level and contributory measures and how they can be selected and used will also be available on this site.

Three of these new measures - acute hospital bed days, preventable hospitalisation rates and patient experience of care - will be financially incentivised in 2016/17, along with the two existing primary care national health targets (better help for smokers to quit and increased immunisation).

Implementation

PHOs, District Health Boards (DHBs) and district alliance leadership teams will drive implementation of the new measures.

In their 2016/17 Annual Plans, DHBs are expected to commit to providing an Improvement Plan. The plan will be developed with and agreed by their PHOs and district alliance(s). It will be provided to the Ministry at the end of quarter one 2016/17 through the existing measure PP22 Improving system integration.

The Improvement Plan will include: Improvement milestones for the four System Level Measures (total acute hospital bed days,

ASH rates for 0 – 4 year olds, patient experience of care and amenable mortality) Contributory measures for each of the four System Level Measures District alliance stakeholder agreement of the Improvement Plan. All stakeholders

responsible for activities in the plan (DHB and PHOs at a minimum) must sign the submitted plan. This indicates stakeholder agreement with the plan, the improvement milestones and the contributory measures.

The Ministry will assess Improvement Plans by 30 November 2016. The 50 percent capacity and capability payment will be paid out to PHOs on approval of the plan.

All alliances are expected to have a more detailed local improvement plan which articulates how the districts will achieve their improvement milestones. The local improvement plan, which does not have to be submitted nationally but will be made available to the Ministry on request, is expected to include:

Specific activities, including those by the DHB (for example emergency department, outpatient clinic and medical ward service reconfiguration) and the PHO, to meet both the improvement milestones for the System Level Measures and the quantitative end-of-year goals for the selected contributory measures

An investment logic that includes the activities described above A local reporting and accountability framework for all participants.

Further information on development of the plans is available in the DHB Annual Planning Guidance on the National Service Framework Library (http://nsfl.health.govt.nz/).

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Overview – DHB heath targets 2016/17 to be confirmed following the Minister’s letter of expectations

Health target Target goalShorter stays in Emergency Departments

95 percent of patients will be admitted, discharged, or transferred from an Emergency Department (ED) within six hours.

Improved access to elective surgery

The volume of elective surgery will be increased by an average of 4,000 discharges per year.

Faster cancer treatment 85 percent of patients to receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016, increasing to 90 percent by June 2017.

Increased immunisation 95 percent of eight months olds will have their primary course of immunisation (six weeks, three months and five months immunisation events) on time.

Better help for smokers to quit 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months

95 percent of hospital patients who smoke and are seen by a health practitioner in a public hospital are offered brief advice and support to quit smoking

90 percent of pregnant women who identify as smokers upon registration with a DHB-employed midwife or Lead Maternity Carer are offered brief advice and support to quit smoking

Childhood obesity target(Title of target tbc)

By December 2017, 95 percent of obese children identified in the Before School Check (B4SC) programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions.

Change key - changes to DHB performance measures compared to 2015/16No significant changeChanges made to deliverables/expectations – yet to be confirmed15/16 measure signalled for removal in 16/17additional deliverables included within existing measureNew measure included for 16/17

Overview – DHB performance measures 2016/17 Measure changes compared to 2015/16

HS Supporting delivery of the New Zealand Health Strategy

New deliverable

PP6 Improving the health status of people with severe mental illness through improved access

Employment aspects of PP7 measure removed as this information will be reported to PRIMHD from 1 July 2016

PP7 Improving mental health services using transition (discharge) planning and employment

PP8 Shorter waits for non-urgent mental health and addiction services

PP10 Oral health: Mean DMFT score at year 8 No change

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PP11 Children caries free at 5 years of age No change

PP12 Utilisation of DHB funded dental services by adolescents from School Year 9 up to and including 17 years

No change

PP13 Improving the number of children enrolled in DHB funded dental services

No change

PP20 Improved management for long term conditions (CVD, Acute heart health, Diabetes, and Stroke)

Previous more heart and diabetes check health target included

Additional stroke measure included - 80 percent of patients admitted with acute stroke who are transferred to inpatient rehabilitation services are transferred within 7 days of acute admission (also report % of acute stroke patients transferred to inpatient rehab)update to indicator title to include reference to acute heart health, focus area 2 removal of reference to diabetes annual reviews, focus area 3 inclusion of specific sub measure titled Indicator 2: Percentage of ‘eligible Māori men in the PHO aged 35-44 years’ who have had a CVD risk recorded within the past five years. Focus area 4 inclusion of reference to ANZACS-QI.

PP21 Immunisation coverage at 2 years of age (IPIF Healthy Start) and 5 years of age, and immunisation coverage for human papilloma virus (HPV)

No significant change - updated progressive targets, and definitions refined

PP22 Delivery of actions to improve system integration and SLMs

This measure has been adjusted to include a requirement for jointly agreed (by district alliances) System Level Measure improvement plans, including improvement milestones, to be submitted to the Ministry at the end of quarter one 2016/17. Assessment, and negotiations with DHBs as necessary, and approval of the improvement plans including improvement milestones (and baselines) by the Ministry will occur in quarter two 2016/17.

PP23 Delivery of actions to improve Wrap Around Services for Older People

PP24 Improving Waiting Times – Cancer Multidisciplinary Meetings

Measure removed

PP25 Delivery of the Prime Minister’s youth mental health initiative

No change

PP26 Rising to the Challenge: The Mental Health and Addiction Service Development Plan

Rising to the Challenge (PP26) three new focus areas (NB - the number of actions required to be reported under this measure has significantly reduced since 2012/13):

DHB Suicide prevention and postvention plans Reducing the rate of Maori on section 29

community treatment orders - this has been a requirement in Maori health plans for the past

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2 years

Improving crisis response services in relation to police involvement - this is the result of significant Police/ Health discussions

PP27 Supporting Vulnerable Children Change to indicator title, greater clarification provided in deliverable definition to clarify differences in expectations for DHBs with Children’s Teams versus other DHBs

PP28 Reducing Rheumatic fever Update to targets and addition of confirmation and exception reports re effective Follow-up of identified rheumatic fever casesSept 16 updated to confirm consolidation of reporting templates previously supplied through a combination of PP28, CFA variation and CMS processes.

PP29 Improving waiting times for diagnostic services No change – targets confirmed in Feb 16 update

PP30 Part A: Faster cancer treatment– 31 day indicator

No change

Part B: Shorter waits for cancer treatment – radiotherapy and chemotherapy

PP31 Better help for smokers to quit in public hospitals (previous health target)

New accountability measure for 16/17

Previous health target

SI1 Ambulatory sensitive hospitalisations (ASH) This measure underwent significant review in 2015/16- A revised measure is now in place.

ASH) rates for zero to four year olds was confirmed as a System Level Measure in the May 2016 update.

SI2 Ensuring delivery of Regional Service Plans Additional deliverables - In quarters two and four regions are expected to provide three new data elements in support the implementation of integrated hepatitis C assessment and treatment services.

SI3 Ensuring delivery of Service Coverage No changeSI4 Elective Services Standardised Intervention Rates Target Intervention rates

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confirmed in Feb 16 update

SI5 Delivery of Whānau ora In November 2015, the Whānau Ora Partnership Group agreed to a set of indicators to support Whānau Ora that form part of the Whānau Ora Outcomes Framework .SI 5 for 2016/17 has been adjusted to reflect that health sector activity will need to focus on progress in five key areas that contribute to Whānau Ora - mental health, asthma, oral health, obesity and tobacco.

SI6 IPIF Healthy Adult - Cervical Screening Removed in May 2016 update

SI7 SLM total acute hospital bed days per capita

New System Level Measure included in May 2016 update

SI8 SLM patient experience of care

New System Level Measure included in May 2016 update, that combines the previous developmental DHB hospital focused measure (DV4) with an additional section referencing primary care patient experience

SI9 SLM amenable mortalityNew System Level Measure included in May 2016 update

OS3 Inpatient length of stay Elective and acute ALOS targets to be confirmed in Feb 16 update.

OS8 Acute readmissions to hospital TBC - The measure is currently under review by a sector working group – changes are expected as a result of this process but are yet to be confirmed.

OS10 Improving the quality of identity data within the National Health Index (NHI) and data submitted to National Collections

Updates made to focus area 2Component of measure focused on PRIMHD data quality has been removed.

Output1 Output delivery against plan No change

DV 4 Improving consumer experience From the Match 2016 update a new measure has been included - SI8 SLM patient experience of care - combining the current DHB hospital focused measure (DV4) with an additional section referencing primary care patient experience

DV5 Childhood Obesity(health target development) Developmental measure discontinued with Health target live from 1 July 2016

DV6 SLM youth access to and utilisation of youth appropriate health services

New System Level developmental measure included in May 2016 update

DV7 SLM number of babies who live in a smoke-free household at six weeks post natal

New System Level Measure included in May 2016 update

.

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2016/17 DHB non-financial monitoring framework (excludes health target definitions – these are provided separately)ContentsOverview of the DHB monitoring framework.............................................................................................11Assessment Criteria/Ratings.................................................................................................................13

HS: Supporting delivery of the New Zealand Health Strategy............................................................14

Policy priorities PP6: Improving the health status of people with severe mental illness through improved access.....................................................................................................................................15Policy priorities PP7: Improving mental health services using transition (discharge) planning....19Policy priorities PP8: Shorter waits for non-urgent mental health and addiction services for 0-19 year olds...................................................................................................................................................23Policy priorities PP10: Oral Health- Mean DMFT score at Year 8.......................................................26Policy priorities PP11: Children caries-free at five years of age........................................................30Policy priorities PP12: Utilisation of DHB-funded dental services by adolescents from School Year 9 up to and including age 17 years...........................................................................................................34Policy priorities PP13: Improving the number of children enrolled in DHB funded dental services38Policy Priorities PP20: Improved management for long term conditions (CVD, Acute heart health, Diabetes, and Stroke)..............................................................................................................................43Policy Priorities PP21: Immunisation coverage (includes previous health target)..........................49Policy Priorities PP22: Improving system integration and SLMs.......................................................54Policy Priorities PP23: Improving Wrap Around Services – Health of Older People............................57Policy Priorities PP25: Prime Minister’s youth mental health project...............................................65Policy priorities PP26: Rising to the Challenge: The Mental Health and Addiction Service Development Plan...................................................................................................................................68Policy Priorities PP27: Supporting Vulnerable Children.....................................................................71Policy Priorities PP28: Reducing Rheumatic fever..............................................................................74Policy Priorities PP29: Improving waiting times for diagnostic services..........................................79Policy Priorities PP30: Faster cancer treatment.................................................................................83Policy Priorities PP31: Better help for smokers to quit in public hospitals (previous health target)..89

System Integration SI1: Ambulatory sensitive hospitalisations (ASH)..............................................92System Integration SI2: Delivery of Regional Service Plans..............................................................97System Integration SI3: Ensuring delivery of Service Coverage......................................................100System Integration SI4: Standardised Intervention Rates (SIRs).....................................................103System Integration SI5: Delivery of Whānau Ora...............................................................................112System Integration SI7: SLM total acute hospital bed days per capita...........................................116System Integration SI8: SLM patient experience of care..................................................................117System Integration SI9: SLM amenable mortality rate......................................................................121

Ownership OS3: Inpatient Average Length of Stay (ALOS)..............................................................122Ownership OS8: Reducing Acute Readmissions to Hospital..........................................................130Ownership OS10: Improving the quality of identity data within the National Health Index (NHI) and data submitted to National Collections...............................................................................................133

Output 1: Mental health output Delivery against Plan.......................................................................142

Developmental measures DV4: Improving patient experience.............................................................144Developmental measures DV6: SLM youth access to and utilisation of youth appropriate health services..................................................................................................................................................147Developmental measures DV7: SLM number of babies who live in a smoke-free household at six weeks post natal....................................................................................................................................147

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Appendix 1: NZ organised acute stroke service specifications and stroke rehabilitation service specifications (refer PP20)...................................................................................................................148

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Overview of the DHB monitoring framework

ContextThe DHB monitoring framework was developed recognising a DHB funding and operating environment where: • DHBs have responsibility for making decisions on the mix, level and quality of health and disability

services, within the parameters of the NZ Health and Disability Strategies and nationwide minimum service coverage and safety standards.

• The Ministry of Health, as agent of the Minister of Health, defines nationwide service coverage, safety standards and the operating environment. The Minister enters into funding agreements with DHBs, containing DHB specific agreed performance targets, and may exercise reserve powers in the case of repeated performance failures.

DHB non-financial monitoring arrangements operate within wider DHB accountability arrangements including legislative requirements, obligations formalised via Crown Funding Agreements and other contractual requirements, along with formal planning documents agreed with the Minister of Health/Minister of Finance.

The measures included within the DHB non-financial monitoring framework are intended to cover a specific set of markers of DHB performance in key areas, rather than all health services or DHB activity. Views and perspectives about what is most important to monitor, measure, and report for accountability purposes change over time with changing priorities. As a result the monitoring framework is updated periodically, and the measures that populate the framework are updated annually.

Within the Ministry of Health clinical and subject area experts are involved in all aspects of the monitoring work programme including: indicator design and definition; establishment of baselines; agreement of performance expectations; data supply and performance feedback; performance management and escalation of non-performance; reporting to Ministers and publication of results.

The Ministry of Health reviews the measures within the monitoring framework as part of the development of annual DHB planning advice. Working drafts are shared with DHBs for comment and feedback. If new measures are included in the framework, these measures must: incorporate intervention logic and a performance story linking the measure to sector outcomes provide clear and transparent deliverables including clearly defined numerators and denominators for

quantitative measures, with data sources clearly identified identify the actions DHB funders can take to influence performance, and activities DHBs can put in

place that have a proven impact on the measure identify the required detail and frequency of reporting identify clear performance expectations, including what constitutes achievement, partial achievement

and non-achievement of the measure.

The burden of reporting is also an important consideration. New measures need to be strongly justified before they are included in the framework, existing measures are generally required to be removed to make way for new measures and minimise indicator creep over time.

DHBs formally agree to deliver on the performance expectations associated with the measures in the DHB monitoring framework through DHB Annual Plans. Each individual measure owner within the Ministry of Health reviews and approves performance expectation for their measures.

DHBs provide quarterly reports to the Ministry via a web based reporting tool. DHB performance against each target or measure is assessed by the Ministry measure owner/subject expert, and performance assessment and feedback is provided directly to DHBs via the web based reporting tool.

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Where DHBs do not meet performance expectations, based on the definitions outlined in this document, the Ministry measure owner/subject expert determines whether the DHB has:

Partially achieved i.e. some or all expected performance expectations/deliverables associated with the measure not met, however there is a an appropriate resolution plan

Not achieved i.e. the deliverable is not met and the DHB does not have an adequate resolution plan.

Where a ‘not achieved’ assessment is made, performance escalation is coordinated by DHB Relationship Managers and through formal monitoring and intervention processes where required. A monitoring and Intervention Framework is used by the Ministry to monitor and manage DHB performance, and provides for increasingly intensive levels of monitoring and, where necessary, intervention to ensure that issues relating to poor performance are addressed.

A dashboard style report is produced each quarter based on the performance assessments undertaken by the Ministry measure owner/subject. These reports summarise on one page performance for the quarter against key expectations agreed in accountability documents. The dashboards are used to report DHB performance to the Minister.

Overview of the monitoring frameworkThe current monitoring framework aims to provide the Minister with a rounded view of performance using a range of performance markers. Four dimensions are identified that reflect DHBs functions as owners, funders and providers of health and disability services. The four identified dimensions of DHB performance cover:• achieving Government’s priority goals/objectives and targets or ‘Policy priorities’ • meeting service coverage requirements and Supporting sector and inter-sector connectedness or

‘System Integration’

• providing quality services efficiently or ‘Ownership’

• purchasing the right mix and level of services within acceptable financial performance or ‘Outputs’’.

‘SLM‘ in the measure title indicates a measure is part of the ‘System Level Measures’ identified for 2016/17.

Code Dimension

PP Policy Priorities

SI System Integration

OP Outputs

OS Ownership

DV Developmental – Establishment of baseline (no target/performance expectation is set)

HS Progress update - highlights re delivery of the NZ Health Strategy (no target/performance expectation is set)

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Assessment Criteria/RatingsUnless otherwise stated in the definition of the performance measure, the following performance assessment criteria will apply:

Rating Abbrev 0Criteria

Outstanding performer/sector leader

O

1. This rating indicates that the DHB achieved a level of performance considerably better than the agreed DHB and/or sector expectations.

2. For those measures, included in the Maori health plan, this rating is applied when the DHB has met the target agreed in its Annual Plan and has achieved the target level of performance for the Maori population group, and the Pacific population group.

Note: this rating can only be applied in the fourth quarter for measures that are reported quarterly or six-monthly. Measures reported annually can receive an ‘O’ rating, irrespective of when the reporting is due.

Achieved

A

1. Deliverable demonstrates targets / expectations have been met in full.

2. In the case of deliverables with multiple requirements, all requirements are met.

3. For those measures, included in the Maori health plan, this rating is applied when the DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Maori population group, and the Pacific population group.

4. Data, or a report confirming expectations have been met, has been provided through a mechanism outside the Quarterly Reporting process, and the assessor can confirm.

Partial achievement

P

1. Target/expectation not fully met, (including not meeting expectations for Maori and Pacific population groups) but the resolution plan satisfies the assessor that the DHB is on track to compliance.

2. A deliverable has been received, but some clarification is required.

3. In the case of deliverables with multi-requirements, where all requirements have not been met at least 50% of the requirements have been achieved.

Not achieved– escalation required

N

1. The deliverable is not met.2. There is no resolution plan if deliverable indicates non-

compliance.3. A resolution plan is included, but it is significantly deficient.4. A report is provided, but it does not answer the criteria of the

performance indicator.5. There are significant gaps in delivery.6. It cannot be confirmed that data or a report has been provided

through channels other than the quarterly process.

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Performance Dimension: Progress update - highlights re delivery of the NZ Health Strategy

HS: Supporting delivery of the New Zealand Health Strategy

All DHBs made strong commitments to the New Zealand Health Strategy in their annual plans, linking local performance stories to the Strategy and its strategic themes. The following deliverable is included within DHB quarterly reporting with the intention of capturing brief snapshots of sector progress in delivery of the strategy.

Delivery of the New Zealand Health Strategy

Each DHB is asked to provide one brief example (single dot point) per strategy theme each quarter, to highlight an action, initiative or activity delivered in the quarter.

These highlights will be included on the DHB quarterly dashboards for sharing with the Minister (no performance assessment will be made).

Delivery of the NZ Health strategy – DHB highlights for the quarter

People-powered Closer to home Value and high performance One team Smart system

one example of an action, initiative or activity delivered in the quarter





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Performance Dimension: Achieving Government’s priorities and targets

Policy priorities PP6: Improving the health status of people with severe mental illness through improved accessEach DHB to report confirming access targets are met

Summary informationTarget/performance expectation

Agreed in DHB Annual Plan

Measure type and reporting frequency

Type: Data & exception

Reporting frequency: Six-monthly

Source information for reporting provided by:

Ministry to provide data via NSFL web site http://nsfl.health.govt.nz/accountability/performance-and-monitoringand the DHB quarterly reporting website

Quarterly reporting - standard timeline applies DHB Reports Due 20th of the month following the end of the quarter

Ministry Initial rating & feedback 8-10 working days from receiving reports

DHB Response due 5 working days from receiving initial ratings

Confirmed rating and feedback 4-5 working days from receiving DHB feedback

Link to outcomesDelivery of this measure supports the overarching outcome for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’ and contributes to whole of sector outcomes:

Improved health and equity for all populations (population focus)

Best value for public health system resources (system focus)

Improved quality, safety and experience of care (individuals and their family/focus).Through improving the health status of people with severe mental illness through improved access to a broad range of services, the DHB will contribute to the Ministerial priority of improving value for money by ensuring their mental health services and cost effective, results focused and have regard to the service impacts on people who are severely affected by mental illness. The DHB will provide people with better health and disability services by ensuring that the range of services closes existing service gaps, and making them easier to access.Better access to a broad range of services improves people’s mental health and wellbeing, and contributes to recovery which impacts on the intermediate outcome to promote and protect good health and independence of New Zealanders who experience mental illness.

The DHB’s range of services will be of high quality, safe, evidence based and provided in the least restrictive environment. This focus is designed to provide better outcomes for people with mental illness and increase people’s confidence and trust in the health and disability system and services.

There are a number of DHBs that have not met minimum access levels particularly for children and youth. Further, improved performance against this measure will support delivery of Rising to the Challenge, The

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Mental Health and Addiction Service Development Plan 2012-2017, the Prime Minister’s Youth Mental Health project, Vulnerable Children’s work stream and the Drivers of Crime initiatives. One of the Drivers of Crime initiatives is to improve access rates to youth alcohol and drug services and is supported by $2 million funding stream. Rising to the Challenge, The Mental Health and Addiction Service Development Plan 2012-2017 and the Youth Mental Health project have clear expectations that access rates for 12-19 year olds will increase mental health and addiction services while also reducing waiting times.

This measure has key linkages to 2016/17 Government planning priorities as highlighted:

2016/17 Government planning priorities Key Linkage identified

Ann

ual P

lan

prio

ritie

s Child and Youth HealthReducing Unintended Teenage Pregnancy (BPS Target)Increased Immunisation (Health Target & BPS Target)Children’s Action Plan (BPS Target)Social Sector TrialsRheumatic Fever (BPS Target)Prime Minister’s Youth Mental Health Project

Long Term Conditions – Prevention, Identification and ManagementHealthy Families NZObesity (Health Target)Living Well with DiabetesCardiovascular DiseaseTobacco (Health Target)Rising to the Challenge

yes

System IntegrationCancer (Health Target)Stroke ServicesCardiac ServicesHealth of Older PeopleShifting ServicesSystem Level MeasuresShorter Stays in Emergency Departments (Health Target)Whānau OraImproved Access to DiagnosticsImproved Access to Elective Surgery (Health Target)

Living Within our MeansLiving Within Our MeansNational Entity Priority InitiativesNZ Health Partnerships Ltd

OtherImproving QualityActions to Support Delivery of Regional Priorities

Reg

iona

l Ser

vice

Pl

an P

riorit

ies

ElectivesStroke ServicesCardiac ServicesHealth of Older PeopleMental Health and AddictionsHepatitis CMajor TraumaWorkforceInformation Technology

Actions and activities are that have a proven impact on this measure:Examples of key activities undertaken to support improved access rates are: development of CAMHS services across all regions, packages of care for individuals with high and complex needs, mental health specialists at emergency departments, Kaupapa Maori services, eating disorder services and older people’s needs to manage dementia, are met by setting up psycho geriatric care. Integration of primary and

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secondary services will result in improving access to a wider range of services and impact on the referrals to specialist mental health services.

Deliverables definitions

Numerator: (Data Source: Ministry of Health)The average number of people domiciled in the DHB region, seen per year rolling every three months being reported (the period is lagged by three months) for:

child and youth aged 0-19, specified for each of the three categories Māori, Other, and in total adults aged 20-64, specified for each of the three categories Māori, Other, and in total older people aged 65+, specified for each of the three categories Māori, Other, and in total.

Denominator: (Data Source: Ministry of Health)Projected population of the DHB region by age and ethnicity.

Interpreting Access RatesThere are at least four factors that can impact on making informed decisions regarding access rates both by DHB and nationally. These factors must be taken into consideration by all parties when negotiating targets. They are:

the more recovery-focused a service, the lower the likely demand will be for services. A point will be reached where access will stabilise at a particular rate that is likely to be unique to each DHB

the number and quality of primary ancillary mental health services (e.g. GPs, Private Counsellors, and Relationship Services) will have an impact on access rates to secondary mental health services

that there is a difference between determining serious mental illness epidemiologically, and a clinical assessment of what constitutes a serious mental illness

that only half of older peoples services are funded directly by mental health

Reporting Period Reporting required: Six monthly, as per the table below:

Quarter For the time periodQuarter 2 1 October – 31 December

Quarter 4 1 April – 30 June

ExpectationsWhere the target has not been met (or in quarter two, is not on track to be met) the DHB is expected to provide commentary/resolution plan on what it is doing to address the performance failure.

The following achievement scale will be applied:

Rating: Definition

Outstanding performer

The DHB has met the target agreed in the Annual Plan, and has also reached or improved on the performance for the Maori population group, and the Other population group.

Achieved The DHB has met the target agreed in the Annual Plan

Partially Achieved

Applied in quarter 2 if the DHB has not met the target agreed in the Annual Plan, but is on track for achievement by year end

Not Achieved Applied in quarter 2 if the DHB has not met the target agreed in the Annual Plan, and is not on track for achievement by year end.Applied in quarter 4 if the DHB has not reached the target agreed in the Annual Plan.

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Policy priorities PP7: Improving mental health services using transition (discharge) planning.

Each DHB to supply reports on DHB discharge/ transition planning

Summary informationTarget/performance expectation ReportingAgreed in Annual Plan Type: Data & exception

Reporting frequency: Quarterly

Source information for reporting provided by: DHBs to provide data to Ministry

Each DHB to supply reports on DHB discharge/ transition planning

Link to outcomesDelivery against this measure supports the health and disability system outcome of ‘New Zealanders living longer, healthier and more independent lives’, this measure will also support delivery of the Minister of Health’s priority of ‘Improving value for money’.

Delivery of this measure supports the overarching outcome for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’ and contributes to whole of sector outcomes:



Improved quality, safety and experience of care (individuals and their family/focus).

Delivery against this measure particularly supports the health outcome of ‘New Zealanders living longer, healthier and more independent lives’, and the primary intermediate outcome of ‘People receive better health and disability services’. Additional intermediate outcomes are ‘Good health and independence are protected and promoted’ and ‘The health and disability system and services are trusted and can be used with confidence’. This measure will also support delivery of the Minister of Health’s priority of ‘Improving value for money’.

This indicator is consistent with and links to Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012-2017. By improving the health status of people with severe mental illness through improved outcomes the DHB will contribute to the Ministerial priority of improving value for money by ensuring their mental health services are cost effective, results focused and have regard to the service impacts on people who are severely affected by mental illness. The DHB will provide people with better health and disability services by ensuring that the range of services closes existing service gaps.

The DHB’s range of services will be of high quality, safe, evidence based and provided in the least restrictive environment. This focus is designed to provide better outcomes for people with mental illness and increase people’s confidence and trust in the health and disability system and services.

