Download - Clinical Governance and Health Reform
![Page 1: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/1.jpg)
CLINICAL GOVERNANCE andHEALTH REFORM
AUSTRALIASIAN COLLEGE FOR EMERGENCY MEDICINE 27th
ANNUAL SCIENTIFIC MEETING
CANBERRA –
23 November 2010
Professor Jim Bishop AOChief Medical Officer
Australian Government Department of Health and Ageing
![Page 2: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/2.jpg)
Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP)
7538
5004
4627
42104079 4063 3970
3793 3737 3696 36773540 3470
3359 33533129 3060 3008 2902 2870
2729 2687 2683
2151
1801 1781 1737
14371213
999852 767
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
1. Refers to insured population rather than resident population. 2. Current expenditure. 3. 2006. 4. 2007. Source: OECD, OECD Health Data, June 2010
Public expenditure on health Private expenditure on health
OECD HEALTH DATA 2010How Does AUSTRALIA Compare
![Page 3: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/3.jpg)
AUSTRALIA’S RANKING AMONGOECD COUNTRIES 1987-2006
Source: AIHW Australia’s Health 2010
![Page 4: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/4.jpg)
Projected Burden of Major Disease Groups, 2010
Source: AIHW Australia’s Health 2010
![Page 5: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/5.jpg)
BROAD CAUSE MORTALITY TRENDS IN AUSTRALIA
Source: AIHW
![Page 6: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/6.jpg)
CANCERS WITH REDUCING DEATH RATES 1997 to 2006 –
ALL AGES
Lung, -18.5Colon, -19.6 Prostate, -19.7
Leukaemia, -23.7
Stomach, -29.4
Head and Neck, -23.7
Bladder, -18.5
Testicular, -42.2
Breast, -13.8
Cervix, -38.3
NHL, -25.1
Unknown, -24.8
Rectum, -19.9
Bowel, -19.7
All cancers, -13.8
, -24.3
-18.5
Kidney, -24.1
, -15.2
-31.9
, -21.1
-19.0-19.0
, -18.9
-7.9
-45
-40
-35
-30
-25
-20
-15
-10
-5
0
Male FemaleSource: Tracey et al, Cancer Institute NSW
![Page 7: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/7.jpg)
Source: AIHW Australia’s Health 2010
AGED ADJUSTED DEATH RATESFrom CVD, 1907 -
2006
![Page 8: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/8.jpg)
Source: AIHW Australia’s Health 2010
CHRONIC PULMONARY DISEASEMORTALITY 1980 to 2007
![Page 9: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/9.jpg)
Source: AIHW Australia’s Health 2010
PREVALENCE OF CURRENT ASTHMA 2007-08
![Page 10: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/10.jpg)
Source: AIHW Australia’s Health 2010
DEATH RATES FROMINFECTIOUS DISEASES, 1922-2007
![Page 11: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/11.jpg)
NSW POPULATION AGE
DISTRIBUTIONS, MALE (1977 –
2036)
Source: Cancer Institute NSW
![Page 12: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/12.jpg)
TOTAL CANCER CASES & DEATHS per year (1972 to 2036)
Source: Cancer Institute NSW
![Page 13: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/13.jpg)
TRENDS IN LEADING CAUSESOF DISEASE BURDEN 2003-2023
Source: AIHW Australia’s Health 2010
![Page 14: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/14.jpg)
Commonwealth Government Health& Hospital expenditure under the NHHN
Source: Commonwealth Budget Papers, DOHA and PMC Analysis
![Page 15: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/15.jpg)
HEALTH REFORM
Increasing expenditure to $15 billion 2010/11
Additional $7.3 billion over 4 years
Local Hospital Networks (LHN) 60% Federal Funds (60% of research and teaching)
Medicare locals (100% Federal funds)
GP Super-clinics –
multi disciplinary teams (100% Federal Funds)
![Page 16: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/16.jpg)
MEDICARE LOCALS
Identification and response to local health needs
Integrated and coordinated care for the patient
Support clinicians to improve care
Implement new primary care initiatives
Accountable for efficiency and quality
OBJECTIVES
![Page 17: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/17.jpg)
BUDGET 2010-11
e-Health –
connecting patients, providers and information systems
The Government will establish a personally controlled electronic
health record system ($466.7m)
The system will:
Enable people –
and their chosen health provider -
to
access online their key health information when and where it is needed, for their care across the health system.
