Measuring Health Outcomes:

Capturing Complexity

Measuring Health Outcomes:

Capturing Complexity

NatStats Conference 2008

Dr Penny AllbonDirector

AIHW

NatStats Conference 2008

Dr Penny AllbonDirector

AIHW

Australian Institute of Health and Welfare

The complexity is growingThe complexity is growing

Australian Institute of Health and Welfare

How is the information environment respondingHow is the information environment responding

Indicators explosion

Data sets explosion

Australian Institute of Health and Welfare

Linked data sets growing

Ehealth looming

Personal record control emerging

Australian Institute of Health and Welfare

key drivers for measuring health outcomes into the futurekey drivers for measuring health outcomes into the future

Assess how healthy we are and how this is changing – monitoring and surveillancethe holy grail of attribution (health research)the drive for effectiveness and efficiency of servicesImprove the outcomes of care and treatmentthe individual’s desire to better understand and control their own health

Australian Institute of Health and Welfare

Australia compares well among OECD

Australia compares well among OECD

Australian Institute of Health and Welfare

Broad cause mortality trends, AustraliaBroad cause mortality trends, Australia

Australian Institute of Health and Welfare

Leading burdens of

disease

Leading burdens of

disease

Australian Institute of Health and Welfare

Source: AIHW & University of Queensland

0 100 200 300 400 500

Malignant neoplasms

Cardiovascular disease

Mental disorders

Nervous system

Respiratory

Injuries

Diabetes mellitus

Musculoskeletal diseases

Other

DALYs ('000)

Unavoidable

Burden due to 14 riskfactors (a)

Other treatable orpreventable (b)

Burden of disease in 2003 by major disease group, subdivided into that portion mostly unavoidable, that portion due to 14 burden of disease risk factors, and other treatable or preventable burden

Burden of disease in 2003 by major disease group, subdivided into that portion mostly unavoidable, that portion due to 14 burden of disease risk factors, and other treatable or preventable burden

Australian Institute of Health and Welfare

Projected health expenditure ($ billion 2003 prices)Projected health expenditure ($ billion 2003 prices)

2003 2033 ChangeDiabetes 1.4 7.0 401%

Dental 5.1 12.4 144%

Cardiovascular 7.9 16.2 105%

Mental 4.3 8.5 97%

Cancer 2.8 5.2 84%

Injuries 5.6 9.4 67%

Maternal 1.78 2.5 41%

Total 71.4 162.3 127%

Australian Institute of Health and Welfare

What’s the impact of obesity?What’s the impact of obesity?Australia experienced significant increases in obesity in the 2 decades to 2003 when heart disease was declining

From the Harvard Nurses study we might conclude that

increasing BMI means coronary heart disease is decreasing at a slower rate than it would otherwise.  

Australian Institute of Health and Welfare

Cancer survival improvingCancer survival improving

Australian Institute of Health and Welfare

Cancer Data ImprovementCancer Data ImprovementCancer Data Clearing House (AIHW) Maintenance function - Improving consistency, keeping up-to-date, reporting

Safety &quality– volume/outcomes analysis?

Recording data on the staging of cancer

Outpatients – chemotherapy, radiotherapy. Slow, can this be given priority?

Australian Institute of Health and Welfare

Potentially preventable hospitalisations (PPH) by remoteness of patient, 2005–06 Potentially preventable hospitalisations (PPH) by remoteness of patient, 2005–06

0

10

20

30

40

50

60

70

80

Major cities Inner regional Outerregional

Remote Very remote

PP

H p

er 1

,000

Vaccine-preventable

Acute

Chronic

Australian Institute of Health and Welfare

Push the basicsPush the basics

Keep basic order and cooperation – standards, business rules, frameworks, metadata expansion Common concepts and definitions

Australian Institute of Health and Welfare

Facilitate re-useFacilitate re-use

Working together and coordinating effort – within a collaborative frameworkCentral portal of what’s available? Use of Clearing Houses?

Australian Institute of Health and Welfare

Think about prioritiesThink about priorities

Do we need a process to prioritize the information requirements for the health outcomes agenda?

Australian Institute of Health and Welfare

Balance privacy/access Balance privacy/access

Be pro-active in educating the public about the usefulness of the information

Australian Institute of Health and Welfare

More data linkageMore data linkage

continue to build the capacity to link data – securely and without scaring the horses.

From stovepipes to integrated systems

Australian Institute of Health and Welfare

Exploit ehealth wellExploit ehealth well

Get the statistical capacity of ehealth set up for maximum benefit

Statistical purposeInformation for analytical purposes including public healthand policy planning, safetyinitiatives, disease detection,research and education

Statistical benefitsBetter planning and demandmanagementBetter epidemiology and publichealth

Australian Institute of Health and Welfare

Clinician or coder raises a terminology or rule-based record

Machine coding according to maps

Unit records withcoded values

Clinician raises a natural language and/or form-based record

Human coding assisted by guidelines

Aggregate reportseg. NMDS,

device registry,patient records

possibly linked by IHI with consent

Patient (IHI) interacts with clinician

Information for research and analysis: hybrid

Map

Map

Classifications

Terminology

Australian Institute of Health and Welfare

Simple truths for a complex worldSimple truths for a complex world

Profile

Institutional strength

Expertise