The significance of transition/discharge planning contributing to improved outcomes for people is evidenced in the literature and is a requirement of the Health and Disability Services Standards (NZS 8135:2008).

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Maintaining and improving patient engagement through the use of transition/discharge plans will ensure that services are patient-centred and responsive, supporting patients’ trust and confidence in services and the health and disability system. People that are better able to better manage their own health condition represents value for money because of the proven reduction in the demand for mental health services.


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Actions and activities are that have a proven impact on this measure: Refer to the Ministry of Health website for information on transition/discharge plans

(http://www.health.govt.nz/publication/transition-planning-guidelines-infant-child-and-adolescent-mental-health-alcohol-and-other-drugs).

Deliverables definitions 1. Child and Youth with a Transition (discharge) plan

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At least 95% of clients discharged will have a transition (discharge) plan.

NumeratorThe number of C&Y clients with a discharged from community mental health and addiction services with a transition (discharge plan) (Data Source: DHB)

Denominator: Number of C&Y clients discharged from the community mental health and addiction services (Data Source: DHB)

Number of C&Y clients discharged from the community mental health and addiction services (DHB data source)

The number of C&Y clients with a transition (discharge) plan from the community (Data Source: DHB)

Percentage of C&Y clients with transition (discharge) plan

Note: the Ministry will compare PRIMHD data with the number provided by the DHB for this denominator – where this is a discrepancy of more than 10% the DHB will be required to explain this. See below for Cohort - inclusions / exclusions.

Reporting Period (data covers a rolling twelve month period and is produced one quarter in arrears)

Reporting required: Quarterly, as per the table below:

Quarter For the time periodQuarter 1 Data to cover the 12 month period to

June

Quarter 2 Data to cover the 12 month period to Sept

Quarter 3 Data to cover the 12 month period to Dec

Quarter 4 Data to cover the 12 month period to March

ExpectationsDHBs are expected to have in place a process that ensures all children and youth have discharge/transition plans. It is expected the DHB accurately report the number of people It is expected that DHBs can demonstrate a method that ensures all clients have up-to-date transition

(discharge) plans DHBs are expected to have in place a process that ensures that all children and youth who are seen,

receive clinical interventions, and are treated, have developed transition plans in line with the guidelines outlined in Transition Planning Guidelines for Infant, Child and Adolescent Mental Health / Alcohol and

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Other Drugs Services 2014 (MoH, 2014). Found here: http://www.health.govt.nz/publication/transition-planning-guidelines-infant-child-and-adolescent-mental-health-alcohol-and-other-drugs

It is important to note that a ‘Transition plan’ is the culmination of an episode of care that generally incorporates all of the components outlined in the guideline here:

http://www.health.govt.nz/system/files/documents/publications/transition-planning-guidelines-infant-child-adolescent-mental-health-alcohol-other-drugs-services-may14.doc

In is expected that the Transition plan comprise the following components as outlined in “My transition plan’ here: http://www.health.govt.nz/system/files/documents/publications/my-transition-plan-may14.docx. This should be clearly evident in the clinical file.

Where the 95% target has not been met, the DHB is expected to provide commentary/resolution plan on what it is doing to address the performance failure.


Rating: DefinitionOutstanding performer

The DHB has met the target agreed in the Annual Plan, and has also reached the same level of performance for the Maori population group, and the non - Maori population group.

Achieved All agreed rates are met.

Partial Achievement

Some or all agreed rates are not met

Not Achieved All agreed rates are not met

Cohort – inclusions / exclusions Child and Youth teams. To age of 19 at time of discharge With a PRIMHD completion code or ‘DR’ ended routinely. Exclude referrals that were not ‘accepted’ (e.g. rejected and cancelled referrals). Exclude referrals that have no face-to-face (actual attendances). Include only those referrals with 3 or more face-to-face attendances (i.e. only those referrals where

the client was seen 3 or more times).

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http://www.health.govt.nz/system/files/documents/publications/my-transition-plan-may14.docx

http://www.health.govt.nz/system/files/documents/publications/my-transition-plan-may14.docx



Policy priorities PP8: Shorter waits for non-urgent mental health and addiction services for 0-19 year oldsEach DHB to supply reports on waiting times for mental health and addiction for 0-19 year olds

Summary informationTarget/performance expectation Reporting80% seen within 3 weeks95% seen within 8 weeks

Type: Full report


Source information for reporting provided by: Ministry to provide data via NSFL

Link to outcomesDelivery against this measure supports the health and disability system outcome of ‘New Zealanders living longer, healthier and more independent lives’. This measure will also support delivery of the Minister of Health’s priority of ‘Improving value for money’. The measure directly links to the Prime Ministers Youth Mental Health Project and the Government’s Drivers of Crime initiative, and contributes to whole of sector outcomes:




Access and shorter waits are very important to patients regardless of the conditions. The waiting time concept is easily understood by the public. Earlier treatment in the progression of illness links to better outcomes as evidenced in international literature. Timeliness is also a key quality indicator in calls for improvement to the health care system. This indicator is consistent with and links to Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012-2017. This will improve provider performance in relation to the Welfare Working Group’s report and the need to address long term welfare dependency through better access to health services. A reducing waiting time indicator is also supported by the Ministry of Justice and Department of Corrections particularly in relation to access to AOD services. This target is a universal deficiency across the country and requires attention now that we can measure waiting times using PRIMHD data.


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System IntegrationCancer (Health Target)Stroke ServicesCardiac Services

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Health of Older PeopleShifting ServicesSystem Level MeasuresShorter Stays in Emergency Departments (Health Target)Whānau OraImproved Access to DiagnosticsImproved Access to Elective Surgery (Health Target)



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Stroke ServicesCardiac ServicesHealth of Older PeopleMental Health and AddictionsHepatitis CMajor TraumaWorkforceInformation Technology

Actions and activities are that have a proven impact on this measure:Provider arm and NGO services may need to modify their triage processes to meet this target and possibly look to adopting a single point of entry process. For people who do not attend (DNA) scheduled appointments services generally have in place processes for declining the referral after 3 DNA’s. However, services could put in place processes, if they haven’t already, that improve the likelihood of a person attending their appointment e.g. reminder texts. DHB services will also need to ensure clients accepted into the service have a treatment plan that leads to appropriate timely discharge. Where there is long-term requirement for treatment and care the DHB will need to have in place Knowing the People Planning or something similar to ensure long term clients are in the best possible position to manage their illness and consequently lower demand on services.

Deliverables definitionsAll DHBs are expected to reach 80% of people referred for non-urgent mental health or addiction services are seen within three weeks and 95% of people are seen within 8 weeks this year.

DHBs will be required to meet this target within three years. DHBs will need to set and agree with the Ministry individualised targets (based on data provided by the Ministry).

The wait time will be counted from the time the referral is received for a person who has not been seen for at least a year (or not at all) to the time of the first face to face contact with a mental health or addiction professional. The wait time will also be calculated for provider arm services and AOD NGOs. Where there are two referrals open for the same client the earliest referral will be counted.The wait time will exclude the following:

1. PRIMHD activity_type_codes (mental health care coordination contact) ,T24 (work opportunities programme attendances), T32 (mental health contact with family/whānau), T35 (did not attend), T37 (on leave), T43 (community support contacts), T44 (advocacy), T45 (peer support)

2. Activity_Setting_Codes WR (written), SM (text), PH (phone)

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3. Referral_end_codes RI (referral declined-inability to provide services) requested) or RO (referral declined other services more appropriate) or DD (Died) or DM (did not attend following the referral)

N.B. Referrals must be entered into the information system as at the date they were received

A narrative is also required to:1. identify what processes have been put in place to reduce waiting times2. explain variances of more than 10% waiting times target

Reporting Period Reporting required: Quarterly reporting, as per the table below:

Quarter For the time periodQuarter 1

Rolling annual waiting time data will be provided from PRIMHD (3 months in arrears)

Quarter 2

Quarter 3

Quarter 4

Note: Monthly reporting may be required from DHBs where waiting times are below 70% of people being seen within 3 weeks.Baseline informationBaseline information will be provided by the Ministry according to the above definitions

Wait times: reporting mental health Alcohol and other drug wait times by adult, older child/youth servicesMental Health Provider Arm

<= 3 weeks <8 weeksAge target (%) Achieved (%) Agreed target (%) Achieved (%)0-19 80% 95%

Addictions (Provider Arm and NGO)<= 3 weeks <8 weeks

Age Target (%) Achieved (%) Target (%) Achieved (%)0-19 80% 95%

Narrative:Identify what processes have been put in place to reduce waiting times

Explain variances of more than 10% in waiting times

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Policy priorities PP10: Oral Health- Mean DMFT score at Year 8

Summary informationTarget/performance expectation Reporting

Transitional measure not included in performance dashboard reports. It is unlikely that a standardised Electronic Oral Health Record system will be utilised by all DHBs and accessible nationally before 2017/18.

Type: Data and exception report

Reporting frequency: Annually

Source data/template for reporting provided by: Data to be supplied by DHBs, template is on NSFL

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’ and contributes to whole of sector outcomes:




Delivery of this measure most strongly supports the following sector outcomes and government priorities: By decreasing the severity of dental decay experienced by children in school Year 8 (12/13-year olds), the DHB will contribute to the outcome of protecting and promoting good health and independence through providing effective publicly funded child oral health programmes (health promotion, prevention and treatments) that reduce the prevalence of oral disease in children of primary school age.This measure also provides information that allows DHBs, and the Ministry, to evaluate how health promotion programmes, and services such as the DHB Community Oral Health Service (COHS) and other child oral health providers, are influencing the oral health status of children. The data breakdowns by ethnicity and fluoridation status enable DHBs to identify and target the populations in their district where children’s oral health status is poorest. It also provides DHBs with information to support the fluoridation of water supplies, which will be important when dealing with territorial local authorities.Through the intermediate outcome, the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives.This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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Actions and activities are that have a proven impact on this measure:The following actions and activities are examples of initiatives that have a proven impact on this measure: increased enrolment of pre-school children in publicly funded child oral health programmes enables early

engagement and provides opportunities for interventions aimed at prevention of oral disease and oral health promotion, and on an overall basis, reduces the prevalence of dental decay; and

the re-investment programme increases accessibility of regular care through “hub” and mobile clinics that will be open throughout the year and operate longer hours, and as well as increasing service productivity to increase service coverage for a greater number of children during the year.

ContextThis measure indicates the prevalence of oral disease and severity of dental decay experienced in children at the end of their primary schooling (Year 8, 12/13-year olds). This impact indicator measures the oral health status of New Zealand’s child population for demonstrating progress towards the population priority of “improving oral health” in the New Zealand Health Strategy.Publicly funded oral health services are available to children and adolescents from birth to 17 years of age (i.e. until the 18th birthday), through DHBs’ Community Oral Health Services (COHS), DHB-funded contracts with Maori oral health providers to provide child oral health services, and DHB-funded contracts with private dentists and Maori oral health providers to provide adolescent oral health services. In 2008, the Government embarked on a reinvestment programme in child and adolescent oral health services supported by the provision of additional capital and operating funding for renewed physical facilities, increased workforce, increased service coverage and increasing the preventive focus in the service delivery model. The reinvestment programme is expected to be fully implemented by DHBs by December 2015.After school Year 8, the majority of children transfer to publicly-funded oral health services provided for adolescents by private dentists contracted by DHBs, although some DHBs continue to provide some adolescent oral health services in their COHS and hospital dental departments. Improvements in this

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measure will show the impact made by the reinvestment programme on the effectiveness of publicly funded child oral health services and the COHS in particular. The World Oral Health Organisation (WHO) also regularly collates this measure for inclusion in its global oral health database for cross-country comparisons.

Deliverables definitionsNumerator: (Data source: DHB via COHS and other oral health providers)Upon the commencement of dental care, at the last dental examination before the child leaves the DHB’s Community Oral Health Service, the total number of:(i) permanent teeth of children in school Year 8 (12/13-year olds) that are –

Decayed (D), Missing (due to caries, M), and Filled (F); and

(ii) children who are caries-free (decay-free).

Denominator: (Data source: DHB via COHS and other oral health providers)The total number of children who have been examined in the Year 8 (12/13-year olds) group, in the year to which the reporting relates.

Other components of this indicator:1. The data reported in the Numerator and Denominator must also be broken down by:

(i) Ethnicity, using “prioritised ethnicity” approach1 into the following (in order of assignment): Māori; Pacific (only for the seven ‘official’ Pacific DHBs); and Other (includes Pacific children in the other DHBs that are not ‘official’ Pacific DHBs); and

(ii) water fluoridation status of the school area the child attends, defined as: fluoridated; and non-fluoridated.

2. The data for this indicator will be generated by DHBs. There is a number of technical interpretation issues associated with oral health, which are centred largely around variances in: processes for data collection amongst DHBs technologies for management of data amongst DHBs.

3. DHBs are encouraged to record data at the unit (individual child) level, using the National Health Index, but data are reported in an aggregated format and should be provided using the Ministry of Health Excel template, available on the quarterly reporting database or from the Ministry of Health’s oral health team.

4. DHBs are required to separately report the number of Decayed, Missing (due to caries), or Filled teeth (DMFT).

1 It is acknowledged that use of the “prioritised ethnicity” approach is not consistent with New Zealand’s Statistical Standard for Ethnicity; but it is considered that this approach is acceptable given that: the historical use of this approach in the long-term data series since 1990 and the standard “total response” approach will not provide an accurate picture of the number of children examined by DHBs’

Community Oral Health Service and other contracted third party providers.30

http://www.stats.govt.nz/~/media/statistics/class-stnd/ethnicity/ethnic05-statistical-standard.aspx



Reporting Period Reporting required: Annual, in the third quarter.

Quarter For the time periodQuarter 3 1 January 2016 – 31 December 2016

ExpectationsDHBs are expected to report complete, comprehensive and timely information. It is expected that all DHBs will meet the specific individually agreed targets, for this indicator, as agreed in their Annual Plans. Where the target has not been met, the DHB must provide commentary or a resolution plan that describes the DHB will do to address the performance failure. DHBs are expected to set targets for this indicator for each of the two calendar years straddled by the fiscal year that the Annual Plan pertains to.

DHBs will retain the “year 2 targets” from the outgoing fiscal year’s Annual Plan as the “year 1 targets” for the incoming fiscal year’s Annual Plan.

Each DHB’s Annual Plans should focus on the activities that the DHB will put in place to achieve the “year 2 target” – this generally allows DHBs a six-month planning window followed by a 12-month implementation window for DHBs to achieve their “year 2 targets”.


Rating: DefinitionOutstanding The DHB has met the targets agreed in the Annual Plan, and is more than 5%

over specified targets, and has also has also reached the same level of performance for the Other population group, and the Maori population group, and the Pacific population group (where applicable).

Achieved All targets agreed in the Annual Plan are met, within 95% - 105% of specified targetsanda resolution plan with appropriate actions is provided if the total population target is not met for the Māori population group, and the Pacific population group

Partially Achieved Some or all targets agreed in the Annual Plan are not met, but delivered results are same as, or better than, the results delivered in the prior yearand/orthe DHB has not met the target/performance expectation agreed in its Annual Plan, and a resolution plan with appropriate actions is provided, including actions to deliver improved performance for the Māori population group, and the Pacific population group

Not Achieved Some or all targets agreed in the Annual Plan are not met, and actual results are worse than the results delivered in the prior year

Reporting TemplateThe Ministry of Health Excel reporting template is also located on the nationwide service framework library web site: http://www.nsfl.health.govt.nz/.

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Policy priorities PP11: Children caries-free at five years of ageSummary information

Target/performance expectation Reporting

Transitional measure included until national data collection is established (not included in performance dashboard reports)








Delivery of this measure most strongly supports the following sector outcomes and government priorities: Increasing the proportion of 5-year olds who have never experienced tooth decay will show that the DHB has made an impact on the outcome of protecting and promoting good health and independence through providing effective publicly-funded child oral health programmes (health promotion, prevention and treatments) that reduce the prevalence of oral disease in children of pre-school age.The measure also provides information that allows DHBs and the Ministry to evaluate how health promotion programmes, and services such as Well Child and the Community Oral Health Service (COHS), are influencing the oral health status of children. The data itemised by ethnicity and fluoridation status enable DHBs to identify and target the populations in their district where children’s oral health status is poorest. It also provides DHBs with information to support the fluoridation of water supplies, which will be important when dealing with territorial local authorities.Through the intermediate outcome, the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives.This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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System IntegrationCancer (Health Target)

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Stroke ServicesCardiac ServicesHealth of Older PeopleShifting ServicesSystem Level MeasuresShorter Stays in Emergency Departments (Health Target)Whānau OraImproved Access to DiagnosticsImproved Access to Elective Surgery (Health Target)



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ContextThis measure indicates the prevalence of oral disease and experienced in children of pre-school age. This impact indicator measures the oral health of status of New Zealand’s child population for demonstrating progress towards the population priority of “improving oral health” in the New Zealand Health Strategy.Publicly funded oral health services are available to children and adolescents from birth to 17 years of age, through DHBs’ Community Oral Health Services (COHS), DHB-funded contracts with Maori oral health providers to provide child oral health services, and DHB-funded contracts with private dentists and Maori oral health providers to provide adolescent oral health services. In 2005, the Government embarked on a reinvestment programme in child and adolescent oral health services supported by the provision of additional capital and operating funding for renewed physical facilities, increased workforce, increased service coverage and increasing the preventive focus in the service delivery model. The reinvestment programme is expected to be fully implemented by DHBs around June 2014.Prior to the reinvestment programme, a majority of children enrol in COHS upon entry to primary school between ages 5 and 6. One of the areas of focus for the reinvestment programme is to increase the enrolment of pre-school children in COHS to enable early interventions to be delivered to pre-school children. Improvements in this measure will show the impact made by the reinvestment programme on the effectiveness of publicly-funded child oral health services.

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The World Oral Health Organisation (WHO) also regularly collates this measure for inclusion in its global oral health database for cross-country comparisons.

Deliverables definitionsNumerator: (Data source: DHB via COHS and other oral health providers)At the first examination after the child has turned five years, but before their sixth birthday, the total number of children who are caries-free (decay-free); Denominator: (Data source: DHB via COHS and other oral health providers)The total number of children who have been examined in the 5-year old age group, in the year to which the reporting relates.

Other components of this indicator:1. The data reported in the Numerator and Denominator must also be broken down by:(i) Ethnicity, using “prioritised ethnicity” approach.(ii) 2 into the following (in order of assignment):

Māori; Pacific (only for the seven ‘official’ Pacific DHBs); and Other (includes Pacific children in the other DHBs that are not ‘official’ Pacific DHBs); and

(iii) water fluoridation status of the school area the child attends, defined as: fluoridated; and non-fluoridated.

2. The data for this indicator will be generated by DHBs. There is a number of technical interpretation issues associated with oral health, which are centred largely around variances in: processes for data collection amongst DHBs technologies for management of data amongst DHBs.


4. DHBs are required to separately report the number of decayed, missing (due to caries), or filled teeth (dmft).



ExpectationsDHBs are expected to report complete, comprehensive and timely information. It is expected that all DHBs will meet the specific individually agreed targets, for this indicator, as agreed in their Annual Plans. Where






the target has not been met, the DHB must provide commentary or a resolution plan that describes the DHB will do to address the performance failure. DHBs are expected to set targets for this indicator for each of the two calendar years straddled by the fiscal year that the Annual Plan pertains to.


Each DHB’s Annual Plans should focus on the activities that the DHB will put in place to achieve the “year 2 target” – this generally allows DHBs a six-month planning window followed by a 12-month implementation window for DHBs to achieve their “year 2 targets”.


Rating: DefinitionOutstanding The DHB has met the targets agreed in the Annual Plan, and are more than 5%

over specified targets, and has also has also reached the same level of performance for the Other population group, and the Maori population group, and the Pacific population group (where applicable).



Not Achieved Some or all expectations are not met, and actual results are worse than the results delivered in the prior year

Reporting TemplateThe Ministry of Health Excel reporting template is also located on the nationwide service framework library web site: http://www.nsfl.health.govt.nz/.

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Policy priorities PP12: Utilisation of DHB-funded dental services by adolescents from School Year 9 up to and including age 17 years


Transitional measure included until national data collection is established (not included in performance dashboard reports)




Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’, and contributes to whole of sector outcomes:




Delivery of this measure most strongly supports the following sector outcomes and government priorities: Increasing the proportion of adolescents, in school Year 9 (13/14-year olds) up to and including 17 years of age, who have accessed DHB-funded oral health services will show that the DHB has made an impact on the outcome of protecting and promoting good health and independence by providing accessible and available publicly-funded adolescent oral health programmes. The programmes will help reduce the prevalence and severity of oral disease in adolescents.Through the intermediate outcome, the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives.This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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System IntegrationCancer (Health Target)Stroke ServicesCardiac ServicesHealth of Older PeopleShifting ServicesSystem Level Measures

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Shorter Stays in Emergency Departments (Health Target)Whānau OraImproved Access to DiagnosticsImproved Access to Elective Surgery (Health Target)



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Actions and activities are that have a proven impact on this measure:The following actions and activities are examples of initiatives that have a proven impact on this measure: increasing the number of dentists contracted under the Combined Dental Agreement to provide DHB-

funded adolescent oral health services; more effective transfers of children at the end of school Year 8 by the DHB’s Community Oral Health

Service to dentists contracted under the Combined Dental Agreement to provide adolescent oral health services; and

increased promotion and follow-through of enrolments in DHB-funded adolescent oral health services.

ContextThis measure indicates the coverage of publicly funded adolescent oral health services. This output indicator provides a measure that can be used to demonstrate progress towards the population priority of “improving oral health” in the New Zealand Health Strategy.Publicly-funded oral health services are available to children and adolescents from birth to 17 years of age (i.e. until the 18th birthday), through DHBs’ Community Oral Health Services (COHS), DHB-funded contracts with Maori oral health providers to provide child oral health services, and DHB-funded contracts with private dentists and Maori oral health providers to provide adolescent oral health services. In 2005, the Government embarked on a reinvestment programme in child and adolescent oral health services supported by the provision of additional capital and operating funding for renewed physical facilities, increased workforce, increased service coverage and increasing the preventive focus in the service delivery model. The reinvestment programme is expected to be fully implemented by DHBs around June 2012.One of the areas of focus for the reinvestment programme is the reinvestment programme to increase the utilisation of publicly funded oral health services by adolescents. Improvements in this measure will show the impact made by the reinvestment programme on the service coverage of publicly funded adolescent oral health services.

Deliverables definitionsNumerator: (Data source: DHBs, via reporting from Sector Services and other DHB-contracted oral health providers.)

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In the year to which the reporting relates, the total number of adolescents accessing DHB-funded adolescent oral health services, defined as:(i) the unique count of adolescent patients’ completions and non-completions under the Combined

Dental Agreement; and(ii) the unique count of additional adolescent examinations with other DHB-funded dental services (e.g.

DHB Community Oral Health Services, Māori Oral Health providers and other contracted oral health providers).

To reduce duplication of effort, at the end of each quarter in the year to which the reporting relates, the Ministry will organise a data extract from Sector Services for all DHBs for claims made by dentists contracted under the Combined Dental Agreement, and provide this data for DHBs’ use in determining part (i) of the Numerator.

Denominator: (Data source: Estimates of DHB population by age, sourced from NZ Census and Statistics New Zealand’s population projections between Census)DHBs do not need to report a denominator. The Ministry will source denominator data, and advise denominator prior to DHBs’ targets being set.The denominator will be calculated as follows:

Half of the cohort aged 13 years All of the cohorts aged 14 – 17 years inclusive.

Other components of this indicator:1. The data reported in the Numerator and Denominator must also be broken down by:(i) Ethnicity, using “prioritised ethnicity” approach3 into the following (in order of assignment):

Māori; Pacific (only for the seven ‘official’ Pacific DHBs); and Other (includes Pacific adolescents in the other DHBs that are not ‘official’ Pacific DHBs); and

The Ministry acknowledges that availability of ethnicity in the Numerator is subject to ethnicity data being available from the source systems concerned.

2. Part of the data for this indicator will be provided by the Ministry (CDA data from the Proclaim payments system) and the balance will be generated by DHBs (non-CDA data on adolescents utilising COHS services and DHB-contracted dental services not paid through Proclaim). There is a number of technical interpretation issues associated with oral health, which are centred largely around variances in: processes for data collection amongst DHBs technologies for management of data amongst DHBs.


Reporting Period Reporting required: Annual, in the fourth quarter.


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ExpectationsDHBs are expected to report complete, comprehensive and timely information. It is expected that all DHBs will meet the specific individually agreed targets, for this indicator, as agreed in their Annual Plans. Where the target has not been met, the DHB must provide commentary or a resolution plan that describes the DHB will do to address the performance failure. DHBs are expected to set targets for this indicator for each of the two calendar years straddled by the fiscal year that the Annual Plan pertains.

DHBs will retain the “year 2 targets” from the outgoing fiscal year’s Annual Plan as the “year 1 targets” for the incoming fiscal year’s Annual Plan. Each DHB’s Annual Plans should focus on the activities that the DHB will put in place to achieve the “year 2 target” – this generally allows DHBs a six-month planning window followed by a 12-month implementation window for DHBs to achieve their “year 2 targets”.

On a quarterly basis, DHBs are expected to monitor their progress towards achieving the agreed targets in their Annual Plans, and put in place appropriate measures to ensure targets are achieved by the end of the year to which the reporting relates.The following achievement scale will be applied:

Rating: DefinitionOutstanding The DHB has met the targets agreed in the Annual Plan, and are more than

5% over specified targets, and has also has also reached the same level of performance for the Other population group, and the Maori population group, and the Pacific population group (where applicable).




Reporting Template

The Ministry of Health Excel reporting template is located on the nationwide service framework library web site NSFL homepage: http://www.nsfl.health.govt.nz/.