Allow people to register online to establish a personally controlled electronic health record from 2012-13
Rigorous governance
Privacy maintained
![Page 18: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/18.jpg)
HEALTH REFORM
KEY NEW STRUCTURES
National Performance Authority
Independent Hospital Pricing Authority
Expanded Australian Commission of Safety and Quality in Health Care (ACSQHC)
![Page 19: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/19.jpg)
SUPPORTS FOR CLINICAL DECISION MAKING
Evidence Base
Highest Impact
Range of best practice tools
Successful implementation methods
Monitor and report
CLINICAL GUIDELINES
![Page 20: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/20.jpg)
CLINICAL GUIDELINESHighest Impact
Greatest Burden of disease
Greatest harm from poor practice
Greatest demonstrated need:-
New Standard of Care
-
Proven variation in practice
Greatest time spent/cost to health system
![Page 21: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/21.jpg)
REVIEW OF CLINICAL GUIDELINES
N –
313N
%
CANCER 17 5%
CARDIOVASCULAR 18 6%
RENAL 22 7%
MENTAL ILLNESS 22 7%
NEUROLOGICAL 0 0%
INJURIES 13 14%
CHRONIC RESPIRATORY 0 0%
DIABETES 11 4%
OTHER 173 67%
TOTAL 313 100%
Buchan et al 2006
![Page 22: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/22.jpg)
NON-COMMERCIAL CANCER RESEARCH EXPENDITURE, 2004
(A$ per CAPITAL)
Source: Eckhouse et al (2007), ABS
![Page 23: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/23.jpg)
NHMRC STRAGEGIC PLAN
2010 -12
![Page 24: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/24.jpg)
NHMRC Support for National Health Priorities Areas
![Page 25: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/25.jpg)
Percentage of Expenditure by Broad Research Area (2000 and 2010)
![Page 26: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/26.jpg)
NHMRC SUPPORT FOR TRANSLATIONAL RESEARCH
Translational funding mechanisms
Partnership Projects for Better Health
Partnership Centres for Better Health
Centres of Clinical Research Excellence
Centres of Research Excellence in Population Health
Research, & Health Services Research
National Health Research Enabling Capabilities Scheme
Industry Development awards
![Page 27: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/27.jpg)
$0
$10
$20
$30
$40
$50
$60
$70
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Mill
ions
0
50
100
150
200
250
300
Total Expenditure Number of Grants
NHMRC PROJECT GRANTS
Clinical Trials Expenditure
![Page 28: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/28.jpg)
Harmonization of Multi-centredEthical Review (HoMER)
National Statement for Ethical Conduct of Human Research (2007)
Process supported by AHMAC conducted by NHMRC
Certification of ethical review processes –
first round
Roles, responsibilities, templates published
NHMRC working with States and Territories
![Page 29: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/29.jpg)
HEALTH WORKFORCE
Established Health Workforce Australia
$1.2 billion in training more GPs and specialists, nurses and allied health
1375 more GPs by 2013, 5500 by 2020
680 more specialists by 2020
4600 practice nurses by 2013, 7500 rural nurses by 2020
![Page 30: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/30.jpg)
GP Training Places per Year2004 -
2014
Source: 2010 NHHN
![Page 31: Clinical Governance and Health Reform](https://reader034.vdocument.in/reader034/viewer/2022051816/546d6fc3af7959693c8b67f2/html5/thumbnails/31.jpg)
Increasing burden of chronic diseases especially cancer, dementia and diabetes
New reform structures offer opportunities to set new clinical guidelines and standards
Opportunities for more coordinated care through medicare locals, local hospital networks and lead clinician groups
Increased health workforce provides opportunities for greater depth in general practice and in specialist training
Increased need for greater evidence base as a framework for improved guidelines and decision tools
CONCLUSIONS