Healthcare systems face increasing pressure and the reasons for this are widely understood. The rising expectations of ageing populations in advanced economies, increasing numbers of patients with chronic and complex conditions and the ever-increasing costs of treatments are encouraging health system managers to seek efficiencies and better ways of working.
Shortages, whether of medicines or money, beds or workers, are no stranger to hospital and health system managers throughout the developed world. But there is no shortage of a commodity that, properly used and with full privacy protections in place, can show us where these efficiencies can be found. This commodity is data, and thanks to the technology revolution of the past 20 years, it is in plentiful supply.
Although impressive efforts have already been made to turn some of Australia’s data into information that health system managers can use, there remains much untapped potential for data to be used in innovative ways to drive health service efficiencies locally. Only more recently have data from different jurisdictions been combined to allow all public hospitals and local communities to compare their performance with that of their peers right across the country. Recent analyses using big data techniques – which have been made possible by the huge leaps in computing power and data storage – have revealed where investments to improve care will yield the highest return.
National Health Performance Authority
The National Health Performance Authority, set up in 2011 with the agreement of all governments, has publicly named local communities where improvements in immunisation rates would almost certainly prevent sickness, hospitalisation or premature death. Other data analyses by the Performance Authority have resulted in the naming of local communities where avoidable hospitalisations for the treatment of chronic health conditions are at least 10 times higher than in other similar communities, and the naming of hospitals with the longest waiting times for life-saving surgery or the highest rates of serious yet preventable infections.
Other new information with a particularly strong potential to drive change was the Performance Authority’s report that revealed marked variation in the average length of time patients were spending in hospital after being admitted for any of 16 common procedures or medical conditions. Together, these conditions account for almost 10 per cent of hospital bed supply nationally. In the case of hip replacements, the report showed the average length of stay varied very substantially across major metropolitan hospitals – from fewer than four days, up to 15 days. And as those figures reflect the average stay at each hospital, about half of patients at each hospital would have stayed longer than average.
These findings are significant given the high cost of acute care hospital beds, which for hip replacement patients can easily exceed a few thousand dollars for each extra day. A report by the Grattan Institute earlier this year estimated avoidable costs amounted to almost $1 billion each year in Australia’s hospitals. In one state, the difference in the cost of hip replacement between the highest and lowest-cost hospital was estimated to be more than $16,000.
Unlocking the data
This kind of reporting on variations in service delivery and costs is just the first step in Australia’s move to unlock the power of data to drive improvements. There is a further step that is more promising still: one that involves the linking of data to permit analyses about patients’ experiences as they navigate the health system across time. This linking of disparate datasets, including activity, claims and clinical data, to identify models of care that optimise health outcomes is the real promise of the “Big Data” revolution.
As an example, the Performance Authority is working on a report due out later this year that will for the first time use information from a number of sources to describe care for those with complex needs who are frequent users of GP services – with nationally comparable information on their experiences with care across time, including costs. This report is likely to be of high interest due to the large proportion of health expenditure and resources consumed by high users.
Of course, important safeguards are and must remain in place. Patient confidentiality and privacy will remain protected. But with appropriate professional support and policy commitment, Australia now has an unprecedented opportunity to harness the potential of national healthcare data to drive efficiencies at the local level, and importantly, to improve outcomes.
Source: Australian Financial Review
Dr Diane Watson is CEO of the National Health Performance Authority.