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Policy priorities PP13: Improving the number of children enrolled in DHB funded dental services


Agreed in Annual Plan Type: Data and exception report



Linkages: This performance measure is also included in the Maori health plan





Delivery of this measure most strongly supports the following sector outcomes and government priorities: By increasing the number of pre-school children less than five years of age (0 – 4 year olds, inclusive), who have enrolled for DHB-funded oral health services and reducing the number who are overdue for their scheduled examination, the DHB will show that it has made an impact on the outcome of protecting and promoting good health and independence. The measures indicates the accessibility and availability of publicly-funded oral health programmes, which will in turn reduce the prevalence and severity of early childhood caries, and improve oral health of primary school children.The measures provide information that allows DHBs and the Ministry to evaluate how health promotion programmes, and services such as Well Child and the Community Oral Health Service (COHS), are influencing the oral health status of children and whether oral health service programmes are delivering timely oral health services to children. Through the intermediate outcome, the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives.This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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Long Term Conditions – Prevention, Identification and ManagementHealthy Families NZObesity (Health Target)Living Well with DiabetesCardiovascular DiseaseTobacco (Health Target)

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Rising to the ChallengeSystem Integration

Cancer (Health Target)Stroke ServicesCardiac ServicesHealth of Older PeopleShifting ServicesSystem Level MeasuresShorter Stays in Emergency Departments (Health Target)Whānau OraImproved Access to DiagnosticsImproved Access to Elective Surgery (Health Target)



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ContextThis indicates the coverage and timeliness of publicly funded child oral health services delivered by DHBs’ Community Oral Health Services (COHS). The output indicators in this measure can be used to demonstrate progress towards the population priority of “improving oral health” in the New Zealand Health Strategy.Publicly funded oral health services are available to children and adolescents from birth to 17 years of age, through DHBs’ Community Oral Health Services (COHS), DHB-funded contracts with Maori oral health providers to provide child oral health services, and DHB-funded contracts with private dentists and Maori oral health providers to provide adolescent oral health services. In 2005, the Government embarked on a reinvestment programme in child and adolescent oral health services supported by the provision of additional capital and operating funding for renewed physical facilities, increased workforce, increased service coverage and increasing the preventive focus in the service delivery model. The reinvestment programme is expected to be fully implemented by DHBs around June 2014.One of the areas of focus for the reinvestment programme is to increase service coverage and workforce productivity to deliver more and better quality care through DHBs’ COHS. Improvements in these measures show the impact made by the programme on the coverage and timeliness of publicly-funded child oral

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health services. Ethnicity data in these measures also enable DHBs to identify and target the populations in their district where children’s oral health status is poorest.

Deliverables definitionsMeasure 1: Number of Pre-School Children Enrolled in DHB-funded Oral Health ServicesNumerator: (Data source: DHBs, via their Community Oral Health Services and other oral health providers.)In the year to which the reporting relates, the total number of children under five years of age, i.e. aged 0 to 4 years of age inclusive, who are enrolled with DHB-funded oral health services (DHB’s Community Oral Health Service and other DHB-contracted oral health providers such as Māori oral health providers).

Denominator: (Data source: NZ Census sourced estimates of DHB population by age)DHBs do not need to report a denominator. The Ministry will source denominator data, and advise denominator prior to DHBs’ targets being set.In the year to which the reporting relates, the total number of children under five years of age, i.e. ages 0 to 4.

Other components of this measure:1. The data reported in the Numerator and Denominator must also be broken down by:(i) Ethnicity, using “prioritised ethnicity” approach4 into the following (in order of assignment):

Māori; Pacific (only for the seven ‘official’ Pacific DHBs); and Other (includes Pacific children in the other DHBs that are not ‘official’ Pacific DHBs); and

1. The data for this indicator will be generated by DHBs. There is a number of technical interpretation issues associated with oral health. This centres largely around variances in: processes for data collection amongst DHBs technologies for management of data amongst DHBs.

2. DHBs are encouraged to record data at the unit (individual child) level, using the National Health Index, but data are reported in an aggregated format and should be provided using the Ministry of Health Excel template, available on the quarterly reporting database or from the oral health team.

Measure 2: Number of Enrolled Pre-School and Primary School Children Overdue for their Scheduled ExaminationsNumerator: (Data source: DHBs, via their Community Oral Health Services and other oral health providers.)In the year to which the reporting relates:(i) the total number of pre-school children and primary school children in total and for each school

decile who have not been examined according to their planned recall period in DHB-funded dental services (DHB’s Community Oral Health Service and other DHB-contracted oral health providers such as Māori oral health providers); and

(ii) the greatest length of time children has been waiting for their scheduled examination, and the number of children that have been waiting for that period.






Denominator: (Data source: DHBs, via their Community Oral Health Services and other oral health providers.)In the year to which the reporting relates, the total number of children enrolled in DHB-funded dental services (DHB’s Community Oral Health Service and other DHB-contracted oral health providers such as Māori oral health providers), showing separately the number of – pre-school children, and primary school children.

Data Definitionsa. Pre-school and primary school children are the children from age 0 (less than 1 year old) to the end of

school Year 8 inclusive.

Other components of this measure:1. The data reported in the Numerator and Denominator must also be broken down by:(i) Ethnicity, using “prioritised ethnicity” approach5 into the following (in order of assignment):

Maori; Pacific (only for the seven ‘official’ Pacific DHBs); and Other (includes Pacific children in the other DHBs that are not ‘official’ Pacific DHBs); and

The Ministry acknowledges that availability of ethnicity in the Numerator is subject to ethnicity data being available from the source systems concerned.

2. The data for this indicator will be generated by DHBs. There is a number of technical interpretation issues associated with oral health. This centres largely around variances in: processes for data collection amongst DHBs technologies for management of data amongst DHBs.

3. DHBs are encouraged to record data at the unit (individual child) level, using the National Health Index, but data are reported in an aggregated format and should be provided using the Ministry of Health Excel template, available on the quarterly reporting database or from the oral health team.



ExpectationsDHBs are expected to report complete, comprehensive and timely information. It is expected that all DHBs will Annual Plans. It is expected that DHBs will meet the specific individually agreed targets s in their Annual Plans. Where the target has not been met, the DHB must provide commentary or a resolution plan that describes the DHB will do to address the performance failure.

DHBs are expected to set targets for this indicator for each of the two calendar years straddled by the fiscal year that the Annual Plan pertains to.







Each DHB’s Annual Plans should focus on the activities that the DHB will put in place to achieve the “year 2 target” – this generally allows DHBs a six-month planning window followed by a 12-month implementation window for DHBs to achieve their “year 2 targets”. The following achievement scale will be applied:

Rating: DefinitionOutstanding The DHB has met the targets agreed in the Annual Plan, and are more than

5% over specified targets, and has also has also reached the same level of performance for the Other population group, and the Maori population group, and the Pacific population group (where applicable).




Reporting TemplateThe Ministry of Health Excel reporting template is located on the nationwide service framework library web site: http://www.nsfl.health.govt.nz/.

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Policy Priorities PP20: Improved management for long term conditions (CVD, Acute heart health, Diabetes, and Stroke)

Summary information

Target/performance expectation:Performance agreed in annual plan

Reporting

Type: Exception reporting


Source data/template for reporting provided by: : A reporting template will be provided on NSFL

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’ , and contributes to whole of sector outcomes:




Long Term Conditions Long-term conditions comprise the major health burden for New Zealand now and into the foreseeable future. This group of conditions is the leading cause of morbidity in New Zealand, and disproportionately affects Maori and Pacific peoples and people who experience mental illness and addiction. As the population ages and lifestyles change these conditions are likely to increase significantly. Cardiovascular disease, including heart attacks and strokes, are substantially preventable with lifestyle advice and treatment for those at moderate or higher risk. Diabetes is also important as a major and increasing cause of disability and premature death and is a good indicator of the responsiveness of a health service to the people in most need.This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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System Level MeasuresShorter Stays in Emergency Departments (Health Target)Whānau OraImproved Access to DiagnosticsImproved Access to Elective Surgery (Health Target)



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Deliverables definitionsThe deliverables will be formally defined in the planning package, including mechanisms for data collection and delivery expectations. Each DHB must provide narrative comment for the indicator on progress on the activities being taken to improve performance, as outlined in their Annual Plan. The narrative is to include specific activities undertaken for Maori and Pacific and where relevant, people from the Indian subcontinent6.There are five Focus Areas within this policy priority.

FA1 Long Term Conditions, FA2 Diabetes services, FA3 Cardiovascular health, FA4 Acute heart services, FA5 Stroke services.

Focus Area 1 Long Term Conditions

Expectation New Zealanders with Long-term Conditions (LTCs) live longer, healthier and more independent lives, with the assistance of an integrated health system.

Deliverables:: Specific Quarterly Reporting:Quarters 1 and 3: Teleconference-based reporting on progress to date on deliverables for Long Term

Conditions identified in the 2016/17 annual plans. The Minutes from the teleconferences will be taken by the DHBs and provided to support any additional reporting arising from the teleconferences.

Quarters 2 and 4 - Confirmation and exception report: confirmation that activity and actions greed in the Annual Plan are on track where there

is no quantitative target associated with the measure a qualitative exception report (recovery plan including milestones to get back on track) if

progress is not on track for either the quantitative targets or the activity based confirmations.

Definitions: Actions to support long term conditions include: Prevention through clearly outlined networks between general practice and community

organisations to maximise physical activity, nutrition, quit smoking and reduction in alcohol use.

Identification of populations at risk using risk stratification to inform systematic

6 The requirement to report about Pacific people applies only to those DHBs with high Pacific populations. These DHBs are: Counties Manukau, Auckland, Waitemata, Waikato, Capital & Coast, Hutt Valley and Canterbury.

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categorisation of people at risk in order to provide appropriate management. As well, showing evidence of proactive recall and management of at risk populations

Management of people with long term conditions through: development and/or implementation of new models of care to support people with LTCs; provision of multi-disciplinary teams including allied health and kaiawhina supporting service delivery in primary care; primary care access to specialist support where appropriate and provision of self-management support and education for people with Long Term Conditions. Support regular primary care multidisciplinary teams to undertake collaborative practice review of the 1% of people with a high level of complex problems.

Enablers demonstrating clinical governance for Long Term Conditions services and IT systems to support risk stratification, case management, shared care and or clinical information sharing (focus on collaboration enablers). As well, Show evidence of staff training and education around goal setting, motivational interviewing and shared decision-making concepts and include ongoing workforce development in primary care, and clinical governance with a named clinical lead. IT capability is to be maintained and improved including provision of audit tools and/or a dashboard reporting system.

Linkages with PP22 Delivery of actions to improve system integration, and SI01 Ambulatory sensitive (avoidable) hospital admissions.

Focus Area 2 Diabetes services –

Expectation People living with diabetes are regarded as leading partners in their own care within systems that ensure they can manage their own condition effectively with appropriate support.Improve or, where high, maintain the proportion of patients with good or acceptable glycaemic control. The expectation in 2016/17 is to begin to implement actions in the Diabetes plan “Living Well with Diabetes”.

Commentary to be provided

Quarterly reporting is required on the implementation of actions in the Diabetes plan “Living Well with Diabetes”, and reporting on the HbA1c indicator.Quarters 1 and 3: Teleconference-based reporting on progress to date on deliverables for Diabetes identified

in the 2016/17 annual plans. The Minutes from the teleconferences will be taken by the DHBs and provided to support any additional reporting arising from the teleconferences.

Quarters 2 and 4: - Confirmation and exception report: confirmation that activity and actions greed in the Annual Plan are on track where there



Deliverables: HbA1c

Numerator – Count of enrolled people aged 15-74 in the PHO with diabetes and the most recent HbA1c during the past 12 months of equal to or less than 64 mmol/mol, equal to or less than 80mmol/mol or equal to or less than 100mmol/mol and greater than 100mmol/mol)Denominator - Count of enrolled people in the PHO aged 15-74 with diabetes on the Ministry of Health Virtual Diabetes Register (VDR 2014).

Data source: MOH will supply VDR, and DHBs/PHOs to provide numerator.Note: Patients coded with diabetes in the General Practice registers can be used instead of VDR once comparisons between the two have been complete, and accuracy of GP registers can be demonstrated.

Additional Commentary

Actions to support delivery of Diabetes services and the Diabetes plan “Living Well with Diabetes” include: Prevention and early intervention, including mental health needs, to reduce the personal and

social burden of disease Reducing disparities in health outcomes between different ethnic, socioeconomic,

geographical and other disadvantaged groups Providing people centred services including for gamily and whanau when appropriate Being sustainable in the long term with consistent services across the country Achieving effective self-management including responding to people’s demand for

technology-enabled tools Information on evidence and test and evaluation promising interventions to improve our

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knowledge of what works for New Zealanders.

Focus Area 3 Cardiovascular (CVD) health

Expectation The following actions and activities are examples of initiatives that have a proven impact on this measure. Strong collaboration and co-ordination between primary and secondary care Working with primary care to ensure that they have access to good data and can identify

patients who need to be recalled for an appointment or need additional support to manage their health.

Community driven outreach programmes (including for example free CVD risk assessments offered at community events and workplaces, and promotion /education by people the target community identifies with, Nurse-led support of self-management and removal of identified barriers such as cost and time limited consultations.)

Use of Budget 2013 funding to support primary care to deliver services that achieves good heart health

Quality improvement plans in place for managing people at risk. Shared management decisions based on discussions between clinicians and people at high

risk of CVD which account for the benefits of appropriate lifestyle change (principally diet, exercise and smoking), diabetes care and medication therapy.

Commentary to be provided

Specific Quarterly Reporting:Quarters 1 and 3: Teleconference-based reporting on progress to date on deliverables for CVD identified in the

2016/17 annual plans. The Minutes from the teleconferences will be taken by the DHBs and provided to support any additional reporting arising from the teleconferences.

Quarters 2 and 4: - Confirmation and exception report: confirmation that activity and actions greed in the Annual Plan are on track where there



Deliverables Indicator 1: 90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years.

Numerator: (Data source: IPIF Programme)Count of enrolled people in the PHO within the eligible population who have had a CVD risk recorded within the last five years

Denominator: (Data source: PHO enrolment register)Count of enrolled people in the PHO who are eligible for a CVD risk assessment.The population eligible for CVDRA is as follows: Males of Maori, Pacific, or Indian sub-continent* ethnicity aged 35-74 years at the end of the

reporting period and enrolled with PHO Females of Maori, Pacific, or Indian sub-continent* ethnicity aged 45-74 years at the end of

the reporting period and enrolled with PHO Males of any other ethnicity aged 45-74 years at the end of the reporting period and

enrolled with PHO Females of any other ethnicity aged 55-74 years at the end of the reporting period and

enrolled with PHO.

Indicator 2: Percentage of ‘eligible Māori men in the PHO aged 35-44 years’ who have had their cardiovascular risk assessed in the past five years.Numerator and denominator are subsets of Indicator 1.

Data source: CVD data provided by the Ministry

Reporting Period for FA1, FA2 and FA3All deliverables within the measure are to be provided as follows:

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Quarter For the time period Indicator to report on1 1 July – 30

SeptemberTeleconference to discuss delivery of services for Long Term Conditions, CVD and Diabetes.

2 1 October – 31 December

Long Term Conditions, CVD and Diabetes. narrative reports and data where required

3 1 January – 31 March

Teleconference to discuss delivery of services for Long Term Conditions, CVD and Diabetes.

4 1 April – 30 June Long Term Conditions, CVD and Diabetes. narrative reports and data where required

Focus Area 4 Acute heart service

Expectation To provide a nationally consistent reporting framework, all regions are required to report agreed indicators from ANZACS-QI and progress to achieving deliverables for acute heart services identified in annual plans.

Deliverable: Current agreed indicators are: 70 percent of high-risk patients will receive an angiogram within 3 days of admission. (‘Day

of Admission’ being ‘Day 0’) by ethnicity Over 95 percent of patients presenting with ACS who undergo coronary angiography have

completion of ANZACS QI ACS and Cath/PCI registry data collection within 30 days Over 95 percent of patients undergoing cardiac surgery at the five regional cardiac surgery

centres will have completion of Cardiac Surgery registry data collection with 30 days of discharge.

Data source: Data provided from ANZACS-QI and the Cardiac surgery registryAdditional Commentary to be provided:

Specific Quarterly Reporting:Quarters 1 and 3: Regional teleconference-based reporting on progress to date on deliverables for acute heart

services identified in annual plans and actions and progress in quality improvement initiatives to support the improvement of agreed indicators as reported in ANZACS-QI

The minutes from the teleconferences will be recorded and uploaded as the quarterly report.Quarters 2 and 4 - Confirmation and exception report:

confirmation that activity and actions agreed in the Annual Plan are on track and indicators achieved.

a qualitative exception report (recovery plan including milestones to get back on track) if progress is not on track for either the quantitative targets or the activity and actions agreed in the Annual Plan.

Definitions: A high-risk patient can be defined by the DHBs.

Focus Area 5 Stroke Services

Expectation: All DHBs will provide an organised acute stroke service for their population as recommended in the NZ Clinical Guidelines for Stroke Management.

Deliverable: 6 percent or more of potentially eligible stroke patients thrombolysed 24/7 80 percent of stroke patients admitted to a stroke unit or organised stroke service with

demonstrated stroke pathway 80 percent of patients admitted with acute stroke who are transferred to inpatient

rehabilitation services are transferred within 7 days of acute admission (also report % of acute stroke patients transferred to inpatient rehab)NB: when reporting against above indicators include numerators and denominators in brackets after percent

Data source : DHBs to provideAdditional Specific Quarterly Reporting:

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Commentary to be provided:

Regional teleconference-based reporting on progress to date on deliverables for stroke identified in the 2015/16 annual plans

The minutes from the teleconferences will be recorded and uploaded as the quarterly report.Quarters 2 and 4: - Confirmation and exception report:

confirmation that activity and actions greed in the Annual Plan are on track where there is no quantitative target associated with the measure

a qualitative exception report (recovery plan including milestones to get back on track) if progress is not on track for either the quantitative targets or the activity based confirmations.

Definitions: A potentially eligible stroke patient is one who has an ischaemic or undetermined stroke. Other strokes, such as Intracerebral hemorrhage (ICH), transient ischemic attack (TIA), or mimics are excluded.

An acute stroke patient is admitted to hospital with a primary discharge diagnosis of ischaemic, haemorrhagic, or undetermined stroke. TIA patients, stroke mimics, and patients discharged from emergency department without being recorded as a hospital admission are excluded. Care should be taken that patients transferred during their admission are only counted once even if managed at two separate institutions.

ICD10 codes included: I61 Intracerebral Haemorrhage with subcodes for site inclusive, I63 Cerebral Infarction with subcodes 163.0-163.9 inclusive, I64 Stroke, not specified as haemorrhage or infarction)

A stroke unit is defined as a discrete ward, or beds within a ward, with a dedicated specialised multi-disciplinary team (MDT) and could include acute stroke units that discharge patients to a rehabilitation service, or an integrated acute and rehabilitation unit (New Zealand National Acute Stroke Services Audit 2009).

Organised Acute Stroke Services are provided by a coordinated specialised interdisciplinary team (IDT) and consist of early and ongoing comprehensive assessments and treatment which is guided by best practice. This is reflected in the use of stroke specific protocols. The IDT meets regularly to discuss, formulate and implement patient management and optimise rehabilitation and patient function. Ideally care is provided in a geographically discrete unit, but depending on DHB size this may not always be feasible.

Minimum specific organised acute stroke service specifications and stroke rehabilitation specifications are included as Appendix 1.

Reporting Period for FA4 and FA5 All deliverables within the measure are to be provided as follows:

Quarter For the time period

Indicator to report on

1 1 July – 30 September

Regional teleconference to discuss ACS, including discussion on ACS indicatorsRegional teleconference to discuss Stroke, including discussion on stroke indicators


DHBs to complete template provided by the Ministry on progress to date on deliverables for ACS identified in the 2016/17 annual plansDHBs to complete template provided by the Ministry on progress to date on deliverables for stroke identified in the 2016/17 annual plans


Regional teleconference to discuss ACS, including discussion on ACS indicatorsRegional teleconference to discuss Stroke, including discussion on stroke indicators

4 1 April – 30 June 2017

DHBs to complete template provided by the Ministry on progress to date on deliverables for ACS identified in the 2016/17 annual plansDHBs to complete template provided by the Ministry on progress to date on deliverables for stroke identified in the 2016/17 annual plans

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Policy Priorities PP21: Immunisation coverage (includes previous health target)

Summary informationIndicators At least 95 per cent of two year olds are fully immunised and coverage is maintained At least 95 percent of four year olds are fully immunised by age 5 years as at June 2017 reported

for each three month period quarterly. At least 70 percent of girls are fully immunised for HPV - reported annually in quarter 4. (for

2016/17 it is the 2003 birth cohort measured at 30 June in 2017)Measures Reporting

Target: Targets set in APs Type: Exception

Reporting frequency: Quarterly if coverage is not reachedAnnual for HPV

Source data/template for reporting provided by: Data supplied from Ministry from NIR

Linkages: This performance measure is also included in the Integrated performance and incentive framework (primary care) or





Delivery of this measure most strongly supports the following sector outcomes and government priorities: Improved immunisation coverage leads directly to reduced rates of vaccine-preventable disease, and consequently better health and independence for children. This equates to longer and healthier lives. The changes which are required to reach the target immunisation coverage levels will lead to better health services for children, because more children will be enrolled with and visiting their primary care provider on a regular basis. It will also require primary and secondary health services for children to be better co-ordinated. These actions are leading to improved implementation of the Primary Health Care Strategy, and the primary care workforce including maternity is better equipped to address the needs of children and families.

Training in immunisation provision, health education for parents, knowledge about vaccine-preventable diseases and how to identify and provide services to high needs populations will generalise to a range of other child and family service areas.

The Ministry of Health recommends a HPV school-based immunisation programme as the preferred service delivery model for eligible girls attending primary, intermediate and secondary schools. There are successful national and international experiences of school/institution-based mass immunisation programmes, achieving high coverage rates resulting in reduced inequalities (CBG Health Research 2006, Ministry of Health 2004). School-based services may be delivered by public health nursing services on a similar basis to the existing school-based Year 7 immunisation programmes.

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DHBs and schools need to work together to determine the most appropriate methods of providing follow up clinics depending upon the needs of the school and the needs of the population.



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Deliverables definitions and performance expectations - Focus area 1: 24 months and 5 year old coverage

Percentage of eligible children fully immunised at 24 months of age – total DHB population, Māori and PacificImmunisation coverage for two year olds will be measured quarterly using the National Immunisation Register datamart report. The coverage will be reported for Total, Māori, and (where relevant) Pacific.

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Fully immunised at age 24 months is defined as having received all measured immunisations scheduled for 6 weeks, 3 months, 5 months and 15 months of age. To be measured as fully immunised, the child must have received all age-appropriate doses of diphtheria, tetanus, whooping cough, polio, hepatitis B, Haemophilus influenzae type B, pneumococcal, measles, mumps and rubella vaccines. Although rotavirus is included in the National immunisation Schedule, it is not currently included in performance measures or health targets. It is anticipated that rotavirus vaccines will be included in performance measures in the future.

Percentage of eligible children fully immunised at 5 years of age – total DHB population, Māori and PacificImmunisation coverage for five year olds will be measured quarterly using the National Immunisation Register datamart report. The coverage will be reported for Total, Māori, and (where relevant) Pacific.Fully immunised at age 5 years is defined as having received all measured immunisations scheduled for 6 weeks, 3 months, 5 months, 15 months and 4 years of age. To be measured as fully immunised, the child must have received all age-appropriate doses of diphtheria, tetanus, whooping cough, polio, hepatitis B, Haemophilus influenzae type B, pneumococcal, measles, mumps and rubella vaccines. Although rotavirus is included in the National immunisation Schedule, it is not currently included in performance measures or health targets. It is anticipated that rotavirus vaccines will be included in performance measures in the future.

Focus area 2: HPV coverage

Percentage of eligible girls fully immunised with HPV vaccine, total DHB population, Māori and Pacific and Other.Immunisation coverage for eligible girls will be measured annually using the National Immunisation Register datamart report. The coverage will be reported for Total, Māori, and Pacific (where relevant) and other.

Assessing DHB Immunisation CoverageFocus area 1: 24 months and 5 year old coverage:Progress towards the 24 months and 5 year old coverage targets will be assessed quarterly.Coverage will be assessed on 3 months data for the previous quarter.

The assessment requirements for each quarter are set out below:

Table 1: Quarters 1, 2 & 3 assessment 24 months and 5 year old coverageRating Explanation

Achieved The DHB has reached the year’s total population immunisation coverage target for children 24 months and children 5 years of age andThis requires that the DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Māori population group, and (where relevant) the Pacific population group.

Partially Achieved The DHB’s immunisation coverage has improved from the coverage at the start of the year

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Not Achieved The DHB’s immunisation has not improved from the coverage at the start of the year

Table 2: Quarter 4 assessment 24 months and 5 year old coverageRating Explanation

Outstanding Performer

The DHB has substantially exceeded the year’s immunisation coverage target for children 24 months, children 5 years of age and/or

The DHB has reached the year’s immunisation coverage target for children 24 months of age, children 5 years of age for:o the total population, ando the Māori population group, and where applicableo the Pacific population.

Achieved The DHB has reached the year’s population immunisation coverage target for children 24 months of age, children 5 years of age.

This requires that the DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Māori population group, and (where relevant) the Pacific population group.

Partially Achieved The DHB’s immunisation coverage has substantially improved from the coverage at the start of the year and progress towards the target is acceptable.

Not Achieved The DHB’s immunisation coverage has failed to substantially progress towards the target.

Focus area 2: HPV coverageProgress towards the HPV coverage target will be assessed annually as part of quarterly 3 reports only.

Table 3: Quarter 4 assessmentRating Explanation

Outstanding Performer

The DHB has substantially exceeded HPV coverage target for eligible girls; and/or

The DHB has reached the HPV target for eligible girls for:o the total population, ando the Māori population group, and where applicableo the Pacific population.

Achieved The DHB has reached the HPV coverage target for eligible girls.

Partially Achieved The DHB’s HPV immunisation coverage has not been achieved but an acceptable resolution plan has been provided.

Not Achieved The DHB’s HPV immunisation coverage has not been achieved and an acceptable resolution plan has not been provided.

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Each quarter, when DHBs do not reach target coverage they are expected to provide an exception qualitative report advising how they will track towards higher coverage.

Both excel and pdf versions of the NIR datamart coverage reports as well as summarised reports will be available to DHBs under the toolkit section of DHB Quarterly database each quarter.

DHBs are expected to use these reports to provide exception qualitative report and/or use this mechanism to raise issues with the Ministry.

Reporting periodAll deliverables within the measure are to be provided quarterly if target coverage is not reached for childhood immunisations (ages 24 months and 5 years).

Quarter For the time period1 1 July – 30 September



4 1 April – 30 June

HPV coverage is to be reported at the end of quarter four (30 June) for the cohort defined by the measure: coverage for the 2003 birth cohort is to be reported on 30 June 2017.

