The mea­sure of a ro­bust sys­tem

The Australian - - LIFE -

For all its faults, for all the times that things don’t go as planned, Aus­tralia’s health sys­tem is world class. Our health prac­ti­tion­ers are among the best. We have some of the most mod­ern fa­cil­i­ties, ac­cess to cut­ting-edge tech­nol­ogy, new drugs and ther­a­pies, all un­der­pinned by rig­or­ous qual­ity con­trols. Univer­sal health­care has gen­er­ally served us well and other coun­tries of­ten look to us for in­spi­ra­tion. This year the Com­mon­wealth Fund, a US-based foun­da­tion, an­a­lysed health sys­tem per­for­mance among 11 wealthy na­tions and ranked Aus­tralia sec­ond over­all be­hind Bri­tain, and first for health­care out­comes and ad­min­is­tra­tive ef­fi­cien­cies. Our life ex­pectancy is among the high­est in the OECD. Other mea­sures sug­gest a rea­son­able bal­ance be­tween ac­cess and cost. The key to main­tain­ing pos­i­tive out­comes is re­port­ing on re­sults, iden­ti­fy­ing weak­nesses and con­stantly striv­ing to im­prove them. While some want to name and shame poor per­form­ers, more se­cre­tive ap­proaches also de­liver re­sults.

‘Un­der­stand­ing a prob­lem is the first step to pro­vid­ing a so­lu­tion’ LEN NO­TARAS AUS­TRALIAN COUN­CIL ON HEALTH­CARE STAN­DARDS

Avoid­able sur­gi­cal deaths are be­com­ing less com­mon, ac­cord­ing to an update from the Aus­tralian and New Zealand Au­dits of Sur­gi­cal Mor­tal­ity re­leased this week. The au­dits in­volve a con­fi­den­tial clin­i­cal review of all such deaths to help sur­geons learn from their ex­pe­ri­ences and those of their peers. About 98 per cent of sur­geons par­tic­i­pate.

“In 2016, the pro­por­tion of cases with ad­verse events was 2.9 per cent com­pared to 4.4 per cent in 2013,” ANZASM chairman Guy Mad­dern says, not­ing that more re­cent cases are still be­ing as­sessed so the lat­est fig­ure may change. “In 2009 the pro­por­tion of ad­verse events was ap­prox­i­mately 6 per cent, so the drop has clearly been sig­nif­i­cant. It is im­pos­si­ble to say for sure whether we can at­tribute this re­duc­tion to the au­dit. How­ever, what we do know for sure is that the au­dit al­lows us to iden­tify trends and to mon­i­tor and ad­dress these is­sues as re­quired.” As the pop­u­la­tion ages and gets fat­ter, there are more knee and hip re­place­ments. The Aus­tralian Or­thopaedic As­so­ci­a­tion’s Na­tional Joint Re­place­ment Reg­istry col­lects data on out­comes to help iden­tify any prob­lem ar­eas. An update this week showed the low re­vi­sion rate for hip and knee re­place­ments, with a 31 per cent de­cline in re­vised hip pro­ce­dures since 2003 and a 16 per cent drop in re­vised knee pro­ce­dures since 2004.

AOA pres­i­dent Ian In­coll says such registries help iden­tify the fac­tors be­hind poor out­comes, of­ten help­ing sur­geons and hos­pi­tals choose the best pros­the­ses for pa­tients. The lat­est data looked at re­vi­sion rates among in­di­vid­ual sur­geons and doc­tors, while fu­ture up­dates may look at pa­tient vari­ables such as obe­sity.

“Any sort of sta­tis­ti­cal rep­re­sen­ta­tion is an ap­prox­i­ma­tion of re­al­ity, so what we’re do­ing is get­ting all these dif­fer­ent per­spec­tives of re­al­ity,” In­coll says. “The more per­spec­tives we have, the closer our ap­prox­i­ma­tion of re­al­ity.”

There is an on­go­ing de­bate over the role and scope of such registries, as well as clin­i­cal tri­als, who should fund them and where they should sit in the reg­u­la­tory process. If the Aus­tralian Coun­cil on Health­care Stan­dards is happy with how things are trend­ing, pa­tients should be too. The coun­cil’s lat­est re­port, analysing 20 data sets of in­di­ca­tors from 2009 to last year, has found mostly sus­tained lev­els of im­prove­ment, with the big­gest gains among day pa­tients, emer­gency medicine, in­ten­sive care and ra­di­a­tion on­col­ogy. “The ben­e­fit for clin­i­cians is sim­ple,” ACHS pres­i­dent Len No­taras says. “Their in­put en­ables clar­ity of where im­prove­ments have been made and where there have been de­te­ri­o­ra­tions. Un­der­stand­ing a prob­lem is the first step to pro­vid­ing a so­lu­tion, and ac­cu­rate data is key to this.”

The Aus­tralian Com­mis­sion on Safety and Qual­ity is play­ing a lead role in analysing per­for­mance and set­ting bench­marks, more re­cently through an at­las of clin­i­cal vari­a­tion to iden­tify ar­eas where med­i­cal in­ter­ven­tion rates are un­usu­ally high or low.

The com­mis­sion is guid­ing fund­ing re­forms that will pe­nalise hos­pi­tals for mak­ing mis­takes and in­tro­duce new stan­dards to drive fur­ther im­prove­ment.

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