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Policy Priorities PP22: Improving system integration and SLMsSummary information

Indicator: Progress on delivery of the actions and milestones to improve integration identified in DHB Annual Plans

Measures Reporting

Target: Actions and milestones agreed in APs Type: Progress update


Source data/template for reporting provided by: Checklist of actions supplied on the quarterly reporting website




Improved quality, safety and experience of care (individuals and their family/focus).This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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Actions to Support Delivery of Regional Priorities

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Deliverables definitionsDHBs are expected to report on delivery of the actions and milestones to improve integration identified in Annual Plans.

Each quarter the Ministry will present checklists that summarise the system integration actions agreed in Annual plans on the quarterly reporting web site as follows:

System integration check list

DHBs are required to provide a quarterly update identifying progress made during the quarter against the actions and milestones (deliverables) in each checklist. The progress update must include:

Whether the DHB is on track meeting each deliverable by the end of quarter 4, including comment on specific actions delivered in the quarter

Where deliverables are not on track the report must include mitigation strategies and new timeframes for delivery

Where quantitative measures are reported – Reports must include baseline, target and quarterly performance progress

System Level Measure improvement plansDHBs are expected to provide jointly agreed (by district alliances) System Level Measure improvement plans, including improvement milestones, the end of quarter one 2016/17. Assessment, and negotiations with DHBs as necessary, and approval of the improvement plans including improvement milestones (and baselines) by the Ministry will occur in quarter two 2016/17.

ExpectationsThe assessment requirements for each quarter are set out below:

Table 1: Quarterly assessmentRating Explanation

Achieved All actions, milestones and measures related to the reporting period are on track.

Partially Achieved Some actions, milestones and measures are not on track but adequate mitigation strategies are presented.

Not Achieved Some actions, milestones and measures are not on track and adequate mitigation strategies are not presented or there are any missing deliverable components.

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Reporting periodQuarter For the time period1 1 July – 30 September



4 1 April 13 – 30 June

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Policy Priorities PP23: Improving Wrap Around Services – Health of Older People

Summary informationIndicator: Progress on delivery of the actions and milestones to improve wrap around services for older people identified in DHB Annual Plans

Measures ReportingType: Process Type: Progress update

Target: Actions and milestones agreed in APs


Source data/template for reporting provided by: Checklist of actions supplied on the quarterly reporting website





DHBs are expected to report on delivery of the actions and milestones to improve wrap around services for older people identified in 2016/17 Annual Plans.

The deliverables for 2016/17 are listed below.

System integration for older people, specifically:DHBs to provide evidence that integrated systems and processes are in place to support

information flow and improve outcomes.

Home and community support services for older people, specifically:Place holder - Pending outcomes resultant of the In-Between Travel Director-General’s Reference Group’s report to the Director-General of Health

InterRAI: Comprehensive Clinical Assessment in aged residential care and in home and community support settings, specifically:DHBs need to continue to implement the roll out of interRAI Comprehensive Clinical Assessments and individual care plans based on those assessments comprehensively in their districts. They need to check that interRAI assessments are being undertaken within appropriate timeframes in all of the pathways to receiving long-term home and community support and aged residential care services and take corrective

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action as required. DHBs also need to ensure that regular reassessments are undertaken. DHBs need to be active in initiating and reviewing reporting on volumes and measures. This includes:

Evidence of the number of older people who received long-term support services for home and community supports and percentage who have had an interRAI Home Care or a Contact assessment and completed care plan.

The percentage of people in aged residential care by facility and by DHB who have a subsequent interRAI long term care facility (LTCF) assessment completed within 230 days of the previous assessment.

The percentage of LTCF clients admitted to an aged residential care (ARC) facility who had been assessed using an interRAI-HC (home care) assessment tool in the six months prior to that first long term care facility (LTCF) assessment.

Show time taken for any referral from any source to complete (not triage) an interRAI assessment. i.e. Contact, interRAI-HC, LTFC assessment.

Use interRAI measures to progress and compare performance with other DHBs and DHB regions.

Dementia care pathways, specifically:

Provide specific detail of improvements to support and services available following a dementia diagnosis (e.g. access to education and support programmes for carers or people living with dementia, initiatives to support informal carers).

Work regionally to:

o complete an analysis of the current state of educational programmes and support groups that support informal carers in operation in the region

o reduce variability of education and support programmes available to support family/whanau carers and people living with dementia.

HOP specialists: Reporting on this measure is no longer required from 2016/17 but the expectation remains within the service coverage schedule.

Integrated Falls and Fracture Prevention and Rehabilitation, specifically: Provide narrative on how older people are being assessed f on their risk of falls

Report the number of older people referred from primary and secondary care into the fracture liaison services (specifying the proportion referred from each)

Report the number of older people referred to a strength and balance retraining service (denominator) and seen by a strength and balance retraining service (numerator)

Report the number of older people referred to osteoporosis management programmes.



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DHB non-financial monitoring framework and performance measures 2016/17A

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Actions and activities that have a proven impact on this measure:DHBs are required to provide a quarterly update identifying progress made during the quarter against the actions and milestones (deliverables) as outlined in the guidance. The progress update must include:

whether the DHB is on track to meet each deliverable by June 2017, including comment on specific actions delivered in the quarter

where deliverables are not on track, the report must include mitigation strategies and new timeframes for delivery

where quantitative measures are reported, reports must include baseline, target and quarterly performance progress (where applicable).


As part of the progress report for each expectation, DHBs should:61


provide the DHB-specific information and/or data requested

provide any other information that is relevant to the deliverables and measures

provide information on progress against the nationwide expectations and measures if any?

indicate whether or not the DHB is on track to meet its targets and, if not, explain why this is the case, what is being done to address the issue, and any revised timelines

include baseline data (where applicable).


Table 1: Quarterly assessment

Rating ExplanationAchieved All actions, milestones and measures are on track.


Not Achieved Some actions, milestones and measures are not on track and adequate mitigation strategies are not presented.

Reporting period

Quarter For the time period1 1 July – 30 September



4 1 April – 30 June

interRAI Assessments For People Receiving Home And Community Support ServicesSummary informationIndicator: The percentage of older people receiving long-term home and community support that have a comprehensive clinical assessment and an individual care plan

Target/performance expectation:Target agreed in annual plan

ReportingType: All DHBs to provide a brief

comment on result (including number and proportion of eligible people receiving assessments).DHBs not meeting expectation are to provide a detailed exception report.

Reporting frequency:

Quarterly

Source data/template for reporting provided by: interRAI data will be supplied by the New Zealand interRAI software host (Health Intelligence Ltd).

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Delivery against this measure would result in:

a more unified and improved health and disability system augmented by all health professionals who support older people having a common language of assessment and easily transferred information about the patient’s health conditions

people receiving better health and disability services because service decisions would be based on a robust internationally verified assessment tool

Good health and independence will be protected and promoted through assessment of rehabilitation potential and individual care plans, and the health and disability system and services will be trusted and used with confidence because the assessments are a comprehensive bio-psycho-social assessment that provides the best information for forming care plans. There will also be more confidence in support services because completing the assessments (and reassessments) will enable the quality of services provided to be measured through the quality indicators the tool produces.

Actions and activities that have a proven impact on this measure:DHBs need to implement the roll out of Comprehensive Clinical Assessments and individual care plans based on those assessments comprehensively in their districts. They need to check that assessments are being undertaken in all of the pathways to receiving long-term support services and take corrective action where required. They also need to ensure that regular reassessments are undertaken. System clinicians need to be active in initiating and reviewing reporting on volumes and quality measures.

Deliverables definitionsNumerator: The number of people aged 65 and older who have received long-term home and community support services in the last three months who have had a Comprehensive Clinical Assessment and a completed care plan.

Denominator: The number of people aged 65 and older who have received long-term home and community support services in the last three months.

Interpretation issues Long-term home and community support services are provided for six or more weeks.

This applies to publicly funded home and community support services.

Comprehensive Clinical Assessments include interRAI Contact Assessments, Home Care and Community Health Assessments.

Any previous CCA would be counted, not just those in the last 3 months.

Reporting Period Quarterly. The measure will be calculated based on data that is one quarter in arrears.The numerator is calculated as follows:

• in quarter one, the numerator is based on data recorded for the 3 months to 30 June;

• in quarter two, the numerator is based on all data recorded for the 3 months to 30 September;

• in quarter three, the numerator is based on all data recorded for the 3 months to 31 December;• in quarter four, the numerator is based on all data recorded for the 3 months to 31 March.The denominator is a three month total calculated as follows:

• in quarter one, the denominator is based on data recorded for the three months to 30 June (to calculate those who received services at any time between 1 April and 30 June) adjusted to count

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only those people who have continued to receive services for at least six weeks. For example if a person begins receiving services on 30 June they must still be receiving services on 11 August to be included in the denominator.

• in quarter two, the numerator is based on data recorded for the three months to 30 September (to calculate those who received services at any time between 1 July and 30 September) adjusted as described above.

• in quarter three, the numerator is based on data recorded for the three months to 31 December (to calculate those who received services at any time between 1 October and 31 December) adjusted as described above.

• in quarter four, the numerator is based on data recorded for the three months to 31 March (to calculate those who received services at any time between 1 January and 31 March) adjusted as described above.

InterRAI (LTCF) For People Living In An Aged Residential Care Facility All DHBs need to monitor staff capability/capacity to complete interRAI long term care facility assessments within appropriate timeframes for people living in age residential care. The indicator below has been drafted by Central Technical Advisory Service’s Data Analysis and Reporting service to inform DHBs quarterly of each age residential care facility’s ability to complete assessments as required. The Ministry of Health requires the reported data to be aggregated up by DHB to indicate sector performance against this measure.

Indicator Percentage of people in aged residential care by facility and by DHB who have a subsequent interRAI long term care facility (LTCF) assessment completed within 230 days of the previous assessment.

Rationale This is a key performance measure for DHBs in the 2016/17 Planning Priorities for Annual Plans and Regional Service Plans to meet their ministerial expectations.The Ministry of Health requires the interRAI Data Analysis and Reporting Service to provide DHBs with this information. This information will enable DHBs to be aware of each Aged Residential Care (ARC) facility’s progress to complete second assessments as required within the ARC agreements.It will also enable DHBs to identify and support facilities that are having difficulty to complete routine interRAI assessments regularly and to report sector performance back to the Ministry of Health via the Annual Plan quarterly reports.The wording of this indicator has altered slightly from the original outcomes document but is consistent with the intent of the indicator.

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ContextFrom July 2015 onwards, an assessor/nurse must complete a short term care plan within 24 hours of admitting a client to an aged residential care facility. It is anticipated that the admission care plan will be informed by the transferred home care assessment. A full interRAI LTCF first assessment and long term care plan should be completed within 21 days of admission. The assessment reference date (ARD) refers to the last date of observation for a particular assessment. A second routine reassessment should be completed within six months of the ARD. Further routine assessments should continue to occur at six month intervals (this indicator of 230 days is more lenient than six months).

PurposeThe purpose of this document is for the interRAI Data Analysis and Reporting team to automate this data to be produced on a quarterly basis to support DHBs in their performance monitoring.

Stakeholders 20 DHB CEOs.

DHB GMs Planning and Funding

DHB Health of Older People (HOP) Portfolio Managers7

Aged Residential Care (ARC) Providers (note that TAS will send this data only to DHBs not to ARC providers)

Ministry of Health8

TAS Resources Mark Seidelin – BI DeveloperShane Kerr – Senior AnalystJason Theobald – Senior Analyst

Stakeholder Engagement/ Communication

The approach in how to send out this reporting to DHBs still needs to be discussed and agreed by TAS. In the past, we have emailed data directly to DHB Portfolio managers or sent through communication via Susan Noseworthy. However, in the future, we could send through data to DHBs, e.g. via Connex.

Indicator Definition

Denominator (note: dates are stated for Q1 2015/16): Count of assessments where

o Assessment type = LTCFo Assessment date = 13/11/2014 – 12/02/2015 (230 days before the

reporting period of 01/07/2015 – 30/09/2015)o Client has not moved facilities between this assessment and the

subsequent assessment By facility (all facilities are to be included even if no matching assessments

have been recorded during the period), by DHB (linked by facilities mapping table)

Numerator: Using the list of NHIs (with facility, DHB, assessment date) generated in

producing the denominator, count the number of NHIs whereo Assessment type = LTCFo Assessment date > previous assessment dateo Assessment date <= previous assessment date + 230 days

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8 Key contact at the Ministry for this reporting is Jacob White, Senior Portfolio Manager, Health of Older People, National Service purchasing National Health Board, Ministry of Health.

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Deliverable A table for each DHB showing the indicator: numerator (number of subsequent assessments), denominator (number of previous assessments) and percentage, for every aged residential care facility within the DHB.

Example of how the report should look like for a DHB

Indicator: Percentage of people in aged residential care by facility and by DHB who have a subsequent interRAI long term care facility (LTCF) assessment completed within 230 days of the previous assessment.Period: 2016/17Q1DHB: Auckland

Facility Number of previous assessments (denominator)

Number of subsequent assessments (numerator)

Percent

Facility1 XX XX XXFacility2 XX XX XXFacility3 XX XX XXFacility4 XX XX XXTotal: XX XX XX

InterRAI Home Care (HC) Assessments Completed For People Going Into Aged Residential Care

DHBs need to complete interRAI-HC assessments to ensure that each potential subsidised resident admitted to aged residential care (either directly from the community or via in-patient care) has been assessed using the interRAI home care assessment tool within the 6 months before the date on which it is intended. The indicator below has been drafted by Central Technical Advisory Service’s Data Analysis and will be circulated to DHBs quarterly so that they are aware of how aged residential facilities in their district are performing against this measure and can take steps if necessary to remedy needs assessment and service coordination processes.

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Policy Priorities PP25: Prime Minister’s youth mental health project Summary information

Indicator: Progress update reports on actions to implement Initiatives 1, 3 and 5 of the Prime Minister’s Youth Mental Health Project

Measures Reporting

Type: Process Type: Qualitative and quantitative

Target: Provision of complete report Reporting frequency: Quarterly





PP25 reports on progress towards achieving three initiatives in the Prime Minister’s Youth Mental Health Project:

Initiative 1: School Based Health Services (SBHS) in decile one to three secondary schools, teen parent units and alternative education facilities

Initiative 3: Youth Primary Mental Health ((reported under PP26) Initiative 5: Improve the responsiveness of primary care to youth.

Note: Initiative 6 is reported under PP8, and Initiative 7 is reported under PP7.

Young people are often unable or reluctant to access primary care and mental health services. Often the services in their local area are geared towards treating adults or people with more acute needs. Young people may require a unique mix of social, developmental and health services, and their family GP may not have sufficient expertise to provide the full range of care needed. Young people can also feel uncomfortable discussing their issues with their usual family GP. To improve youth access to appropriate primary care services, young people need a range of sustainable youth-friendly health and social services, including:

youth specific services as appropriate for the locality, which may include youth wellness hubs/networks, School Based Health Services or Youth One Stop Shops (YOSS); and

General practice that is responsive to youth

Responsive primary care, YOSS, Youth Wellness Hubs, and other youth-friendly organisations provide young people with a wide range of services, including mental health services, in a non-judgemental and community-based environment. Youth-friendly services help young people to overcome their reluctance and enable them to open up about their issues. This can lead to significant improvements in their mental health and wellbeing, while assisting with other problems they may be facing.

Changes we would expect to see:

Primary care services are more responsive to the specific needs of young people Improved youth access to appropriate services Improved integration of services for youth Improved sustainability of youth-specific services, such as YOSS


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Actions and activities that have a proven impact on this measure:DHBs are expected to use the Alliance Leadership Team and youth Service Level Alliance Teams (SLATs) to jointly develop 2015/16 DHB Annual Plans for the Youth Services component of the Prime Minister’s Youth Mental Health Project. From 2014/15 every District Alliance shall have a youth SLAT to implement an integrated approach to improving the health and wellbeing of young people. Youth SLATs (or equivalent) shall have a mandate to make recommendations to the Alliance Leadership Team on local youth health needs and agreed changes to service provision, while providing oversight on the implementation of actions to improve youth health across the system.

The youth SLATs should include membership from youth specific health services, Social Sector Trials (SST) where they exist, and other relevant stakeholders (including the education and social sectors) as appropriate. Where SST are operating locally, DHBs are expected to work with local SST Leads for the actions identified to improve access to youth mental health and youth AOD services.

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Deliverables definitionsInitiative 1: School Based Health Services (SBHS) in decile one to three secondary schools, teen parent units and alternative education facilities.

1. Provide quarterly quantitative reports on the implementation of SBHS, as per the template provided. 2. Provide quarterly narrative progress reports on actions undertaken to implement Youth Health Care

in Secondary Schools: A framework for continuous quality improvement in each school (or group of schools) with SBHS.

Initiative 3: Youth Primary Mental Health

1. Provide quarterly narrative progress reports (as part of PP26 Primary Mental Health reporting) with actions undertaken in that quarter to improve and strengthen youth primary mental health (12-19 year olds with mild to moderate mental health and/or addiction issues) to achieve the following outcomes: early identification of mental health and/or addiction issues better access to timely and appropriate treatment and follow up equitable access for Maori, Pacific and low decile youth populations.

2. Provide quantitative reports using the template provided under PP26

Initiative 5: Improve the responsiveness of primary care to youth.

1. Provide quarterly narrative reports with actions undertaken in that quarter to ensure the high performance of the youth SLAT(s) (or equivalent) in your local alliancing arrangements.

2. Provide quarterly narrative reports with actions the youth SLAT has undertaken in that quarter to improve the health of the DHB’s youth population (for the 12-19 year age group at a minimum) by addressing identified gaps in responsiveness, access, service provision, clinical and financial sustainability for primary and community services for the young people, as per your SLAT(s) work programme.

ExpectationsRating Explanation

Achieved All actions, milestones and measures are on track.







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Policy priorities PP26: Rising to the Challenge: The Mental Health and Addiction Service Development Plan

Summary informationMeasures Reporting

Type: Input Type: Full report

Target: No target – supply of information Reporting frequency: Quarterly

Source data/template for reporting provided by: Not applicable

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and contributes to whole of sector outcomes:




Rising to the Challenge: The Mental Health and Addiction Service Development Plan (Rising to the Challenge) clearly articulates prioritised service developments for the next four years. The Plan aims to ensure that across the spectrum of primary, specialist treatment and support services access and responsiveness will be enhanced; integration will be strengthened while improving value for money and delivering improved outcomes for people using services.



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System IntegrationCancer (Health Target)Stroke ServicesCardiac ServicesHealth of Older PeopleShifting ServicesSystem Level MeasuresShorter Stays in Emergency Departments (Health Target)Whānau OraImproved Access to Diagnostics

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Improved Access to Elective Surgery (Health Target)Living Within our Means

Living Within Our MeansNational Entity Priority InitiativesNZ Health Partnerships Ltd


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Focus area 1: Primary Mental Health (Note - this focus area individually identified on performance dashboard)As part of the implementation of goal six Delivering increased access for adults with high-prevalence conditions while increasing service integration and effectiveness, the Ministry monitors access to evidence-informed psychological therapies for mental health and addictions issues in primary care.

Primary mental health and addiction interventions are for people presenting with mild to moderate mental health and addiction problems. In addition to the general primary care response to the needs of people of any age, access to primary mental health interventions are funded for the following specific population groups:

1. The enrolled adult population focused on Maori, Pacific and/or low income. The expected outcome is increased access to psychological and psychosocial interventions for these at-risk groups.

2. Youth primary mental health services, available to all youth in the 12 to 19 year age group (regardless of PHO enrolment) who require such a service. The expected outcomes are to enable early identification of developing mental health and/or addiction issues and better access to timely and appropriate treatment and follow up.

Reporting PeriodBy the 20th of January, April, July and October each year using the Ministry quarterly reporting website.

Reporting required: Each quarter, please update the reporting template provided (refer to the DHB quarterly reporting web site and toolkit).

Reporting (also links to PP25 Youth Mental Health Project for youth)1. Provide quarterly reports on the attached template which covers the amount of service delivered

including alcohol brief interventions (numbers of adults and youth (12-19) seen by ethnicity and services accessed). Grey boxes are optional but helpful particularly if outcome data is being captured locally.

2. Narrative report on the following: Overall assessment of the services delivered and Any major achievements/successes Major issues that have affected the achievement of the contracted Services

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Whether services have been externally evaluated / reviewed / audited and status of recommendations made.

Focus Area 2 District Suicide Prevention and Postvention (Note - this focus area individually identified on performance dashboard)

Suicide prevention and postvention plans were completed and agreed in mid 2015. Please report the following as result of the plan being implemented (note: this is not a comprehensive reporting requirement on every action identified in the plan):

Please select three actions from your plan to report on, and include highlights, challenges/exceptions and milestones. Please also note that when an action is completed then another action will need to be identified for reporting.

Focus Area 3 Improving Crisis response services

Reducing the demand on police for crisis support of known clients is an important interagency goal. There is a significant range in the rate of known clients referred by police crisis services. Please provide actions that have been undertaken to reduce the rate of known clients being referred by police to crisis teams and what difference have the above actions made to police referrals.

Focus Area 4 Improve outcomes for children

Please provide an exceptions report where actions identified in the annual plan for improving outcomes for children are not on track

Focus area 5 improving employment and physical health needs of people with low prevalence conditions:

Please provide an exceptions report where actions identified in the annual plan for improving the physical and employment outcomes of people with low prevalence conditions are not on track.

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Performance Dimension: ‘Achieving Government’s priorities and targets’

Policy Priorities PP27: Supporting Vulnerable ChildrenSummary information

Indicator: Progress on delivery of the actions and milestones identified in DHB Annual Plans support the implementation of the Children’s Action Plan and the Vulnerable Children Act 2014.

Measures Reporting

Type: Process Type: Progress update

Target: Actions and milestones agreed in APs Reporting frequency: Quarterly



Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders are healthier and more independent ’, and ‘the health system is cost effective and supports a productive economy’,This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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DHB non-financial monitoring framework and performance measures 2016/17R

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s ElectivesStroke ServicesCardiac ServicesHealth of Older PeopleMental Health and AddictionsHepatitis CMajor TraumaWorkforceInformation Technology

ContextThe cross-agency Children’s Action Plan (CAP), is a key priority for the Government. The CAP sets out what will be done to protect vulnerable children who are at greatest risk of maltreatment. The CAP supports the Prime Minister’s Better Public Services (BPS) Key Result Area for Supporting Vulnerable Children, particularly the result area of reducing child assaults by 5 percent by 2017. DHBs have an important role in supporting the implementation of the CAP and BPS. The White Paper (Volumes 1 & 2) and additional information about CAP can be accessed at www.childrensactionplan.govt.nz

DHBs, through delivering on the CAP, particularly through the support they provide to Children’s Teams, and other health sector initiatives that support the prevention and early identification of child maltreatment (such as VIP programmes, health professional training and implementation of the National Child Protection Alerts System and Shaken Baby Prevention programmes), will contribute to better coordinated services and improved outcomes for vulnerable children and their families/whanau.

Deliverables definitionsDHBs are required to provide a quarterly update identifying progress made during the quarter against the actions and milestones (deliverables) committed to in their Annual Plan. The progress update must include:

DHBs with Children’s Teams only the numbers (head count and FTE) and roles of staff participating in the children’s team, including Local Governance representation, Lead Professionals, Service Brokers, Panel members and any other role.

All DHBs the link to the online copy of the DHB’s child protection policy – Quarter 1 only exception reporting on child protection policies for funded providers: where the DHB has not yet included the requirement for providers of children’s services to adopt a child protection policy within the provider’s funding agreement, the DHB will report actions to introduce this requirement and to support providers to implement the policy exception reporting on safety checking: detail of individual instances where the DHB has not met the requirements for safety checking newly employed or engaged core and non-core children’s workers the number of existing staff found working in core children’s workers roles who have been suspended under s28 of the Act (identified as having committed a specified offence), and a summary of the DHB’s subsequent employment decisions for that worker actions or initiatives to reduce deaths and hospitalisations due to assault, neglect or maltreatment of children 0-14, including description of how initiatives are being (or will be) evaluated for success.

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http://www.childrensactionplan.govt.nz/


For additional activity the DHB must report:

Whether the DHB is on track meeting each deliverable, including comment on specific actions delivered in the quarter

Where deliverables are not on track the report must include mitigation strategies and new timeframes for delivery.


Table 1: Quarterly assessmentRating Explanation








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Performance Dimension: ‘Achieving Government’s priorities and targets’

Policy Priorities PP28: Reducing Rheumatic feverSummary information

Progress against the DHBs’ rheumatic fever prevention plan, report on root cause analysis and delivery of agreed acute rheumatic fever hospitalisation rates


Agreed in Annual Plan Type: progress update and exception report

Reporting frequency: quarterly

Source information for reporting provided by: Ministry sourced from NMDS






In June 2012, Cabinet agreed targets for the Better Public Services (BPS) key result areas. For rheumatic fever, the target is to reduce the incidence of rheumatic fever by two thirds to 1.4 cases per 100,000 people by June 2017. This is considered to be a stretch target that will be challenging to achieve. Rheumatic fever primarily affects school and intermediate-aged children and generally follows a Group A streptococcal throat infection. It is a preventable disease and can have serious consequences, such as the development of rheumatic heart disease. Rheumatic fever is unevenly distributed in New Zealand – it occurs mainly in the North Island, is strongly correlated with poor socio-economic status, and disproportionately affects Māori and Pacific people. This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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Actions and activities that have a proven impact on this measure:In order to achieve the overall reduction in rheumatic fever, DHB target numbers and rates have been set for each financial year to 2016/17. The target numbers and rates for 2013/14 and 2014/15 are shown in Table 1. The actions DHBs can take to improve performance are included in each DHB’s rheumatic fever prevention plan.The DHB rheumatic fever prevention plans identify the DHB’s approach and commitment to delivering a range of actions which will contribute to achieving their rheumatic fever target. The plans cover the period from 20 October 2013 to 30 June 2017.

Table 1: Acute rheumatic fever initial hospitalisation target rates and numbers per year by District Health Board (per 100,000 total population), 2011/12 and 2015/16

District Health Board

Rates Numbers

2009/10–2011/12

Baseline rate

(3-year average rate)

2013/14

Target:

10% reduction from baseline level

2014/15

Target:


2015/16

Target:


2009/10–2011/12

Baseline numbers

(3-year average rate)

2013/14

Target:


2014/15

Target:


2015/16

Target:


Northland 10.5 9.5 6.3 4.7 17 15 10 8

Waitemata 2.3 2.0 1.4 1.0 12 11 8 6

Auckland 3.2 2.9 1.9 1.4 15 14 9 7

Counties Manukau 13.2 11.9 7.9 5.9 66 62 42 32

Northern region 6.6 5.9 4.0 3.0 110 102 69 52

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Waikato 3.5 3.2 2.1 1.6 13 12 8 6

Lakes 7.8 7.0 4.7 3.5 8 7 5 4

Bay of Plenty 3.8 3.4 2.3 1.7 8 7 5 4

Tairawhiti 9.3 8.4 5.6 4.2 4 4 3 2

Taranaki 0.9 0.8 0.5 0.4 1 1 1 0

Midland region 4.1 3.7 2.5 1.8 34 31 21 16

Hawkes Bay 4.3 3.9 2.6 1.9 7 6 4 3

MidCentral 1.6 1.4 0.9 1.0 3 2 2 2

Whanganui 3.2 2.9 1.9 1.4 2 2 1 1

Capital and Coast 2.9 2.6 1.8 1.3 9 8 5 4

Hutt 4.9 4.4 2.9 2.2 7 6 4 3

Wairarapa 0.0 0.0 0.0 0.0 0 0 0 0

Central region 3.2 2.9 1.9 1.5 28 25 17 13

Southern region 0.4 0.4 0.3 0.2 5 4 3 2

New Zealand 4.0 3.6 2.4 1.8 177 162 109 83

The 2017 Better Public Service target for each DHB is included in the following table.DHB 2017 Better Public Service

target (rate per 100,000 total population)

Northland 3.5Waitemata 0.7Auckland 1.1Counties Manukau 4.5Waikato 1.2Lakes 2.6Bay of Plenty 1.3Tairawhiti 2.8Taranaki 0.3Hawke’s Bay 1.5MidCentral 0.6Whanganui 1.1Capital &Coast 1.0Hutt Valley 1.6Wairarapa 0.0Southern region 0.2New Zealand 1.4


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Update confirmed Sept 16 - all rheumatic fever reporting for 2016/17 will be expected to be provided via three templates for quarterly reporting as outlined below.These templates replace all other reporting templates used previously for PP28, CFA variation and CMS reporting and will be used for reporting against contracts with the Ministry of Health as well as on progress in implementing your Rheumatic Fever Prevention Plans.Please note DHBs will no longer required to submit monthly reports.

There are three templates, these can be found in the toolkit on the quarterly reporting website:I. Contract reportingII. Progress reporting for the rheumatic fever prevention plansIII. Systems failure analysis

Focus area 1 Reducing the Incidence of First Episode Rheumatic FeverPart 1: 1. Progress against target

2. Progress report for rheumatic fever prevention plan Each DHB with a high incidence of rheumatic fever (as defined in the guidance document for the rheumatic fever prevention plan issued in July 2013) must provide a progress report against the DHB’s rheumatic fever prevention plan. A template has been supplied by the Ministry in rheumatic fever prevention plan guidance documents. DHBs with a lower incidence of rheumatic fever are not required to report against their Rheumatic Fever Prevention Plan. The Ministry of Health will monitor the rheumatic fever hospitalisation rates in these DHBs through their general monitoring processes. If a DHB has a significant increase in rheumatic fever numbers or rates, they will be required to submit a more detailed action plan and will be required to report against progress.

3. Provide a report on the lessons learned and actions taken following reviews each quarter. A reporting template has been provided by the Ministry.

Part 2: Exception report

Hospitalisation rates per 100,000 DHB total population for acute rheumatic fever are above the target for the financial year.

Expectation and Deliverable:

Those DHBs with an acute rheumatic fever hospitalisation rate above the agreed target and outside a 95% confidence interval of agreed target are required to provide an exception report outlining the resolution plan the DHB has in place.

Data on acute rheumatic fever hospitalisation rates will be supplied by the Ministry.

Reporting Period Reporting required: Progress reports are required quarterly. Due to the reliance on NMDS data (where the deadline for submission is about one month after the end of the quarter), the data used to derive the hospitalisation measure will be for one quarter in arrears.

Expectations

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Rating: DefinitionAchieved Agreed target met or hospitalisation rate below target.

An achieved rating is applied when the DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Māori population group, and the Pacific population group. As 90% of hospitalisation for rheumatic fever are among Māori and Pacific populations, 'significant progress' for Māori and Pacific populations is defined as the DHB meeting the DHB target agreed in its Annual Plan.

Partially Achieved

DHB hospitalisation rate above agreed target (including not making agreed progress for Maori and Pacific population groups), and within a 95% confidence interval of agreed target.As 90% of hospitalisations for rheumatic fever are among Māori and Pacific populations, this rating is applied if the resolution plan supplied by the DHB includes actions specifically focused on improving results for the Maori and Pacific populations.

Not Achieved

DHB hospitalisation rate above agreed target and outside a 95% confidence interval of agreed target

Focus area 2: Facilitating the Effective Follow-up of Identified Rheumatic Fever Cases

Deliverable

DHBs are expected to provide confirmation and exception reports on progress in following-up known risk factors and system failure points in cases of first episode and recurrent acute rheumatic fever.

ExpectationsRating Explanation








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Policy Priorities PP29: Improving waiting times for diagnostic servicesSummary information

Measures Reporting

Target: Agreed targetType: Variation from expectation

Reporting frequency: Monthly

Source data/template for reporting provided by:

Coronary Angiography – data to be supplied by DHBs to the National Booking Reporting System (NBRS) in accordance with national collection reporting rules

Colonoscopy – data to be supplied by DHBs either to the NBRS, or via a generic template

Computed Tomography and Magnetic Resonance Imaging - each DHB is to provide monthly data on a generic template. Templates will be due 20 days after the end of the calendar month – a copy of the templates is attached

Link to outcomes Delivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’, and contributes to whole of sector outcomes:



Improved quality, safety and experience of care (individuals and their family/focus).Diagnostics are a vital step in the pathway to access appropriate treatment. Improving waiting times for diagnostics can reduce delays to a patient’s episode of care and improve DHB demand and capacity management.

Improving access to diagnostics will improve patient outcomes in a range of areas: Cancer pathways will be shortened with better access to a range of diagnostic modalities Emergency Department (ED) waiting times can be improved if patients have more timely access to

diagnostics Access to elective services will improve, both in relation to treatment decision-making, and also

improved use of hospital beds and resources Workforce opportunities can be explored to consider alternative and more efficient ways of providing

diagnostics

These efforts will help to promote and protect good health and independence, and contribute to the high level outcome of New Zealanders living longer, healthier and more independent lives.A multi-year programme commenced in 2012/13 and involves a staged approach being taken to improving waiting times for diagnostics (from receipt of referral to provision of diagnostic service).

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Link to priority areas of focusDelivery of this measure will support Better Sooner More Convenient Health Services for New Zealanders by ensuring people are provided more timely access to diagnostic services. Increasing delivery will improve access and reduce waiting times will increase public confidence that the health system will meet their needs.

Delivery of this measure will also support the 2016/17 key (strategic) planning approaches of regional collaboration and governance, and integration by encouraging DHBs to adopt a regional view of diagnostic service delivery. This requires improved integration across all clinical services, and patient pathways.



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Deliverables definitionsDescription:For 2016/17 the programme will involve deliverables in the following four modalities:

Coronary angiography Colonoscopy Magnetic Resonance Imaging (MRI) Computed Tomography (CT)

These procedures were identified because they are aligned with other health sector priorities, and because national or regional representative groups are established. The Ministry of Health has worked with clinical networks to establish nationally agreed expectations regarding what appropriate timeframes should be for these diagnostic modalities.

Refer to the Improving Waiting Times for Diagnostic Services Indicator Templates for more information on the deliverables, definitions and expectations.

Reporting Period Reporting required: Monthly reporting from as follows:

Elective coronary angiogram to be reported to the National Booking Reporting System (NBRS) in accordance with NBRS data dictionary reporting requirements.

CT, MRI and colonoscopy reporting templates to be submitted to the Ministry of Health within 20 days of the end of the previous month. The reporting template is emailed out by National Collections.

Performance monitoring against this measure will be undertaken quarterly via the non-financial performance monitoring framework as follows:

Quarter ResultsQuarter 1 September results

Quarter 2 December results

Quarter 3 March results

Quarter 4 June results

Expectations DHBs are required to collect, measure and monitor how long people are waiting for identified diagnostic procedures. Incremental improvements are required each year. Expectations for 2016/17 are:

1. Coronary angiography – 95% of accepted referrals for elective coronary angiography will receive their procedure within 3 months (90 days)

2. CT and MRI – 95% of accepted referrals for CT scans, and 85% of accepted referrals for MRI scans will receive their scan within 6 weeks (42 days).

3. Diagnostic colonoscopy –

a. 85% of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks (14 calendar days, inclusive), 100% within 30 days

b. 70% of people accepted for a non urgent diagnostic colonoscopy will receive their procedure within six weeks (42 days), 100% within 90 days

Surveillance colonoscopy

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c. 70% of people waiting for a surveillance colonoscopy will wait no longer than twelve weeks (84 days) beyond the planned date, 100% within 120 days

Performance Ratings for PP29: Improving waiting times for diagnostic servicesSeparate performance rating will be applied for each of the three expectation areas within this performance measure:

1. Coronary angiography (one indicator)2. Radiology (CT & MRI indicators)3. Colonoscopy (three indicators)

The following achievement scale will be applied for each of the three areas

Rating:Achieved The DHB has achieved all the waiting time indicator or indicators for the

respective diagnostic area

Partial Achievement The DHB has either:- achieved some, but not all, of the waiting time indicators for the

respective diagnostic area (for example, achieved the CT indicator but not the MRI indicator), and has provided a report that includes planned actions to lift performance; or

- achieved none of the indicators for the respective diagnostic areas, but shows improvement over the previous quarter, and has provided an adequate work-out plan to reach the target by year-end.

Not Achieved The DHB has not achieved the waiting time indicators for the respective diagnostic area, and has not demonstrated an adequate work-out plan to reach the target by year-end.

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Policy Priorities PP30: Faster cancer treatmentPart A: Faster cancer treatment – 31 day indicator

Link to outcomes Delivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’ and contributes to whole of sector outcomes:




Faster cancer treatment takes a pathway approach to care, to facilitate improved hospital productivity by ensuring resources are used effectively and efficiently. DHBs working towards achievement of Faster cancer treatment supports public trust in the health and disability system; and that these services can be used with confidence. Implementation of Faster cancer treatment requires existing capacity and resources to be maximised, this results in effective and efficient use of resources and supports the key planning consideration of value for money.

Implementing the overall faster cancer treatment programme supports the overarching goal of Better, Sooner, More Convenient Health Services for New Zealanders. Cancer treatment is provided across all DHBs, although not all DHBs provide all services. This requires DHBs to collaborate across boundaries to ensure services are integrated and patients receive a seamless service.

Actions to deliver improved performance in this focus area include: use of the Faster Cancer Treatment Indicators: Business Rules and Data Definitions and High

suspicion of cancer definitions (to ensure consistency of reporting improve the quality of data (volume of patients, number of tumour types, types of first treatment)

captured analysis of the data to identify areas for system and process improve along the patient pathway and

any differences in access or timeliness by ethnicity or geography. review and re-design of the coordination of treatment processes and booking processes to ensure

optimal use of capacity. This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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Long Term Conditions – Prevention, Identification and ManagementHealthy Families NZObesity (Health Target)Living Well with Diabetes

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Cardiovascular DiseaseTobacco (Health Target)Rising to the Challenge


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DeliverablesDHBs will be required to supply data monthly (within 20 days of the end of the month) via secure file transfer protocol on the length of time taken for patients to receive their first cancer treatment (or other management) from date of decision-to-treat.

The Faster cancer treatment 31 day indicator includes all patients who receive a publicly-funded first cancer treatment, irrespective of how they were initially referred.

Detailed information on the definitions, inclusions and process for submitting data to the Ministry of Health is outlined in Faster Cancer Treatment Indicators: Business Rules and Data Definitions (version 3.1, March 2014) available from: http://nsfl.health.govt.nz/accountability/performance-and-monitoring/business-rules-and-templates-reporting/faster-cancer.

The DHB of domicile is responsible for collecting and reporting information on their domiciled population even if it is not the DHB of:

receipt of referral service.

No further quantitative reporting is required as part of the quarterly reporting process.

DHBs are required to submit a quarterly qualitative report through the quarterly reporting database outlining:

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the activities being undertaken to ensure data quality and volumes delays identified along the cancer pathway and challenges with implementing Faster cancer

treatment actions taken and planned in response to the delays and challenges identified.

Reporting periodDHB achievement of the Faster cancer treatment 31 day indicator will be calculated based on six months rolling data as outlined in the table below:

Reporting quarter Achievement based on patients receiving their first cancer treatment between:

Quarter 1 1 April – 30 September

Quarter 2 1 July – 31 December

Quarter 3 1 October - 31 March

Quarter 4 1 January – 30 June

ExpectationsThe following achievement scale, which is aligned to the achievement scale for the Faster cancer treatment health target, will be applied:

Rating:

Achieved will apply where at least 85 percent of patients receive their first cancer treatment (or other management) within 31 days from date of decision-to-treat.

Partially Achieved will apply where less than 85 percent of patients receive their first cancer treatment (or other management) within 31 days from date of decision-to-treat, but the narrative comment satisfies the assessor that the DHB has a plan to improve achievement.

Not Achieved will apply where less than 85 percent of patients receive their first cancer treatment (or other management) within 31 days from date of decision-to-treat and the narrative comment does not satisfy the assessor that the DHB has a plan to improve achievement.

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Part B: Shorter waits for cancer treatment – radiotherapy and chemotherapy

Link to outcomes Delivery against this measure supports the health and disability system outcome of ‘New Zealanders living longer, healthier and more independent lives’, and the intermediate outcome of ‘the health and disability system and services are trusted and can be used with confidence’.

Continued performance of the DHB against this measure, ensuring the timely access to cancer treatment for everyone needing it, will support public trust in the health and disability system; and that these services can be used with confidence. Through the intermediate outcomes the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives.

Radiotherapy treatment is provided in the six cancer centre DHBs requiring DHBs to collaborate across boundaries to support continued achievement of this measure for the DHB’s domicile population. Chemotherapy treatment is provided in almost all DHBs and requires collaboration across boundaries to ensure services are integrated and patients receive a seamless service.

Achievement of this measure requires existing capacity and resources to be maximised, this results in effective and efficient use of resources and supports the key planning consideration of value for money.This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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Actions to deliver improved performance in radiotherapy include: use information systems that provide information on prospective demand management allowing

flexibility in management of workflow and scheduling undertake lean-thinking reviews to identify areas where the workflow can be streamlined from First

Specialist Assessment (FSA) to start of treatment to ensure patients start treatment within four weeks

undertake regular process reviews to identify system bottlenecks and ensure processes can be put in place to minimise the bottlenecks and / or impact of bottlenecks on target achievement

continue to upgrade and replace capital in timely manner to ensure appropriate capacity is maintained

improve training and education opportunities to improve the skill mix of key workforce include radiation therapists, medical physicists and radiation oncologists

implement strategies to support recruitment and retention of key workforce.

Actions to deliver improved performance in chemotherapy include: use information systems that provide information on prospective demand management allowing

flexibility in management of workflow and scheduling undertake lean-thinking reviews to identify areas where the workflow can be streamlined from FSA

to start of treatment to ensure patients start treatment within four weeks undertake regular process reviews to identify system bottlenecks and ensure processes can be put

in place to minimise the bottlenecks and / or impact of bottlenecks on target achievement implement strategies to support recruitment and retention of medical oncology and haematology

workforce.

DeliverablesAll patients ready-for-treatment, wait less than four weeks for radiotherapy or chemotherapy from decision to treat.

Radiotherapy – DHB of service (Cancer Centre DHB) reports all patients by DHB of domicileCompleted monthly templates that measure the interval between the decision-to-treat and the patient beginning radiation treatment along with other related measures, are supplied on time and complete from the DHB of service (Cancer Centre DHB) as detailed in the reporting template located on the nationwide service framework library web site NSFL homepage: http://www.nsfl.health.govt.nz/. Patients are identified by DHB of domicile.

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Chemotherapy – DHB of service reports all patients by DHB of domicileCompleted monthly templates that measure the interval between the decision-to-treat and the patient beginning chemotherapy treatment along with other related measures, are supplied on time and complete from all DHBs where chemotherapy treatment has commenced (DHB of service) as detailed in the reporting template located on the nationwide service framework library web site NSFL homepage: http://www.nsfl.health.govt.nz/. Patients are identified by DHB of domicile.

All DHBs – confirmation and exception reports Provide a report confirming the DHB has reviewed the monthly wait time templates produced by the DHB of service or its own DHB where treatment commenced at that DHB for the quarter.

Where the monthly wait time data identifies: any patients domiciled in the DHB waiting more than four weeks, due to capacity issues, and/or wait time standards were not met.

DHB of domicile must understand and report the resolution path being taken by the DHB of service where it does not provide radiotherapy or chemotherapy itself.

Interpretation issuesWhere there are clearly identified reasons for delays that meet the defined delay code criteria, other than service capacity issues, the target will be treated as met.

Reporting Period Monthly supply of templates (within two weeks of the end of the month) and quarterly supply of confirmation and exception reports, as per the following table:

Quarter For the time periodQuarter 1 1 July – 30 September

Quarter 2 1 October – 31 December

Quarter 3 1 January – 31 March


ExpectationsThe following achievement scale will be applied: Rating:

Achieved will apply, for all of the three months under review, where all patients ready-for-treatment receive treatment within four weeks from decision-to-treat (excluding delays that meet the defined delay code criteria).

Partially Achieved will apply, for two of the three months under review, where all patients ready-for-treatment receive treatment within four weeks from decision-to-treat (excluding delays that meet the defined delay code criteria).

Not Achieved will apply, for one month or more in the period under review, where some patients ready-for-treatment did not receive treatment within four weeks from decision-to-treat (excluding delays that meet the defined delay code criteria).

Note: Calculation of target achievement excludes Category D radiation patients.

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Policy Priorities PP31: Better help for smokers to quit in public hospitals (previous health target)

Summary information 95 percent of hospital patients who smoke and are seen by a health practitioner in a public hospital

are offered brief advice and support to quit smoking

Measures ReportingTarget: Target agreed in

Annual PlansType: Data & report



Hospital target data – supplied by DHBsAll reporting templates will be supplied by the Ministry.

Link to outcomes Delivery against this measure supports the health and disability system outcome of ‘New Zealanders living longer, healthier and more independent lives’, and contributes to whole of sector outcomes:



Improved quality, safety and experience of care (individuals and their family/focus).It also supports ‘a more unified and improved health and disability system’. The measure also supports the Government’s aspirational goal of a Smokefree New Zealand by 2025. Achieving a Smokefree New Zealand will mean that: our children and grandchildren will be free from exposure to tobacco and tobacco use the prevalence of smoking across all populations will be less than 5 percent tobacco will be difficult to sell and supply.

At present, tobacco smoking places a significant burden on the health of New Zealander’s and on the New Zealand health system. Tobacco smoking is related to a number of life-threatening diseases, including cardiovascular disease, chronic obstructive pulmonary disease and lung cancer. It also increases pregnant smokers’ risk of miscarriage, premature birth and low birth weight, as well as their children’s risk of Asthma and Sudden Unexplained Death in Infants (SUDI). Stopping smoking confers immediate health benefits on all people, and is the only way to reduce smokers’ risk of developing a smoking-related disease. Providing smokers with brief advice to quit increases their chances of making a quit attempt. The chance of that quit attempt being successful is increased if medication and/or cessation support are also provided. Most medications roughly double a smoker’s chance of quitting, but using medication in conjunction with a cessation support service (such as the Quitline or an Aukati KaiPaipa service) can increase a smoker’s chance of quitting by as much as four times.By ensuring that all health professionals are routinely providing their patients with advice and support to quit, DHBs are helping to ensure that people receive better health and disability services, and live longer and healthier lives. The following actions and activities are examples of initiatives that have had an impact on this measure: Mechanisms for capturing data are accessible and easy to use. Methods for referring patients to cessation support services are simple and succinct. Services are able to monitor their progress towards the target on a regular basis.

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Smokefree champions are in place within each ward, practice or service to provide motivation, education and support for the target.



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DeliverablesEach quarter, DHBs will be required to complete the template supplied by the Ministry (numerical and narrative sections must be completed). Local patient management systems will be used to capture the necessary data using the relevant ICD-10-AM codes (see table 1).

Table 1: Smoking related ICD-10-AM codes

Measurement of Target

ICD Code ICD Definition

Hospitalised F17.1 Mental and behavioural disorders due to use of tobacco, harmful use is 93


Measurement of Target

ICD Code ICD Definition

smokers assigned when a clearly documented relationship exists between a particular condition and smoking.

F17.2 Mental and behavioural disorders due to use of tobacco, dependence syndrome is assigned only when a formal diagnosis of ‘tobacco dependence syndrome’ has been made.

Z72.0 Tobacco use, current is assigned if the patient has smoked tobacco within the last month and when there is insufficient documentation available to qualify the assignment of either F17.1 or F17.2.

Advice and support

Z71.6 Counselling for tobacco use disorder is assigned in addition to a tobacco status code when a health care worker has provided either advice to quit smoking and/or cessation therapy while the patient is in hospital.- For completeness if Z71.6 coding exists in the absence of a code for

hospitalised smoker, then apply code Z72.0.

Those DHBs that do not meet the 95 percent target for the quarter must provide the Ministry with an action plan detailing how they will improve their result, and must begin reporting their results to the Ministry monthly.Eligible populationsAll adults who are: aged 15 years and over admitted to hospital either acutely or for elective procedures admitted as an inpatient; and identified as a current tobacco smoker at the time of admission (a current tobacco smoker is someone

who has smoked within the last four weeks). Explanation of termsFor the purpose of the hospital target a current smoker is someone who has smoked at all within the last four weeks. A facility is a place which may be a permanent, temporary or mobile structure, which health care users attend or are resident in, for the primary purpose of receiving health care or disability support services. This definition excludes supervised hostels, halfway houses, staff residences and rest homes where the rest home is the patient’s usual place of residence.For the purposes of data collection for the hospital target, private hospitals are excluded. Therefore, the facility type includes, but is not limited to, public hospitals, psychiatric hospitals and drug and alcohol treatment facilities.Reporting periodQuarterly reports must be submitted to the Ministry by the 20th of the month following the relevant quarter.Expectations All DHBs are expected to maintain performance of 95 percent for the hospital target. The achievement scale below will be applied to each of the target areas individually every quarter. Achievement Scale

Rating Definition

Achieved* The DHB has met the percentage target

Partial Achievement The DHB has not met target, but has improved on its result from the previous quarter.

Not Achieved The DHB has not met target, and its result has dropped since the previous quarter.

*From 2014/15 for all performance measures included in the Maori health plan this rating is applied when the DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Maori population group, and the Pacific population group.

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Performance Dimension: Meeting service coverage requirements and Supporting sector inter-connectedness

System Integration SI1: Ambulatory sensitive hospitalisations (ASH) ASH for zero to four-year-olds has been identified as a System Level Measure for 2016/17

The Ministry has recently undertaken a review of the definition and use of ASH data to ensure that it remains a meaningful measure of system performance.

ASH data has been collected and reported in New Zealand since 2001, as a proxy measure of avoidable hospital admissions. ASH conditions are a subset of all health conditions that are believed to be relatively amenable to out-of-hospital management. ASH rates are undoubtedly impacted by the quality of primary care services, but also by high quality population health care, and the interfaces between population health, primary/community care, and secondary/hospital care.

There have been changes over time in both systems of hospital care and hospital coding practices, and the revised Ministry ASH definition takes into account these changes. The focus will continue to be incremental reduction of ASH rates as a measure of high quality health care in a community setting, but with greater emphasis on equity for all New Zealanders.


Type: Exception report

Target: Target agreed in Annual Plan Reporting frequency: Six monthly

Source data/template for reporting provided by: Data supplied by Ministry (NMDS)






Reducing ambulatory sensitive hospital admissions (ASH) reflects the Ministerial priorities of timely patient care closer to home and value for money. Improvements in community-based care can reduce avoidable hospitalisations, and free up hospital staff and resources.

The Māori and Pacific Health Plans will show how the DHB plans to reduce ASH rates for Māori and Pacific populations to that of the total population.

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Link to priority areas of focusDelivery of this measure will require improved integration of services, and contribute to a reduction in the total number of unplanned hospital admissions, a substantial proportion of which are ambulatory sensitive. This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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Actions and activities that have a proven impact on this measureThese actions are best identified through a “whole of system” approach that engages patients and their families, as well as community and hospital based services. A number of activities have been shown to be effective in reducing avoidable hospitalisations - they include:

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1. System or institution-wide programmes to improve access to health services, especially for children and other underserved populations.

2. Comprehensive disease management programmes which are patient-focused and involve multidisciplinary teams.

3. Education and self-management programmes in association with disease management programmes.

4. Disease-specific management programmes, in particular for long-term conditions such asthma and ischaemic heart disease.

A Systematic Review that identified the effective interventions for reducing these admissions was published in 2008 by the Health Services Assessment Collaboration.9

Deliverables definitionsEach DHB is expected to provide a commentary on their latest 12 month ASH data which is available on the nationwide service framework library web site (NSFL) homepage: http://www.nsfl.health.govt.nz/. The data on this site is based on the DHB of domicile population, so all ASH admissions will be captured regardless of which hospital people are admitted to.

The DHB commentary may include additional district level data that is not captured in the national data collection and also information about local initiatives that are intended to reduce ASH admissions.

ASH per 100,000The number of ASH admissions per 100,000 population (DHB and national rates) are provided for two different age groups. These are 45 – 64 years and 0 – 4 years.

Please note that Ambulatory sensitive hospitalisations (ASH) rates for zero to four year olds has been confirmed as a System Level Measure for 2016/17. In relation to the SLM DHBs should identify a target that improves on their non-standardised baseline positon (this approach also applies to the 45-64 age band target included in the Annual Plan).

Māori Health PlanThe key metric against which targets are set, and DHBs monitored, is the ASH rate for the DHB Māori population (as a percentage of the National ‘total population’ ASH rate). This is a change from previous Annual Planning cycles intended to enhance the focus on equity for Māori and Pacific populations in particular. The change reflects a deliberate focus on addressing the marked inequity in ASH rates between Māori, Pacific, and other New Zealanders, as this represents the most significant and consistent quality issue related to ASH. Whilst the Māori ASH rates will determine target setting, the targets will be set with a view to eliminating the equity gap for all population groups over a 2-5 year period for both age bands.

Each ASH age band total population data is divided into: Māori Pacific – for the seven DHBs with the highest number of Pacific people. These are: Auckland,

Waitemata, Counties Manukau, Waikato, Capital and Coast, Hutt, and Canterbury Other

9 Basu, A., & Brinson, D. (2008). The effectiveness of interventions for reducing ambulatory sensitive hospitalisations: A Systematic Review. HSAC Report.

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Additional information can be found on the nationwide services framework library web site www.nsfl.govt.nz including five year trend data (DHB and national), which together with the condition level data assists with interpretation at a DHB level. Denominator: The DHB population is derived from Statistics NZ 2013 Census data and age standardised using the Indigenous Standard population.

Expectations Targets will be derived from DHB ASH rates for the Māori population. The baseline rates for the DHB will be compared with national total population rates, and targets set accordingly. The only exception to this is DHBs with Māori ASH rates at or below the national total population rates. For those DHBs, the target will be equity for all population groups within the DHB (Māori and Pacific within 5% of Total Population DHB ASH rates)

The ‘equity gap’ refers to the difference between the DHB Māori ASH rate and the national total population ASH rate, expressed as a percentage of the total population rate. For example, if the Waikato DHB Māori child ASH rate is 6,000 per 100,000 population, and the national total population child ASH rate is 4,000 per 100,000, the equity gap would be 50% (2,000 per 100,000 = 50% of the national total population rate).ASH targets will be set with a view to eliminating the equity gap over a 2-5 year period depending on baseline position. With this in mind, targets should be for reduction of the existing equity gap by at least ½ each year. If the equity gap is less than 10%, then the target would be to eliminate the equity gap (i.e. for DHB Māori ASH rates to be at or below national total population rates). ASH rates that are within 5% for Māori, Pacific, and Total Population would be considered to be equivalent.For DHBs with local Māori ASH rate presently equivalent to, or lower than the national total population ASH rate, the target should be to achieve equity for all population groups within the DHB. This would be reflected by ASH rates for Māori and Pacific that are within 5% of DHB total population rates.

Expected improvement should fall in the following ranges based on baseline position:Baseline Equity Gap Expected ImprovementDHB Māori ASH > 10% Above National Total Population Rate Halve the equity gapDHB Māori ASH 5-10% above National Total Population Rate Eliminate the equity gapDHB Māori ASH <5% Above National Total Population Rate (or less than National Total Population Rate)

Reduce DHB Māori and Pacific ASH rates to within 5% of DHB Total Population Rate (equity within the DHB)

Worked example:

Fictional DHB

Age Group Baseline DHB Māori rate

Per 100,000

Compared to national total

rate

Target % Targetrate

0 – 4 yearsNational Rate 6,000 per 100,000

Māori 5500 Below national rate

Equity within DHB

<5,000

Pacific 6500 <5,000

Total 5000 <5,000

45 – 64 Māori 6000 120% 110% <5,500

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yearsNational Rate 5,000 per 100,000

Pacific 7000 <5,500

Total 3600 <5,500

Additional DataAdditional condition level data is available to DHBs through the NSFL website.

Reporting Period Annual Plan and SLM Six monthly in the second and fourth quarters, (against results based on most complete previous 12 months’ data).Maori Health Plan - Six monthly in the first and third quarters, (against results based on most complete previous 12 months’ data).

Assessment CriteriaThese assessments will be based on analysis of the most complete 12 months rolling data available at the time of the assessment. The following achievement scale will be applied:

Rating:Outstanding Performer(3rd quarter only)

The DHB has met all targets agreed in the Annual Plan, and has similar ASH rates for Māori, Pacific, and “Total” populations.

Achieved An achieved rating is applied when the DHB has met all the targets agreed in its Annual Plan.A realistic resolution plan is provided that demonstrates how the DHB will achieve equitable ASH rates for Maori and Pacific.

Partially Achieved The DHB has not met all of the targets agreed in its Annual Plan.A realistic resolution plan is provided that demonstrates how the DHB will achieve target ASH rates for Maori and Pacific.

Not Achieved A realistic resolution plan that demonstrates how the DHB will achieve target ASH rates for Maori and Pacific has not been provided.

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Performance Dimension: Meeting service coverage requirements and supporting sector inter-connectedness

System Integration SI2: Delivery of Regional Service PlansSummary information

Target/performance expectation:Agreed in Regional and Annual Plans

Reporting progress report against actions in the regional implementation plan

Type: Qualitative


Source data/template for reporting provided by:Report to be provided by Shared service agency on behalf of DHBs.





By reporting on the regional performance measure the DHB demonstrates that they are collaborating regionally. This measure enables the formal monitoring of delivery of regional priorities and supports achieving the regional planning purpose. Regional planning objectives are to reduce clinical and financial vulnerability of services and improve service sustainability, reduce costs and improve quality, by coordinated service model development and coordinated planning of workforce and information technology. Delivery of this measure supports achieving improved system integration by linking commitments made in the Regional Service Plans (RSP) and Annual Plan (AP).

RSPs include the regional government priorities and may also include locally agreed regional priorities. The Ministry’s assessment of RSPs and quarterly reports is focussed on the government priorities. Per government priority area the regions are required to specify measures and deliverables as per the RSP guidance.



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Deliverables1. A single progress report will be supplied on behalf of the region, agreed by all DHBs within that region.

The report should focus on the actions agreed by each region as detailed in its RSP implementation plan.

For each government priority10, and its associated actions, the progress report will identify:

the nominated lead DHB/person/position responsible for ensuring the action is delivered

whether actions and milestones are on track to be met or have been met

performance against agreed measures and targets11; and

financial performance against budget associated budget associated with the action where applicable.

If actions/milestones /performance measures/financial performance are not tracking to plan a resolution plan must be in place and agreed. The resolution plan should include actions and regional decision-making processes being undertaken to agree to the resolution plan.

To streamline reporting individual DHBs will not be required to report on local actions to support regional priorities through their local DHB quarterly reports.

2. In quarters two and four regions are expected to provide the following information in support the implementation of integrated hepatitis C assessment and treatment services:

10 Regions may be requested to include specific updates on areas outside the government priorities on an as agreed basis. 11 In relation to the measures within the stroke priority area, regional indictor results are not required to be supplied as each DHB is supplying local performance data under PP20 focus area 4.

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Report six monthly broken down by quarters on the following measures:

Measures Data and source1. Number of people diagnosed with hepatitis C

per annum (by age).Total number of people with a positive HCV PCR test in the DHB region (data from 5 reference labs provided to regional DHBs).

2. Number of HCV patients who have had a Fibroscan in the last year(a) new patients(b) follow up(by age and ethnicity).

Total number of hepatitis C Fibroscans performed annually (data from the delivery of Fibroscans in primary and secondary care).

3. Number of people receiving PHARMAC funded antiviral treatment per annum (by age and ethnicity).

Total number of people prescribed antiviral treatment who have hepatitis C (data from PHARMAC provided to regional DHBs).

Reporting Period Quarterly

Reporting required: A reporting template will be developed to support consistency of approach across the regions.

Quarter For the time periodQuarter 1 1 July – 30 September

Quarter 2 1 October – 31 December

Quarter 3 1 January – 31 March


ExpectationsRegional progress in the delivery of each government priority area will be assessed quarterly according to the criteria outlined below:

Definitions of ratings of government prioritiesAchieved All health targets/deliverables/milestones have been tracking to plan;

Partially Achieved

Health targets have been achieved; some indicators/deliverables/milestones are not tracking to plan but an adequate resolution plan is in place; more clarification is required from the region.

Not Achieved One or more health targets indicators/deliverables/milestones have not been achieved; no adequate resolution plan is in place; there are delays in the implementation of the plan.

The overall report for this performance measure will get one rating based on the following criteria:

Definitions of ratings of overall regional reportAchieved All regional government priorities are tracking to plan

Partially Achieved

Some priorities are not tracking to plan but an adequate resolution plan has been provided.

Not Achieved One or more priorities are not tracking to plan and resolution plan is inadequate.

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System Integration SI3: Ensuring delivery of Service CoverageSummary information

Measures Reporting

Type: Output Type: Confirmation & exception

Target: Exceptions set out in APs Reporting frequency: Six monthly

Source data/template for reporting provided by: Not Applicable





By ensuring service coverage for its population and addressing service gaps, the DHB will increase the public’s trust and confidence that the health and disability system is able to provide them the services they may need. Providing these essential health services will contribute to the high level outcome of New Zealanders living longer, healthier and more independent lives.

This measure is included as a formal mechanism for ensuring service coverage gaps are transparently managed. The DHB monitoring framework focuses on key marker services. This measure allows performance failures in those service areas that are not routinely monitored to be formally managed within the accountability framework.

Delivery of this measure will support Better Sooner More Convenient Health Services for New Zealanders by ensuring that service risks are managed and Government’s decisions about the national minimum range of services to be made available to the public are delivered.

Delivery of this measure will also support the key (strategic) planning approaches of Improved Integration and Regionalisation by encouraging DHBs to collaborate to find solutions to service coverage issues and risks, especially in relation to vulnerable services and collectively ensure service coverage is delivered.



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Long Term Conditions – Prevention, Identification and ManagementHealthy Families NZObesity (Health Target)Living Well with Diabetes

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Actions and activities that have a proven impact on this measure:Actions that support resolution of service coverage gaps and issues may include: development and implementation of a work-out plan, employment of additional staff or equipment, funding additional volumes or making service(s) available through an alternate provider/DHB, or identifying funding, contractual, or other constraints, which must be addressed before the issue can be resolved.

Deliverables definitionsQualitative indicatorDHBs to report providing the following information:Report progress achieved during the quarter towards resolution of exceptions to service coverage identified in the Annual Plan, and not approved as long term exceptions, and any other gaps in service coverage identified by the DHB or Ministry through:• analysis of explanatory indicators• media reporting • risk reporting• formal audit outcomes• complaints mechanisms• sector intelligence.

Reporting Period

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Reporting required: Six Monthly, in the second and fourth quarters

ExpectationsDHBs are expected to ensure service coverage expectations are met, and to demonstrate resolution of service coverage gaps by reporting complete, comprehensive, and timely information on the deliverable outlined above, demonstrating an appropriate resolution plan is in place for identified issues, and adequate progress is being made against the resolution plan.• A partial achievement rating will be obtained when a DHB has a service coverage gap that has not

been agreed as a formal long term exception for the period of the DAP, and an appropriate resolution plan is supplied that demonstrates the DHB is making progress towards resolution of the service coverage gap.

• An achieved rating will be obtained when all service coverage expectations have been met for the period under review.

• An outstanding performer/sector leader rating does not apply for this risk-based measure.

Exception reporting Exception reports should include progress made towards resolution of service coverage gaps, including milestones for final resolution.

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System Integration SI4: Standardised Intervention Rates (SIRs)Summary information

Standardised Intervention Rates (SIRs) measure a DHB’s service delivery to their population relative to the service delivery in other DHBs, standardised to take account of variations in the population profiles of different DHBs. The Ministry will be monitoring DHB SIRs for cataracts, major joints, and cardiac services, including cardiac surgery, percutaneous coronary revascularization (angioplasty), and coronary angiography services.

Measures Reporting

Type: Impact Type: Exception

Target: Targets agreed in AP Reporting frequency: Annually cataracts major joints

Quarterly cardiac surgery coronary

angiography coronary angioplasty

Source data/template for reporting provided by: Data supplied by DHBs to the National Minimum Dataset, and report provided by Ministry. Reports will be loaded on Quickr.Note: While DHB reporting on cataracts and major joints is only required on an annual basis, update reports will be made available on Quickr quarterly to allow DHBs to monitor their progress.





Link to outcomesDelivery against this measure supports the health and disability system outcome of ‘New Zealanders living longer, healthier and more independent lives’ and the primary intermediate outcome that ‘People receive better health and disability services’. An additional outcome is ‘The health and disability system and services are trusted and can be used with confidence’.

Elective services, including cardiac, are an important part of the health care system for the treatment, diagnosis and management of health problems. Timely access to these services is also considered a measure of the effectiveness of the health system. Elective surgery is important to New Zealanders as these are essential services to reduce pain or discomfort, and improve independence and wellbeing. This is particularly the case for surgery such as cardiac, cataract, and major joint replacement procedures. To provide elective services at appropriate rates for its population, the DHB will need to improve or maintain access to key elective procedures, and ensure people receive better and more timely access to treatment.

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Improving relative access to electives will also contribute to delivery of the Government’s pledge to increase elective surgery by an average of 4,000 discharges year on year.

Meeting standardised intervention rates for a variety of types of surgery means that access is fair, and not dependent upon where a person lives. Knowing that access to services is equitable will improve the public’s trust and confidence in the public health system.

This measure will help improve people’s quality of life and help people to live longer, healthier and more independent lives.

Link to priority areas of focus

Delivery of this measure will support Better Sooner More Convenient Health Services for New Zealanders by improving or maintaining access to elective services, and ensuring people receive better and more timely access to health services, regardless of where they live.

Pathways to improve access for these conditions require seamless flow between primary and secondary care, and regional collaboration.This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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The following actions and activities are examples of initiatives that have a proven impact on this measure. 1. The Orthopaedic, Cataract and Cardiac Initiatives, which provided additional ring fenced funding for

joint, cataract and cardiac surgery – funding continues to be available to DHBs to support improved access to these procedures;

2. The Electives Initiative which has provided funding to improve access to a wide range of elective surgery, including cardiology inpatient treatment or diagnostics;

3. The Ambulatory Initiative which has provided funding to improve access to first specialist assessments, including cardiology, and to community referred diagnostics.

Deliverables definitionsQuantitative Indicator*Expectations

• For major joint replacement procedures, a target intervention rate of 21.0 per 10,000 of population will be achieved.

• For cataract procedures, a target intervention rate of 27.0 per 10,000 of population will be achieved.• For cardiac surgery12 a target intervention rate of 6.5 per 10,000 of population will be achieved.

DHBs with rates of 6.5 per 10,000 or above in previous years will be required to maintain this rate.• For percutaneous revascularization a target rate of at least 12.5 per 10,000 of population will be

achieved. • For coronary angiography services a target rate of at least 34.7 per 10,000 of population will be

achieved.• ICD10 codes for each of the procedure groups are included in the technical specification to this

document.

Qualitative IndicatorFor any procedure where the standardised intervention rate in the preceding 12 month period is significantly below the target level a report demonstrating:1. what analysis the DHB has done to review the appropriateness of its rate

AND2. whether the DHB considers the rate to be appropriate for its population13

OR3. a description of the reasons for its relative under-delivery of that procedure; and

12 Cardiac surgery is defined as coronary artery bypass graft (CABG), and valve replacement or repair (including transcatheter aortic valve implantation, and valve sparing aortic root procedures) for patients aged 15 and over.13 If a DHB deems the rate delivered to be appropriate then this must be supported with the analysis the DHB has done to review the appropriateness of its rate (as per 1 and 2 above). If the analysis is substantial enough to give confidence in the DHBs position, then this would be accepted, and an Achieved rating would be provided. If not, depending on the analysis provided, a Partial rating may be given. It is important to acknowledge that DHBs commit to SIRs in their annual plans. Analysis should be completed at least annually, and this should inform the rate which is agreed between the Ministry and the DHB. If a DHB considers that their SIR should be set lower than the national rate, then this analysis and discussion should be discussed with the Ministry as part of the annual planning cycle.

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4. the actions being undertaken in the current year (2016/17) that will ensure the target rate is achieved.

Reporting periodFor cataracts and major joints, annually as follows:

Quarter For the time periodQuarter 1 2015/16 financial year’s results

For cardiac services, reported quarterly as follows:

Quarter For the time period*Quarter 1 2015/16 financial year’s results

Quarter 2 2016/17 quarter 1 results

Quarter 3 2016 calendar year’s results

Quarter 4 2016/17 quarter 3 results

* Due to the reliance on NMDS data (where the deadline for submission is about one month after the end of the quarter), the data used to derive this measure will be for one quarter in arrears.

ExpectationsWhat are the Ministry’s expectations of performance?Quantitative measures Standardised intervention rates not significantly below the expected level.

Qualitative measuresThe analysis report (1 and 2 above) must cover the relationship between the secondary and primary sectors, including evidence of consultation with primary care as to the perceived level of access (does primary care have patients they consider should be able to access this procedure who cannot, or who they are no longer referring because of historic access issues, etc.). The report must also provide confirmation from the relevant service clinical director that the rate being provided is appropriate for the DHB population.

Unless the above information is provided, the Quarter One report (3 and 4 above) needs to outline actions being undertaken in the current year (2016/17) to achieve the required rate. Subsequent quarterly reports for cardiac services need to outline progress being made against these plans.

Baseline informationBaseline information can be found on the Electives restricted access website (Quickr). Current performance reports will be provided by the Ministry via the quarterly reporting database. Full standardised intervention rate information is available via Quickr, the restricted Electives website.

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WIES version The most current version of WIES available at the time baseline data is run. For 2016/17 this is New Zealand WIES version tbc methodology.

Standardisation Methodology

Date is standardised by - Age (5 year age bands)- Gender (Male, Female)- Ethnicity (Maori Pacific, Other)- Deprivation Quintile (NZ Dep 2006 Quintiles)

DHB data is standardised to the total New Zealand population using indirect standardisation methodology.

Direct standardisation methodology relies on there being a number of people in all possible population groups. If these criteria are not met there is a risk of unreliable intervention rates for population groups with very low numbers. The distribution of the standard population should not be markedly different from the study populations being compared.

However many of the possible population groups within some DHBs have few or no people, and the population profiles vary markedly between DHBs. Therefore, the indirect standardisation methodology is used to develop the DHB’s intervention rates, to avoid the risk of distortion.

The national intervention rate for each population group is applied to the same population group in each DHB, for all population groups, and these numbers are summed to give an expected number of procedures.

The observed (actual) number of procedures is divided by the expected number of procedures to give a standardised discharge ratio (SDR). The national intervention rate is multiplied by the SDR to give the standardised intervention rate for the DHB

SIR = total observed discharges x national intervention rate total expected discharges

= ∑ni x R∑piRi

Where:ni = the number of discharges in age, gender, ethnicity and dep group ipi = the population in age, gender, ethnicity and dep study group iRi = the national intervention rate for age, gender, ethnicity and dep group iR = the overall national intervention rate

Admission types:

• AC – Acute• AA – Arranged• AP – Private hospital elective admission

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• WN – Admitted from waiting list (Elective)

Principle health purchaser code:

• 13 – DHB base purchase (retired)• 20 – Overseas eligible• 34 – MOH funded purchase• 35 – DHB funded purchase

Purchase units:

All purchase units

ICD10 Codes included in the reports

To ensure no procedures are omitted from a procedure group, all relevant codes from all ICD versions are included in this list.

Type Code DescriptionCardiac Surgery 3849700 Coronary artery bypass, using 1 saphenous vein graftCardiac Surgery 3849701 Coronary artery bypass, using 2 saphenous vein graftsCardiac Surgery 3849702 Coronary artery bypass, using 3 saphenous vein graftsCardiac Surgery 3849703 Coronary artery bypass, using >= 4 saphenous vein graftsCardiac Surgery 3849704 Coronary artery bypass, using 1 other venous graftCardiac Surgery 3849705 Coronary artery bypass, using 2 other venous graftsCardiac Surgery 3849706 Coronary artery bypass, using 3 other venous graftsCardiac Surgery 3849707 Coronary artery bypass, using >= 4 other venous graftsCardiac Surgery 3850000 Coronary artery bypass, using 1 LIMA graftCardiac Surgery 3850300 Coronary artery bypass, using >= 2 LIMA graftsCardiac Surgery 3850001 Coronary artery bypass, using 1 RIMA graftCardiac Surgery 3850301 Coronary artery bypass, using >= 2 RIMA graftsCardiac Surgery 3850002 Coronary artery bypass, using 1 radial artery graftCardiac Surgery 3850302 Coronary artery bypass, using >= 2 radial artery graftsCardiac Surgery 3850003 Coronary artery bypass, using 1 epigastric artery graftCardiac Surgery 3850303 Coronary artery bypass, using >= 2 epigastric artery graftsCardiac Surgery 3850004 Coronary artery bypass, using 1 other arterial graftCardiac Surgery 3850304 Coronary artery bypass, using >= 2 other arterial graftsCardiac Surgery 9020100 Coronary artery bypass, using 1 other material graft, not elsewhere classifiedCardiac Surgery 9020101 Coronary artery bypass, using 2 other material grafts, not elsewhere classifiedCardiac Surgery 9020102 Coronary artery bypass, using 3 other material grafts, not elsewhere classifiedCardiac Surgery 9020103 Coronary artery bypass, using >=4 other material grafts, not elsewhere classifiedCardiac Surgery 3863700 Re-operation for reconstruction of occluded coronary artery graftCardiac Surgery 3845610 Open valvotomy of aortic valveCardiac Surgery 3848000 Repair of aortic valve, 1 leafletCardiac Surgery 3848100 Repair of aortic valve, 2 or more leafletsCardiac Surgery 3848300 Decalcification of aortic valve leafletCardiac Surgery 3848800 Replacement of aortic valve with mechanical prosthesisCardiac Surgery 3848801 Replacement of aortic valve with bioprosthesisCardiac Surgery 3848900 Replacement of aortic valve with homograftCardiac Surgery 3848901 Replacement of aortic valve with unstented heterograftCardiac Surgery 3845615 Other intrathoracic procedures on aortic valve without cardiopulmonary bypassCardiac Surgery 3865304 Other intrathoracic procedures on aortic valve with cardiopulmonary bypassCardiac Surgery 3848700 Open valvotomy of mitral valveCardiac Surgery 3848001 Repair of mitral valve, 1 leaflet

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Cardiac Surgery 3848101 Repair of mitral valve, >= 2 leafletsCardiac Surgery 3848501 Decalcification of mitral valveCardiac Surgery 3847500 Mitral valve annuloplastyCardiac Surgery 3847700 Mitral valve annuloplasty with ring insertionCardiac Surgery 3847702 Aortic valve annuloplasty with ring insertionCardiac Surgery 3848802 Replacement of mitral valve with mechanical prosthesisCardiac Surgery 3848803 Replacement of mitral valve with bioprosthesisCardiac Surgery 3848902 Replacement of mitral valve with homograftCardiac Surgery 3848500 Reconstruction of mitral valve annulusCardiac Surgery 3845616 Other intrathoracic procedures on mitral valve without cardiopulmonary bypassCardiac Surgery 3865305 Other intrathoracic procedures on mitral valve with cardiopulmonary bypassCardiac Surgery 3845611 Open valvotomy of tricuspid valveCardiac Surgery 3848002 Repair of tricuspid valve, 1 leafletCardiac Surgery 3848102 Repair of tricuspid valve, >=2 leafletsCardiac Surgery 3847501 Tricuspid valve annuloplastyCardiac Surgery 3847502 Aortic valve annuloplastyCardiac Surgery 3847701 Tricuspid valve annuloplasty with ring insertionCardiac Surgery 3848804 Replacement of tricuspid valve with mechanical prosthesisCardiac Surgery 3848805 Replacement of tricuspid valve with bioprosthesisCardiac Surgery 3848903 Replacement of tricuspid valve with homograftCardiac Surgery 3845617 Other intrathoracic procedures on tricuspid valve without cardiopulmonary bypassCardiac Surgery 3865306 Other intrathoracic procedures on tricuspid valve with cardiopulmonary bypassCardiac Surgery 3845601 Open valvotomy of pulmonary valveCardiac Surgery 3848806 Replacement of pulmonary valve with mechanical prosthesisCardiac Surgery 3848807 Replacement of pulmonary valve with bioprosthesisCardiac Surgery 3848904 Replacement of pulmonary valve with homograftCardiac Surgery 3848905 Replacement of pulmonary valve with unstented heterograft

Cardiac Surgery 3845618Other intrathoracic procedures on pulmonary valve without cardiopulmonary bypass

Cardiac Surgery 3865307 Other intrathoracic procedures on pulmonary valve with cardiopulmonary bypassCardiac Surgery 3849000 Reconstruction and re-implantation of subvalvular structures

Cardiac Surgery 3849300Operative management of acute infective endocarditis during heart valve procedure

Cardiac Surgery 3855000 Repair of ascending thoracic aortaCardiac Surgery 3855001 Replacement of ascending thoracic aortaCardiac Surgery 3855300 Repair of ascending thoracic aorta with aortic valve repairCardiac Surgery 3855301 Repair of ascending thoracic aorta with aortic valve replacement

Cardiac Surgery 3855600Repair of ascending thoracic aorta with aortic valve repair and implantation of coronary arteries

Cardiac Surgery 3855601Repair of ascending thoracic aorta with aortic valve replacement and implantation of coronary arteries

Cardiac Surgery 3855900 Repair of aortic arch and ascending thoracic aortaCardiac Surgery 3855901 Replacement of aortic arch and ascending thoracic aortaCardiac Surgery 3856200 Repair of aortic arch and ascending thoracic aorta with aortic valve repairCardiac Surgery 3856201 Repair of aortic arch and ascending thoracic aorta with aortic valve replacement

Cardiac Surgery 3856500Repair of aortic arch and ascending thoracic aorta with aortic valve repair and implantation of coronary arteries

Cardiac Surgery 3856501Repair of aortic arch and ascending thoracic aorta with aortic valve replacement and implantation of coronary arteries

Cardiac Surgery 3855302 Replacement of ascending thoracic aorta with aortic valve repairCardiac Surgery 3855303 Replacement of ascending thoracic aorta with aortic valve replacement

Cardiac Surgery 3855602Replacement of ascending thoracic aorta with aortic valve repair and implantation of coronary arteries

Cardiac Surgery 3855603Replacement of ascending thoracic aorta with aortic valve replacement and implantation of coronary arteries

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Cardiac Surgery 3856202 Replacement of aortic arch and ascending thoracic aorta with aortic valve repair

Cardiac Surgery 3856203Replacement of aortic arch and ascending thoracic aorta with aortic valve replacement

Cardiac Surgery 3856502Replacement of aortic arch and ascending thoracic aorta with aortic valve repair and implantation of coronary arteries

Cardiac Surgery 3856503Replacement of aortic arch and ascending thoracic aorta with aortic valve replacement and implantation of coronary arteries

Cataract 4269800 Intracapsular extraction of crystalline lensCataract 4270200 Intracapsular extraction of crystalline lens with insertion of foldable artificial lensCataract 4270201 Intracapsular extraction of crystalline lens with insertion of other artificial lens

Cataract 4269801Extracapsular extraction of crystalline lens by simple aspiration (and irrigation) technique

Cataract 4270202Extracapsular extraction of crystalline lens by simple aspiration (and irrigation) technique with insertion of foldable artificial lens

Cataract 4270203Extracapsular extraction of crystalline lens by simple aspiration (and irrigation) technique with insertion of other artificial lens

Cataract 4269802Extracapsular extraction of crystalline lens by phacoemulsification and aspiration of cataract

Cataract 4270204Extracapsular extraction of crystalline lens by phacoemulsification and aspiration of cataract with insertion of foldable artificial lens

Cataract 4270205Extracapsular extraction of crystalline lens by phacoemulsification and aspiration of cataract with insertion of other artificial lens

Cataract 4269803Extracapsular extraction of crystalline lens by mechanical phacofragmentation and aspiration of cataract

Cataract 4270206Extracapsular extraction of crystalline lens by mechanical phacofragmentation and aspiration of cataract with insertion of foldable artificial lens

Cataract 4270207Extracapsular extraction of crystalline lens by mechanical phacofragmentation and aspiration of cataract with insertion of other artificial lens

Cataract 4269804 Other extracapsular extraction of crystalline lens

Cataract 4270208Other extracapsular extraction of crystalline lens with insertion of foldable artificial lens

Cataract 4270209Other extracapsular extraction of crystalline lens with insertion of other artificial lens

Cataract 4269805 Other extraction of crystalline lensCataract 4270210 Other extraction of crystalline lens with insertion of foldable artificial lensCataract 4270211 Other extraction of crystalline lens with insertion of other artificial lens

Cataract 4273101Extraction of crystalline lens by posterior chamber sclerotomy with removal of vitreous

Cataract 4271900 Capsulectomy of lensCataract 4271902 Mechanical fragmentation of secondary membraneCataract 4272200 Capsulectomy of lens by posterior chamber sclerotomyCataract 4273100 Capsulectomy of lens by posterior chamber sclerotomy with removal of vitreousCataract 4273400 Capsulotomy of lensCataract 4273700 Needling of posterior capsule of lensCataract 4278800 Capsulotomy of lens by laserCataract 4279102 Corticolysis of lens material by laserCataract 4271600 Removal of juvenile cataractMajor Joints 4931800 Total arthroplasty of hip, unilateralMajor Joints 4931900 Total arthroplasty of hip, bilateralMajor Joints 4932400 Revision of total arthroplasty of hipMajor Joints 4932700 Revision of total arthroplasty of hip with bone graft to acetabulumMajor Joints 4933000 Revision of total arthroplasty of hip with bone graft to femurMajor Joints 4933300 Revision of total arthroplasty of hip with bone graft to acetabulum and femurMajor Joints 4933900 Revision of total arthroplasty of hip with anatomic specific allograft to acetabulumMajor Joints 4934200 Revision of total arthroplasty of hip with anatomic specific allograft to femur

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Major Joints 4934500Revision of total arthroplasty of hip with anatomic specific allograft to acetabulum and femur

Major Joints 9060700 Resurfacing of hip, unilateralMajor Joints 9060701 Resurfacing of hip, bilateralMajor Joints 4951700 Hemiarthroplasty of kneeMajor Joints 4951800 Total arthroplasty of knee, unilateralMajor Joints 4951900 Total arthroplasty of knee, bilateralMajor Joints 4952100 Total arthroplasty of knee with bone graft to femur, unilateralMajor Joints 4952101 Total arthroplasty to knee with bone graft to femur, bilateralMajor Joints 4952102 Total arthroplasty to knee with bone graft to tibia, unilateralMajor Joints 4952103 Total arthroplasty to knee with bone graft to tibia, bilateralMajor Joints 4952400 Total arthroplasty of knee with bone graft to femur and tibia, unilateralMajor Joints 4952401 Total arthroplasty of knee with bone graft to femur and tibia, bilateralMajor Joints 4953400 Total replacement arthroplasty of patellofemoral joint of kneeMajor Joints 4953000 Revision of total arthroplasty of knee with bone graft to femurMajor Joints 4953001 Revision of total arthroplasty of knee with bone graft to tibiaMajor Joints 4953300 Revision of total arthroplasty of knee with bone graft to femur and tibiaMajor Joints 4955400 Revision of total arthroplasty of knee with anatomic specific allograftMajor Joints 4953401 Total replacement arthroplasty of patellofemoral joint of kneeMajor Joints 4952700 Revision of total arthroplasty of kneeAngiography 3821500 Coronary angiographyAngiography 3821800 Coronary angiography with left heart catherisationAngiography 3821801 Coronary angiography with right heart catherisationAngiography 3821802 Coronary angiography with left and right heart catherisationAngioplasty 3530400 Percutaneous transluminal balloon angioplasty of 1 coronary arteryAngioplasty 3530500 Percutaneous transluminal balloon angioplasty of >= 2 coronary arteriesAngioplasty 3531000 Percutaneous insertion of 1 transluminal stent into single coronary arteryAngioplasty 3531001 Percutaneous insertion of >= 2 transluminal stents into single coronary arteryAngioplasty 3531002 Percutaneous insertion of >= 2 transluminal stents into multiple coronary arteriesAngioplasty 3830000 Percutaneous transluminal balloon angioplasty of 1 coronary arteryAngioplasty 3830300 Percutaneous transluminal balloon angioplasty of >= 2 coronary arteriesAngioplasty 3830600 Percutaneous insertion of 1 transluminal stent into single coronary arteryAngioplasty 3830601 Percutaneous insertion of >= 2 transluminal stents into single coronary arteryAngioplasty 3830602 Percutaneous insertion of >= 2 transluminal stents into multiple coronary arteriesAngioplasty 3830900 Percutaneous transluminal coronary rotational atherectomy [PTCRA], 1 artery

Angioplasty 3831200Percutaneous transluminal coronary rotational atherectomy [PTCRA], 1 artery with insertion 1 stent

Angioplasty 3831201Percutaneous transluminal coronary rotational atherectomy [PTCRA], 1 artery w insertion >= 2 stents

Angioplasty 3831500Percutaneous transluminal coronary rotational atherectomy [PTCRA], multiple arteries

Angioplasty 3831800Percutaneous transluminal coronary rotational atherectomy [PTCRA], multi arteries w insert 1 stent

Angioplasty 3831801Percutaneous transluminal coronary rotational atherectomy, multi arteries w insert >= 2 stents

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System Integration SI5: Delivery of Whānau Ora DHBs will contribute to achieving Whānau Ora across the whole of the health system focusing on progress in five key areas - mental health, asthma, oral health, obesity and tobacco – to achieve accelerated progress towards health equity for Māori; and where appropriate collaborating with Whānau Ora non-government organisation (NGO) Commissioning Agencies to benefit the health of whānau.

Summary informationMeasures ReportingHealth priority areas

Achievement rating of the relevant DHBs performance measure within the monitoring framework for the five health priority indicators (mental health, asthma, oral health, obesity and tobacco)

Health area reporting frequency:

As per key health area reporting requirements. No additional reporting is required.

Narrative report target:

Progress since last year Narrative report reporting frequency:

Annual

Source information for reporting provided by:

Not applicable





In November 2015, the Whānau Ora Partnership Group agreed to a set of indicators to support Whānau Ora. These indicators are part of the Whānau Ora Outcomes Framework.

The Whānau Ora Partnership Group is a crown-iwi advisory body responsible for the strategic leadership of Whānau Ora. Chaired by the Minister for Whānau Ora, it consists of equal membership comprising six representatives from the Iwi Chairs Forum (identified by the National Iwi Chairs Forum), and six Ministers representing the crown.

The Whānau Ora Partnership Group provides leadership to Whānau Ora by setting its direction and priorities and overseeing its progress and success. At a strategic level it informs complementary effort across ministerial portfolios and identifies opportunities between Iwi and the Crown to support shared development, aims and aspirations.

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The five government agencies, Ministries of Health, Finance, Education, Social Development, and Economic Development have indicated some key activities underway, or planned, to progress achievement of Whānau Ora short-term outcomes.

Within those, health sector activity will need to focus on progress in five key areas that contribute to Whānau Ora - mental health, asthma, oral health, obesity and tobacco – to achieve accelerated progress towards health equity for Māori and Pacific, and Whānau Ora in the next four years.

In addition to progress in these areas, DHBs will be expected to continue work with the three Whānau Ora Commissioning Agencies across the country.



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Actions and activities that have a proven impact on this measure:DHBs have a role in contributing to achieving Whānau Ora across the whole of the health system, and where appropriate collaborating with Commissioning Agencies to benefit the health of whānau.

As DHBs are required within the Annual Plan, and Māori Health Plan, to achieve agreed annual health targets, they are best placed to use the opportunity to demonstrate, and action, system-level changes to achieve Whānau Ora and health equity.

The Ministry expects that the whole health system contributes to Whānau Ora outcomes, by providing quality accessible health services to everyone living in New Zealand.

The DHB actions/activities that demonstrate this include:1. Commitments to having a heightened focus to achieve accelerated progress towards Whānau Ora and

health equity within the five health priorities, within the respective Annual or Māori Health Plans. It is expected that within the five health priorities, DHBs will support improved outcomes for Māori individuals, and their whānau. Linkages have been included within each of the health areas within the Annual and Māori Health Plans. This will be demonstrated through improved performance for the following indicators:

Key Area Indicator Used Annual or Māori Health Plan

Mental health reduced rate of Māori committed to compulsory treatment relative to non-Māori.

Māori Health Plan

Asthma reduced asthma and wheeze admission rates for Māori children (ASH 0-4 years).

Māori Health Plan

Oral health Increase in the number of children who are caries free at age 5.

Annual Plan

Obesity By December 2017, 95 percent of obese Māori children identified in the Before School Check (B4SC) programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions.

Annual Plan

Tobacco 95% of all pregnant Māori women smoke free at two weeks post-natal

Māori Health Plan

2. Active engagement and collaboration with Whānau Ora Commissioning Agencies. This could include involving local commissioning agencies in planning, working on joint projects/commissioning together or building strong relationships with the Commissioning Agencies for the benefit of whānau.

The three established Whānau Ora Commissioning Agencies are:

Te Pou Matakana (North Island Commissioning Agency)

Te Pūtahitanga o Te Waipounamu (South Island Commissioning Agency); and

Pasifika Futures (Commissioning Agency for Pacific families).

Performance reporting and deliverable definitionsProgress for how DHBs are achieving Whānau Ora in a measureable way will be completed in two methods.

Five priority health areasThe obesity and oral health priority health areas will be assessed based on the achievement rating of the relevant DHBs performance measures; and mental health, asthma and oral health through engagement related to progress made against programmes included in the Māori Health Plan. The indicators are included in the table above. It is expected that no additional data reporting is required.

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Annually in quarter four Five priority health areas

DHBs are recommended to provide additional narrative of other ways that they are supporting and/or delivering progress in the five priority health areas to support Whānau Ora, and the impact of this progress for whānau, where this is not covered by existing reporting requirements (a template will be provided ahead of the reporting period).

Commissioning AgenciesDHBs are required to provide an annual narrative report outlining how they are engaging with their relevant Whānau Ora Commissioning Agency, progress made on joint collaborations or investment, how well this has been achieved and the impact of their effort for whanau (this will be included in the template provided)

Expectations The following achievement scale will be applied:

Achieved Performance expectations are met across all the measures associated with the five priority areas and both narrative reports cover all areas indicated in the reporting template

Partially Achieved

Performance expectations are not met across all the measures associated with the five priority areas, but acceptable resolution plans are provided and both narrative reports cover all areas indicated in the reporting template

Not Achieved Performance expectations are not met across all the measures associated with the five priority areas, and acceptable resolution plans are not provided and/or one or both narrative reports do not cover all areas indicated in the reporting template

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System Integration SI7: SLM total acute hospital bed days per capita

Summary informationTotal acute hospital bed days per capita is being introduced as a System Level Measure in 2016/17.

Performance measure definition

Please refer to www.hqmnz.org.nz

System Level Measure Performance expectations and reporting

DHBs are expected to provide jointly agreed (by district alliances) System Level Measure improvement plans, including improvement milestones, the end of quarter one 2016/17. Assessment, and negotiations with DHBs as necessary, and approval of the improvement plans including improvement milestones (and baselines) by the Ministry will occur in quarter two 2016/17.

The System Level Measure improvement plans are expected to be reported through PP22 ‘Delivery of actions to improve system integration’

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System Integration SI8: SLM patient experience of care

Patient experience of care is a being introduced as a System Level Measure 2016/17. The new measure combines the previous developmental DHB hospital focused measure (DV4) with an additional section referencing primary care patient experience

Focus area 1: National inpatient survey

Summary informationImplementing a national approach to collection, measurement and use of patient experience information.

Measures ReportingTarget: Provide patient experience data

and establish baselines for future target


Quarterly


DHBs to supply data by either:- Submitting patient information to the national

survey provider (yet to be appointed) who will conduct the national patient experience survey and reporting on their behalf, or

- Providing completed national patient experience survey data to the national provider for incorporation in national reports.





Patient experience data is an important performance indicator, and is vital in driving service improvements. However, New Zealand does not have a consistent national approach to collection, measurement and use of patient experience information.

Recent international opinion has shifted from measuring patient satisfaction to measuring the broader concept of patient experience. Furthermore, studies have shown that patient / consumer experience is a good indicator of the quality of health services, with patient experience positively correlated to processes of care for prevention, disease management, and with adherence to medical advice and treatment plans. Better experience, stronger partnerships with consumers, and patient and family-centred care have been linked to improved health, clinical, financial, service and satisfaction outcomes.

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The focus on local needs for quality improvement is as important as consistent data for a national perspective. The indicators must be flexible enough to allow DHBs to plan and track local service-level improvements. They must be usable in DHB performance monitoring and accountability processes focused on hospitals, but also have more general application across the system, including in primary care.



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Actions to deliver improved performance in this focus area:The information gathered at local and national levels through these measures can be used to benchmark patient experience across the country and to improve services locally. The indicators are collected via surveys completed by patients, carers and family/whānau.

The aim of the national programme is to develop:121


- a nationally consistent model of patient experience indicators incorporating four key domains (communication, partnership, coordination, and physical and emotional needs) supported by additional questions

- a set of questions that can be incorporated in existing local patient experience surveys- adopting pre-existing and validated tools, where possible- an approach consistent with international best practice, to allow New Zealand data to be compared

with overseas results.

Deliverables definitions1. DHBs are expected to supply patient experience data according to the detailed information provided

in the requirements document published on the HQSC web site www.hqsc.govt.nz and the nationwide service framework library web site www.nsfl.govt.nz, that includes: the national patient experience survey methodological rules (including sample size and timing) patient data extract file specification correspondence examples national reporting rules and timeframes.

2. Each quarter DHBs will supply a report via the DHB quarterly reporting process: confirming patient experience data has been supplied according to the requirements document confirming the DHB has delivered the patient experience actions and milestones identified in its

Annual Plan identifying any local survey management issues providing a resolution plan if it has not delivered to requirements or to plan for any survey

management issues identified.

Reporting Period DHBs will supply patient experience data and confirmation reports in line with the following quarters:

Quarter For the time period1 e.g.1 July – 30 September

2 e.g.1 October – 31 December

3 e.g.1 January – 31 March

4 e.g.1 April – 30 June

Further detail on timing of data supply is specified in the requirements document.

Quarterly survey reports at national and DHB level will be made available by the national survey provider two weeks following the end of the quarter. DHBs will be able to see other DHBs reports.

ExpectationsAll DHBs submit data for a sample group of patients on all the core survey questions. The Ministry of Health and Health Quality and Safety Commission expects that DHBs will make improvements in the quality of the data in each quarter enabling baselines to be set and future performance expectations to be developed.

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DHBs are expected to include local patient experience information in their Quality Accounts.

Focus area 2: Primary care survey



System Level Measure Performance expectations and reporting in relation to both focus area 1 and 2



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System Integration SI9: SLM amenable mortality rate

Summary informationAmenable mortality is being introduced as a system level measure in 2016/17.



System Level Measure Performance expectations and reporting



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Performance Dimension: Providing quality services efficiently

Ownership OS3: Inpatient Average Length of Stay (ALOS)Summary information


Agreed in Annual Plan Type: Comprehensive measurement







By shortening hospital length of stay, while ensuring patients receive sufficient care to avoid readmission, the DHB will impact on the Ministerial priority of improved hospital productivity. This will be achieved through freeing up beds and other resources so the DHB can both provide more elective surgery and reduce length of stay in the emergency department.

There is a need for DHBs to manage within a slower funding growth path and make demonstrable productivity improvements to offset cost pressures and to meet wider Crown expectations (i.e. maintain per capita service coverage, achieve national Health Targets, and eliminate DHB deficits). Shortening hospital length of stay will also help to delay infrastructure expansion and/or make savings that can assist in reducing DHBs’ deficits.

Addressing the factors that influence a patient’s length of stay in hospital will require the DHB to consider its performance on other measures, such as reducing readmissions, and increasing its integration activities that strengthen the ability of primary care to treat people more appropriately in the community. Supporting patients to return home sooner may, in part, be achieved by reducing the rate of patient complications and better use of the time clinical staff spend with patients. Patients will also be less at risk of contracting nosocomial (or hospital-acquired) infections. Through these actions, the DHB will contribute to an improved patient experience.

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Actions and activities that have a proven impact on this measure:The following actions and activities are examples of initiatives that have a proven impact on this measure:

Implementing programmes such as The Productive Ward – Releasing Time to Care or Optimising the Patient Journey which focus on improving ward processes and environments to help nurses and therapists spend more time on patient care, thereby improving safety and efficiency

Process mapping and/or service redesign to improve the patient journey, reduce “waste” and improve primary care’s access to services

Improving rates of day of surgery admissions (DOSA) for elective patients Improving pre-admission programmes for elective patients

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Deliverables definitionsEach DHB will report against two ALOS measures – Part One: Elective surgical inpatient ALOSPart Two: Acute inpatient ALOS Both Part One and Part Two of the measure are calculated using information held in the National Minimum Data Set (NMDS), and do not require a separate DHB data submission.

Description:The standardised ALOS is the ratio of ‘observed’ (actual) to ‘predicted’ ALOS, multiplied by the nationwide inpatient ALOS.

The length of stay calculation includes day case events, and joins multiple discharge events where The events have the same NHI The events have the same DHB of Service The prior event ends in a transfer There is less than 24 hours between the end of one event and the start of the next event

Where multiple discharge events are joined, the admission type for the stay is the admission type of the first event. In the rest of this document:

An elective discharge is defined as a stay where the first or only event in the stay is elective An acute discharge is defined as a stay where the first or only event in the stay is acute

Other linking criteria are included in the Appendix 1: Technical Specifications1. Elective surgical inpatient average length of stay:

Quantitative Indicator

The standardised ALOS for inpatient discharges in a surgical specialty with an elective admission type, expressed as the ratio of the observed to predicted ALOS, multiplied by the nationwide elective surgical inpatient ALOS.

The DHB observed ALOS, and the nationwide elective surgical inpatient ALOS, are both defined as the total bed days for elective surgical inpatients discharged during the 12 months to the end of the quarter, divided by the total number of discharges for elective surgical inpatients during the 12 months to the end of the quarter.

The predicted ALOS is derived by taking the nation-wide ALOS for each grouping of patient discharges, defined by DRG cluster and complexity group, multiplying this by the proportion of total discharges this group represents, and summing the result across all discharge groups. A contingency table is used to provide the ALOS across all DHBs for each DRG and complexity group. This information is then used to calculate the standardised ALOS for the casemix DRGs within each DHB.

Exclusions:• where the first event in the stay doesn't have a valid DHB of service e.g. is missing• where every event in the stay is non-casemix• where the first event in the stay is not Elective• where the purchaser of the first event in the stay is not in a set list• where the stay is Elective and no event has a surgical purchase unit (ie the purchase unit code does

not start with “S”• where the last event in the stay ended in a transfer

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The purchase unit codes for the measure are included in Appendix 1: Technical Specification.

ExpectationsDHBs will be supplied with comparative baseline data for the twelve months to September 2014 showing performance relative to other DHBs.

The suggested target is 1.55 days, which represents the 75th centile of national performance.

For any DHB that is already achieving an elective surgical inpatient ALOS of tbc days or less in their baseline result (derived from the baseline data), a target that maintains their current performance or represents a modest improvement is suggested.

The Ministry will assume that 25 percent of the improvement towards target can be made each quarter, unless the DHB specifies otherwise.

Where the DHB is not achieving in line with the target, the DHB should provide information about any factors that are thought to be hindering achievement, and any actions being taken to gain improvements.

Reporting PeriodReported quarterly. Due to the reliance on NMDS data (where the deadline for submission is about one month after the end of the quarter), the data used to derive this measure will be for one quarter in arrears.

Performance Rating for Elective ALOS measureA separate performance rating will be applied for each expectation within this performance measure, i.e. the Elective Surgical Inpatient ALOS and the Acute Inpatient ALOS expectations.

The following achievement scale will be applied for the Elective Surgical Inpatient ALOS measure:

Rating:Achieved The DHB has achieved their agreed elective surgical inpatient ALOS target

for the quarter

Partial Achievement The DHB has not achieved the agreed target for the quarter, but has demonstrated an adequate work-out plan to reach the target by year-end.

Not Achieved The agreed ALOS target for the quarter has not been achieved, and the DHB has not demonstrated an adequate work-out plan to reach the target by year-end.

2. Acute inpatient ALOS:

Quantitative Indicator The standardised ALOS for acute discharges in any medical or surgical specialty, expressed as the ratio of the observed (actual) to predicted ALOS, multiplied by the nationwide acute inpatient ALOS.

The DHB observed ALOS, and the nationwide acute inpatient ALOS, are both defined as the total bed days for acute medical or surgical inpatients discharged during the 12 months to the end of the quarter, divided by the total number of discharges for acute inpatients during the 12 months to the end of the quarter.

The predicted ALOS is derived by taking the nation-wide ALOS for each grouping of acute medical or surgical patient discharges, defined by DRG cluster and complexity group, multiplying this by the proportion of total discharges this group represents, and summing the result across all discharge groups.

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Exclusions: • where the first event in the stay doesn't have a valid DHB of service e.g. is missing• where every event in the stay is non-casemix • where the first event in the stay is not acute • where the purchaser of the first event in the stay is not in a set list• where the last event in the stay ended in a transfer.

ExpectationsDHBs will be supplied with comparative baseline data for the twelve months to September 2015 showing their performance relative to other DHBs.

The suggested target for 2016/17 is 2.35 days, which represents the 75th quartile of national performance.

For any DHB that is already achieving an acute inpatient ALOS of 2.35 days or less in their baseline data, a target that maintains their current performance or represents a modest improvement is suggested.

The Ministry will assume that 25 percent of the improvement towards target can be made each quarter, unless the DHB specifies otherwise.

Where the DHB is not achieving in line with the target, the DHB should provide information about any factors that are thought to be hindering achievement, and any actions being taken to gain improvements.

Reporting PeriodReported quarterly. Due to the reliance on NMDS data (where the deadline for submission is about one month after the end of the quarter), the data used to derive this measure will be for one quarter in arrears.

Performance Rating for ALOS measuresA separate performance rating will be applied for each expectation within this performance measure, i.e. the Elective Surgical Inpatient ALOS and the Acute Inpatient ALOS expectations

The following achievement scale will be applied for the Acute Inpatient ALOS measure:

Rating:Achieved The DHB has achieved their agreed acute inpatient ALOS target for the

quarter


Not Achieved The agreed ALOS target for the quarter has not been achieved, and the DHB has not demonstrated an adequate work-out plan to reach the target by year-end.

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Appendix 1: Technical Specifications

WIES version:The most current version of WIES available at the time baseline data is run. For 2015/16 this is NZ WIES version tbc.

DHB of service:Hospital agency codes are used to derive DHB of service.Where the stay has multiple events, the DHB which provides the first event will be considered to be the DHB of Service WIES recognised private facilities are excluded.

Joining Discharge Events into StaysDischarge events are considered to be part of the same stay if:

The events have the same NHI The events have the same DHB of Service The prior event ends in a transfer There is less than 24 hours between the end of one event and the start of the next event

If an event starts before the end of a previous event with the same NHI, its start time is set to the end time of the prior event

If an event ends before the end of a previous event with the same NHI, its end time is set to the end time of the prior event

The quarter before the 12 month time period is also loaded to help detect long stays.

Only stays which end within the 12 month time period are included.

Determining Stay Information Where there is more than one discharge event in a stay, the following criteria are usedDHB of Services = the DHB that provided the first eventStart Date =; the earliest event start dateEnd Date = the latest event end dateAdmission Type = the admission type of the first discharge eventDRG = the DRG of the highest caseweight eventPCCL = the PCCL of the highest caseweight eventCaseweight = the sum of every events' caseweightLength of Stay = the sum of the duration (in hours) of every event in the stay

Calculating Length of Stay

Each discharge event's length is calculated, rounded to the closest half hour, then summed together. No adjustment is made for leave days. Non-casemix events have their length set to zero

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Admission types: Where multiple discharge events are joined, the admission type for the stay is the admission type of the first event.

Elective surgical inpatient ALOS:

An elective discharge is defined as a stay where the first or only event in the stay has an admission type of:• AP – Private hospital elective admission• WN – Admitted from waiting list (Elective)

Acute inpatient ALOS:

An acute discharge is defined as a stay where the first or only event in the stay has an admission type of:

• AC – Acute• ZC – Acute, discontinued code

All other admission types, including arranged types, are excluded. Views from the sector are that while it is important to manage the length of stay for arranged admissions, inclusion of arranged admission type in either the acute or elective calculation can mask trends, and make the measures less useful. For this reason, arranged admissions are excluded from both calculations.

Principal health purchaser code:

The principal purchaser code for the first or only event in the stay must be in • 20 – Overseas eligible• 34 – MOH funded purchase• 35 – DHB funded purchase

Purchase units

Elective Surgical Inpatient ALOS:

S00001 General Surgery - Inpatient Services (DRGs)S05001 Anaesthesia Services (inpatient)S15001 Cardiothoracic - Inpatient Services (DRGs)S25001 Ear Nose and Throat - Inpatient Services (DRGs)S30001 Gynaecology - Inpatient Services (DRGs)S35001 Neurosurgery - Inpatient Services (DRGs)S40001 Ophthalmology - Inpatient Services (DRGs)S45001 Orthopaedics - Inpatient Services (DRGs)S55001 Paediatric Surgical Services (DRGs)S60001 Plastic & Burns - Inpatient Services (DRGs)S70001 Urology - Inpatient Services (DRGs)S75001 Vascular Surgery - Inpatient Services (DRGs)

Acute Inpatient ALOS:

All medical or surgical purchase units that are casemix included.

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How the data is standardisedStandardisation is a process by which health delivery data is adjusted to take account of variations in the characteristics of different population or service delivery groups. This provides a basis for comparison for different populations or providers with different service mixes.

Often data is standardised by age, but data can be standardised by any characteristic that needs to be statistically controlled.

In deciding what variables to use to standardise the data, the effect of various factors such as sex, deprivation, age, ethnicity and rurality on ALOS were tested using regression methods. It was found that the only factors that had a statistically significant effect across all DRGs were admission type (acute or elective), and patient complexity and co-morbidity. Other factors have therefore been omitted from routine consideration.

ALOS is standardised to reflect differences in the type of service provision and is broken down into the following groups:

DRG cluster Patient Complexity and Comorbidity level (pccl)

The DRG cluster is the first three characters of the DRG code. The national ALOS is calculated by these groups using all DHB data for the relevant time period.

The individual DHB data is split by the same DRG cluster and pccl groupings so the record level DHB length of stay can be compared to the national DRG cluster and pccl grouping ALOS.

The data used for the ALOS calculation is:Stays - the number of inpatient stays by DHB meeting the ALOS criteria

Expressed mathematically:standardised ALOS

∑observed length of stayDHB ∑observed length of stayNational

∑ predicted length of stayDHB ∑staysNational

The predicted length of stay is calculated by creating a contingency table of DRG by Complication & Comorbidity Code.

A discharge group is defined by the combination of DRG cluster (first three characters of the DRG) and the pccl group. Standardisation by discharge group is carried out using a contingency table approach14.

The standardised ALOS adjusts for differences between the DHB observed length of stay and the predicted length of stay based on the mix of the services the DHB provides and the ALOS for each DRG cluster. This ratio is applied to the national rate to give a standardised rate.

This method of standardising means that the overall rate is not skewed by the relative proportion of data within each DHB DRG cluster group. All methods of standardisation need to be qualified in that they cannot control for or mitigate data quality or administrative practices.

141 In deciding what variables to use to standardise the data, the effect of various factors such as sex, deprivation, age, ethnicity and rurality on ALOS were tested using regression methods. It was found that the only factors that had a statistically significant effect across all DRGs were admission type (acute or elective), and patient complexity and co-morbidity. Other factors have therefore been omitted from routine consideration. .

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Performance Dimension: Providing quality services efficiently

Ownership OS8: Reducing Acute Readmissions to Hospital

The readmission model currently in use is based on work carried out in 1991, with some technical adjustments made in 1995/96.

A recent assessment suggests there is a need for review and re-development of the model. This work is currently underway with changes to the measure yet to be confirmed. However, it is anticipated that the acute readmissions model will be begin to be implemented with data sharing in quarters one and two of 2016/17 and with more formal reporting by DHBs for quarters three and four of 2016/7.


Agreed in Annual Plan Type: Comprehensive measurement


Quarterly

Source data/template for reporting provided by: Not applicable – data from NMDS





An unplanned acute hospital readmission may often (though not always) occur as a result of the care provided to the patient by the health system. Reducing unplanned acute admissions can therefore be interpreted as an indication of improving quality of acute care, in the hospital and/or primary care. , ensuring that people receive better health and disability services. Through the intermediate outcome that people receive better health and disability services, the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives while receiving better care closer to home. This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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Living Well with DiabetesCardiovascular DiseaseTobacco (Health Target)Rising to the Challenge


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Actions and activities that have a proven impact on this measure:The following actions and activities are examples of initiatives that have a proven impact on this measure: Focus on effective management of long term conditions Process mapping and redesign of patient pathways, particularly to improve primary care access

to services to diagnose and treat people in the community Initiatives to improve hospital discharge processes Appropriate integration between secondary and primary services to ensure continuity of care for

patients.

Deliverables definitions Ownership 8: Acute Readmissions to Hospital is calculated from information held in the National Minimum Data Set (NMDS), and does not require a separate DHB data submission.

The following admissions are excluded: Where the admissions is non-casemix Where the admission is for palliative care Where the DHB of service is unknown

The following readmissions are excluded: Where the readmission is non-acute

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Where the readmission is more than 28 days from the previous admission Where the readmission is within 24 hours and has a transfer flag Where the readmission matches a list of planned readmissions Where the readmission is a statistical readmission Where any previous admission ended in patient’s death

Readmissions are grouped by the DHB of service. Where the admission and readmission occur in different DHBs, the readmission is counted toward the first DHB.

Ownership 8 provides both standardised and unstandardized acute readmission to hospital rates for each DHB. The standardised rate is calculated using a regression method, and is designed to control for differences in admissions to DHBs, i.e. ethnicity, age, complexity. The formula used to calculate it is:

Reporting PeriodReported quarterly. Due to the reliance on NMDS data (where the deadline for submission is 21 days after the end of the month of discharge), and due to the time lapse required in order to observe 28 day readmissions, this measure will operate using data that is one quarter in arrears.

ExpectationsDHBs will be supplied with comparative data on performance relative to other DHBs and suggested target ranges. There is some flexibility for DHBs to go outside suggested target ranges where DHBs can demonstrate this is in the interests of wider objectives. (As well as measuring DHB performance against target for the standardised measure, the target will be converted to an unstandardised rate to facilitate DHB measurement of performance between quarters.)

Please note: This definition and expectations also apply for over 75 readmissions

DHBs are to state their year-end target. The Ministry will assume that 25 percent of the improvement towards target can be made each quarter, unless the DHB specifies otherwise.

Where the DHB is not achieving in line with target, the DHB should provide information about any factors that are thought to be hindering achievement, and any actions being taken to gain improvements.


Rating:Achieved The DHB achieves the agreed target for the quarter.


Not Achieved The agreed target for the quarter has not been achieved, and the DHB has not demonstrated an adequate work-out plan to reach the target by year-end.

For the final year-end assessment, a simple achieved/not achieved rating will apply.

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Ownership OS10: Improving the quality of identity data within the National Health Index (NHI) and data submitted to National Collections

Summary informationImproving the quality of identity data within the National Health Index (NHI) and event data submitted to the National Collections Systems (NCS).

Measures Reporting

Type: Output Type: Comprehensive measurement

Target: Pre-Set Reporting frequency: Quarterly


Data to be supplied by DHBs as required by the Operational Policy Framework (OPF)





By ensuring the quality of the data it provides to the National Collections Systems, the DHB will impact the outcome of unifying and improving the health and disability system. Quality data supports good policy making, decision-making and planning. It also helps identify and address issues and improve services across the whole health and disability system through improving hospital productivity. This happens through DHBs sharing their information, and monitoring and analysis done by the Ministry of Health and health researchers. DHBs are the primary data stewards of the NHI as the master ‘source of truth’ patient identity system used by all health providers. Ensuring that patient identity is correctly established, confirmed and maintained means that DHBs are able to accurately identify patients, and make sure clinicians can access all relevant health information, previous history and warnings and alerts for them. This means increased patient safety, leading to the health and disability system and services being trusted and used with confidence. It also means reduced duplication and consequent reduction of time and effort spent resolving duplicates to maintain unique identifiers. This measure has key linkages to 2016/17 Government planning priorities as highlighted:


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By ensuring the quality of the data it provides to the National Collections Systems, the DHB will impact the outcome of unifying and improving the health and disability system. Quality data supports good policy making, decision-making and planning. It also helps identify and address issues and improve services across the whole health and disability system through improving hospital productivity. This happens through DHBs sharing their information, and monitoring and analysis done by the Ministry of Health and health researchers.

DHBs are the primary data stewards of the NHI as the master ‘source of truth’ patient identity system used by all health providers. Ensuring that patient identity is correctly established, confirmed and maintained means that DHBs are able to accurately identify patients, and make sure clinicians can access all relevant health information, previous history and warnings and alerts for them. This means increased patient safety, leading to the health and disability system and services being trusted and used with confidence. It also means reduced duplication and consequent reduction of time and effort spent resolving duplicates to maintain unique identifiers.

Actions and activities that have a proven impact on this measure:Following are the actions and activities that have a proven impact on the indicators within this measure:

NHI

New NHI registration in error (causing duplication): Users of the NHI interface must be fully trained in search and evaluation techniques and receive regular refresher training to maintain skills and knowledge. DHBs should provide feedback to individuals involved in instances of duplication detected by monitoring. Business processes should support users in establishment, confirmation and maintenance of identity – eg. use of forms for patients to record details. DHB subscribing Patient Management System (PMS) interfaces to the NHI must be compliant with relevant Standards and technical specifications at all times and present correct and meaningful warning and error messages.

Recording of non-specific ethnicity: Users of the NHI interface must be fully trained in ethnicity collection and recording processes as set out in the Ethnicity Data Protocols for the Health & Disability Sector. DHB’s should provide feedback to individuals involved in instances of recording non-specific values in either new registration

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or update of records. Business processes should support users in accurate collection and recording eg. use of the Standard ethnicity question, follow-up with a presenting patient to obtain specific ethnicity if a referral was received with no or non-specific ethnicity. DHB subscribing Patient Management System (PMS) interfaces to the NHI must be compliant with relevant Standards and technical specifications at all times.

Address validation quality: Users of the NHI interface must be fully trained in recording patient addresses in a way which validate against the Standard. DHBs should provide feedback to individuals involved in instances of poor quality addresses where validation should have been possible. Business processes should support users in accurate collection, recording and validation of addresses. DHB subscribing Patient Management System (PMS) interfaces to the NHI must be compliant with relevant Standards and technical specifications at all times.

Invalid NHI data updates causing potential identity confusion (overlay): Users of the NHI interface must be fully trained in the process of confirming and maintaining patient identity information i.e. selection of the correct person/record and updates to existing data elements of name, DOB, gender or address. DHB’s should provide feedback to individuals involved in instances of updates to these data fields that are subsequently confirmed to be invalid. Business processes should support users in accurate collection and recording of data elements eg, seeking additional confirmation of a change in DOB. DHB subscribing Patient Management System (PMS) interfaces to the NHI must be compliant with relevant Standards and technical specifications at all times and present correct and meaningful warning and error messages.

National collections

Assessment of data reported to the NMDS. It is recommended that DHBs monitor the standard classification concepts versus the clinical statements for the specified range of diagnosis codes.

The Ministry encourages DHBs to update their business processes so that detailed information is recorded in the clinical record and is made available to enable clinical coders to extract the detailed clinical statements to improve the clarity and context of the information reported to the NMDS. Where standard classification concepts are reported to the NMDS this is an indication that the clinical record lacked detailed information. DHBs are encouraged to work with clinical staff and clinical coders to ensure the information recorded in the clinical record provides the specificity for quality clinically coded data to be reported to the NMDS.

Timeliness of NNPAC data: This is a new measure; however DHBs that are successful on this indicator have a data warehouse which holds data across all of their outpatient services. They will continually monitor data quality and update their records and have regular communication with other DHBs in their region.

NBRS events for exited treated patients match to NNPAC or NMDS events: DHBs that are successful on this indicator have integrated patient management systems for NBRS and outpatient and inpatient data. They use the data from both sources as part of their patient reporting and internal performance monitoring.

National Collections file load success rate: DHBs that are have a high file load success rate for NMDS, NBRS, NNPAC and PRIMHD data are those organisations that have built the business rules into their extracts. They also use the same data to monitor and report within their own organisations as they report to the national collections; thus any systemic data quality issues are identified before the information is provided to the Ministry of Health.

PRIMHD data quality: PRIMHD data will be assured by a routine internal audit thus any systematic data quality issues are identified before the information is provided to the Ministry of Health.

Deliverables definitionsThis measure has three parts as set out below:

Focus area 1: Improving the quality of identity data within the NHI

Focus area 2: Improving the quality of data submitted to National Collections

Focus area 3: Improving the quality of the Programme for the Integration of Mental Health data (PRIMHD)

Focus area 1: Improving the quality of identity data within the NHI

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Indicator 1: New NHI registration in error (causing duplication)

Numerator: Number of new NHI registrations requiring subsequent linking by MOH per DHB per quarter. It excludes pre-allocated NHI numbers used, newborn NHI registrations and unidentified patient NHI registrations. It is cumulative across the quarter.

Denominator: Total number of new NHI registrations per DHB per quarter (excluding pre-allocated NHI numbers, newborn registrations and unidentified patient NHI registrations).

Indicator 2: Recording of non-specific ethnicity in new NHI registration

Numerator: Total number of new NHI registrations with ethnicity recorded as ‘Not Stated’ (99) or ‘Response Unidentifiable’ (97) per DHB per quarter. It excludes pre-allocated NHI numbers used and unidentified patient NHI registrations. It is cumulative across the quarter.

Denominator: Total number of new NHI registrations per DHB per quarter (excluding pre-allocated NHI numbers, and unidentified patient NHI registrations)

Indicator 3: Update of specific ethnicity value in existing NHI record with a non-specific value

Numerator: Total number of updates to any ethnicity field in an existing NHI record with a non-specific value(‘Not Stated’ [99] or ‘Response Unidentifiable’ [97]) where a specific value existed in that field, per DHB per quarter

Denominator: Total number of NHI ethnicity updates per DHB per quarter

Indicator 4: Invalid NHI data updates

Numerator: Confirmed incorrect updates Denominator: Total number of queried updates

Reporting PeriodTo be reported quarterly.ExpectationsThe table below illustrates the Ministry’s expectations for each measure:

Rating

Not Achieved– Escalation Required

Partial Achievement Achieved

Outstanding Performer/ Sector

Leader

Mea

sure

1 New NHI registration in error (duplication)

SEE NOTE BELOW reA, B and C

A > 6% A>4% and <= 6% A

>2% and <= 4% A

<= 2%

B > 4% B>3% and <= 4% B

>1% and < =3% B

<=1%

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C > 12% C>6% and <=12% C

>1.5% and<= 6% C

<= 1.5%

2 Recording of non-specific ethnicity in new NHI registration

Greater than 4%>2% and < or equal to 4%

>05% and < or equal to 2%

< or equal to 0.5%

3. Update of specific ethnicity value in existing NHI record with a non-specific value

Greater than 4%>2% and < or equal to 4%

>05% and < or equal to 2%

< or equal to 0.5%

4. Validated addresses excluding overseas, unknown and dot (.) in line 1

< or equal to 70%>70% and < or equal to 76%

>76% and < or equal to 85% Greater than 85%

5. Invalid NHI data updates

Still to be confirmed

NOTE: this indicator will not be measured for at least Q1 and

Q2 2014-15




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DHB’s have been split into 3 groups for measure 1 based on volumes of new registrations (this is to take into account the effect of small numbers on percentages to better reflect actual performance)

GROUP A GROUP B GROUP C

Auckland Bay of Plenty South Canterbury

Canterbury Hawkes Bay TairawhitiCapital and Coast Hutt Valley Wairarapa

Counties Manukau Lakes West Coast

Southern Mid Central Whanganui

Waikato Nelson MarlboroughWaitemata Northland

Taranaki

DHBs must provide explanations if ratings are ‘not achieved’ or ‘partially achieved’ and submit plans for improvement and/or remediation.

Focus area 2: Improving the quality of data Submitted to National Collections DHB results from production data reported to the national collections will be the basis for the initial assessments. All DHBs can provide feedback on their performance. This will inform the Ministry about data quality activities in the DHB and it will also be taken into account when assigning the final ratings.

Description:National Collections and Reporting (Information Group, National Health Board) have developed a quarterly toolkit showing results for each DHB by measure.

Indicator 1: NBRS collection has accurate dates and links to NNPAC and NMDS.

For all Exited Treated patients in the NBRS there is an event with the same procedure date in NMDS with matching PMS Unique ID or NNPAC with matching Client System Identifier.

Numerator: Total number of records reported as Treated Exited in NBRS where an event with the same procedure date exists in NMDS or NNPAC per DHB per quarter.

Denominator: Total number of records reported as Treated Exited in NBRS per DHB per quarter.

Indicator 2: National Collections File load Success

Numerator: Number of PRIMHD, NMDS, NNPAC and NBRS records successfully submitted per DHB per quarter.

Denominator: Total number of PRIMHD, NMDS, NNPAC and NBRS records submitted per DHB per quarter.

Note: The rating for this measure will be an average of the rating across all 4 collections. A breakdown of the percentage and rating for each individual collection will be provided.

Indictor 3: Assessment of data reported to the National Minimum Data Set (NMDS)

Numerator: Number of clinical statements for specific diagnosis codes (M00 to M99, S00 to T98, U50 to Y98 (excluding M30 to M36, U739, Y920, Y9249, Y929, X59)) per DHB per quarter.

Denominator: Total number of specific diagnosis codes (M00 to M99, S00 to T98, U50 to Y98 (excluding M30 to M36, U739, Y920, Y9249, Y929, X59)) per DHB per quarter.

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Indicator 4: Timeliness of National Non-admitted Patient (NNPAC) data

Numerator: Total number of publicly funded NNPAC events loaded into the NNPAC more than 21 days post month of discharge per DHB per quarter.

Denominator: Total number of publicly funded NNPAC events in the NNPAC per DHB per quarter.

This measure only applies to records reported for mandatory purchase units where the reporting requirements were published in the PUC Data Dictionary at the beginning of the financial year

Note: The last submitted date will be used to calculate this measure to account for instances where the Ministry are late to load the files that have been submitted.

Explanation of terms

Assessment of data reported to the NMDS

This measure refers to the distinction between the use of standard classification concepts (as per ICD-10-AM and 3MTM CodefinderTM) and clinical statements for specific diagnosis codes submitted to the NMDS. Standard classification concepts limit the usefulness of data, as they lack detail and specificity. DHBs are, therefore, encouraged to record and report clinical statements by adding detailed text extracted from the clinical record to improve the clarity and context of the information reported. This measure focuses on musculoskeletal diagnoses, injuries, poisonings and certain other consequences of external cause and external cause i.e. those in the range M00 to M99, S00 to T98 and U50 to Y98 (excluding M30 to M36, Y920, Y9249, U739, Y929, X59).

NBRS links to NNPAC and NMDS NBRS data is used to manage elective booking lists. The links between NBRS and NMDS/NNPAC provides high quality information about the surgeries that is consistent and robust, and also minimises risks of patients being accidentally exited without treatment. This ability to trace a patient’s episode across the national collections is central to developments in this area.

Timeliness of NNPAC data: Calculated as the difference between the date a record is loaded into NNPAC and the date of service reported in the record. 21 days includes weekends and public holidays. This is the timeliness requirement signed up to in the Operational Policy Framework. Further several DHBs have been deleting their whole years NNPAC data and re-submitting it within days of the end of year wash-up. This measure is to allow users to have a measure of the consistency of the data in this collection.

National Collections File Success Rate This is the success rate of NNPAC, NMDS, NBRS and PRIMHD records submitted by the DHB in the quarter. DHBs are required to reach an high level to achieve compliance and this measure is to ensure that they continue to achieve a rate of 98% or above. Accurate file loading ensures that the national collections data is timely and complete.

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DHBs should explain their improvement plans for where their ratings fall into the ‘not achieved’ or ‘partially achieved’ levels.

Reporting PeriodTo be reported quarterly, with a toolkit placed on the Quickplace website.

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ExpectationsThe table below illustrates National Collections and Reporting’s expectations for each measure:

Rating

Not Achieved– Escalation Required

Partial Achievement Achieved

Outstanding Performer/ Sector

Leader

Mea

sure

1 NBRS links to NNPAC and NMDS.

Less than

95%

Greater than or equal to 95% and

less than 97 %

Greater than or equal to 97% and less than 99.5 %

Greater than or equal to 99.5%

2 National Collections File load Success

Less than

95%


less than 98 %

Greater than or equal to 98% and less than 99.5 %

Greater than or equal to 99.5%

3 Assessment of data reported to the NMDS

Less than 60%Greater than or

equal to 60% and less than 75%

Greater than or equal to 75%

N/A

4 NNPACtimeliness

Less than

85%


less than 95 %


less than 98 %

Greater than or equal to 98%

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Performance Dimension: purchasing the right mix and level of services within acceptable financial performance

Output 1: Mental health output Delivery against Plan

Summary informationTarget/performance expectation:Agreed in Annual Plan (Production Plan)

Reporting

Type: Comprehensive measurement


Source data/template for reporting provided by:Mental Health area (for part B)




Improved quality, safety and experience of care (individuals and their family/focus).This measure has key linkages to 2016/17 Government planning priorities as highlighted:


Ann

ual P

lan

prio

ritie



yes


Living Within our MeansLiving Within Our Means

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National Entity Priority InitiativesNZ Health Partnerships Ltd


Reg

iona

l Ser

vice

Pl

an P

riorit

ies Electives



DescriptionEach DHB must monitor, evaluate and report on the delivery of Mental Health Services set out in its Annual Plan Production Plan.

For Mental Health Services provided by the DHB’s provider arm, the DHB must complete the Mental Health Volumes Reporting template. This will be provided by the Ministry, and included with the main quarterly reporting template.

Reporting PeriodReported quarterly.

Expectations


Rating: DefinitionAchieved Volume delivery for specialist Mental Health and Addiction services is within:

a) five percent variance (+/-) of planned volumes for services measured by FTE,b) five percent variance (+/-) of a clinically safe occupancy rate of 85% for inpatient services measured by available bed day, andc) actual expenditure on the delivery of programmes or places is within 5% (+/-) of the year-to-date plan.

Partial Achievement Volume delivery is outside the bounds for an ‘Achieved’ rating and the accompanying exception reporting is satisfactory.

Not Achieved Volume delivery is outside the bounds for an ‘Achieved’ rating and the accompanying exception reporting is not satisfactory.

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Developmental measures DV4: Improving patient experience

Summary informationImplementing a national approach to collection, measurement and use of patient experience information.

Measures ReportingTarget: Provide patient experience data

and establish baselines for future target


Quarterly


DHBs to supply data by either:- Submitting patient information to the

national survey provider (yet to be appointed) who will conduct the national patient experience survey and reporting on their behalf, or

- Providing completed national patient experience survey data to the national provider for incorporation in national reports.


Linkages: This performance measure is also included in the Integrated performance and incentive framework (primary care)

Signalled for future development

Link to outcomes Delivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’,This measure has key linkages to 2016/17 Government planning priorities as highlighted:


Ann

ual P

lan

prio

ritie



System IntegrationCancer (Health Target)Stroke Services

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Cardiac ServicesHealth of Older PeopleShifting ServicesSystem Level MeasuresShorter Stays in Emergency Departments (Health Target)Whānau OraImproved Access to DiagnosticsImproved Access to Elective Surgery (Health Target)



yes

Reg

iona

l Ser

vice

Pl

an P

riorit

ies Electives


Patient experience data is an important performance indicator, and is vital in driving service improvements. However, New Zealand does not have a consistent national approach to collection, measurement and use of patient experience information.

Recent international opinion has shifted from measuring patient satisfaction to measuring the broader concept of patient experience. Furthermore, studies have shown that patient / consumer experience is a good indicator of the quality of health services, with patient experience positively correlated to processes of care for prevention, disease management, and with adherence to medical advice and treatment plans. Better experience, stronger partnerships with consumers, and patient and family-centred care have been linked to improved health, clinical, financial, service and satisfaction outcomes.

The focus on local needs for quality improvement is as important as consistent data for a national perspective. The indicators must be flexible enough to allow DHBs to plan and track local service-level improvements. They must be usable in DHB performance monitoring and accountability processes focused on hospitals, but also have more general application across the system, including in primary care.

Actions to deliver improved performance in this focus area:The information gathered at local and national levels through these measures can be used to benchmark patient experience across the country and to improve services locally. The indicators are collected via surveys completed by patients, carers and family/whānau.

The aim of the national programme is to develop:- a nationally consistent model of patient experience indicators incorporating four key domains

(communication, partnership, coordination, and physical and emotional needs) supported by additional questions

- a set of questions that can be incorporated in existing local patient experience surveys- adopting pre-existing and validated tools, where possible- an approach consistent with international best practice, to allow New Zealand data to be compared

with overseas results.

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Deliverables definitionsDHBs are expected to supply patient experience data according to the detailed information provided in the requirements document published on the HQSC web site www.hqsc.govt.nz and the nationwide service framework library web site www.nsfl.govt.nz, that includes:

the national patient experience survey methodological rules (including sample size and timing) patient data extract file specification correspondence examples national reporting rules and timeframes.

Each quarter DHBs will supply a report via the DHB quarterly reporting process: confirming patient experience data has been supplied according to the requirements document confirming the DHB has delivered the patient experience actions and milestones identified in its

Annual Plan identifying any local survey management issues providing a resolution plan if it has not delivered to requirements or to plan for any survey

management issues identified.

Reporting Period DHBs will supply patient experience data and confirmation reports in line with the following quarters:

Quarter For the time period1 e.g.1 July – 30 September

2 e.g.1 October – 31 December

3 e.g.1 January – 31 March

4 e.g.1 April – 30 June

Further detail on timing of data supply is specified in the requirements document.

Quarterly survey reports at national and DHB level will be made available by the national survey provider two weeks following the end of the quarter. DHBs will be able to see other DHBs reports.

ExpectationsAll DHBs submit data for a sample group of patients on all the core survey questions. The Ministry of Health and Health Quality and Safety Commission expects that DHBs will make improvements in the quality of the data in each quarter enabling baselines to be set and future performance expectations to be developed.

DHBs are expected to include local patient experience information in their Quality Accounts.

Baseline information

To be established from 2014/15 and subsequent data reported.

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Developmental measures DV6: SLM youth access to and utilisation of youth appropriate health services

Detail not yet available

Developmental measures DV7: SLM number of babies who live in a smoke-free household at six weeks post natal

Detail not yet available

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Appendix 1: NZ organised acute stroke service specifications and stroke rehabilitation service specifications (refer PP20)

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155


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