Changes from the 1996/97 Edition

The methodology for establishing peer groups has been subjected to close scrutiny and Area Health Services have been given the opportunity to review and comment on the revised groups. A key emphasis has been to base the peer groups on empirical measures that capture important differences between hospitals. By necessity this process will be ongoing, as hospitals change roles and the nature of the services they provide.

For more information on Peer Groups please click here.

Format and Layout

Volume One - Service Activity and Comparative Performance Indicators

Volume Two - Casemix Information

Expansion of Electronic Information

The development and implementation of The Framework for Managing the Quality of Health Services in NSW has necessitated the identification of indicators for measuring and managing the quality of health care. The development of “quality of care” indicators has been a slow process locally, nationally and internationally. A great deal of work needs to be undertaken to ensure that such indicators are sufficiently robust to be reliable, valid and useful and that the results they produce are interpreted correctly.

The NSW Health Department in conjunction with the NSW Ministerial Advisory Committee on Quality in Health Care has constituted an Indicators Implementation Group to identify the set of indicators which health services will be expected to collect, report and act upon. These indicators will be published progressively in future editions of the NSW Public Hospitals Data Comparison Book.

The set of indicators will be developed around the six dimensions of quality identified in The Framework for Managing the Quality of Health Services in NSW. The dimensions are safety, access, appropriateness, efficiency, effectiveness and consumer participation in health care. The five cross-dimensional issues are competence, continuity of care, accreditation, information management and education and training for quality. There will be a three phase implementation strategy.

PHASE 1:
Those indicators which are currently defined, collectable or being collected in some or all Area Health Services. They will be collected as a set commencing July 1st 1999.

PHASE 2:
Those indicators which, with definition, development and preparation by both the Health Department and the Areas will be ready for implementation by July 1st 2000.

PHASE 3:
Those indicators which will require significant preparation by both the Health Department and the Areas and will be ready for implementation by July 1st 2001.

As new health care quality indicators are developed, suitable ones will progressively be incorporated into the NSW Public Hospitals Comparison Data book. The 1997/98 edition commences that process with the re-ordering of existing measures around the six dimensions of safety, access, appropriateness, efficiency, effectiveness and consumer participation identified in the framework. The first two Phase 1 quality of care measures have been included from the Midwives Data Collection. They provide some indications of the appropriateness of the place of delivery of premature babies. The measures are:

1. Liveborn babies born less than 34 weeks gestation (no. and % of all livebirths). This is important from a service provision point of view as only certain hospitals are able to deal with premature babies.
2. Babies transferred to a level 6 hospital (no. and % of total livebirths).

For further definition see the Glossary of Terms.

Measures

The Editorial Committee reviewed the 1996/97 edition and comments received from users. A small number of changes to measures have resulted. The Glossary of Terms has been updated and in some instances, definitions and formulae may have been reworded, revised or changed.

Changes to Measures

Significant changes to measures which were also published in 1996/97 are detailed below:

• The preliminary cost weights derived from the 1997/98 HCDC have been applied throughout this edition and incorporated in accordance with the 1998/99 Casemix Standards (see Appendix 1). This represents a significant improvement over previous years, where for example in 1996/97 the cost weights were derived from the previous year’s HCDC rather than the same year.

• Cost per Casemix Weighted Inpatient: and its derivatives: For the first time this measure is derived from the HCDC and therefore is substantially more precise than in previous years. Readers should be aware that there are differences in the methods of calculation used by NSW and the Commonwealth (as published in Australian Hospital Statistics (AIHW)). The Commonwealth definition does not accurately identify acute inpatient costs, but rather uses acute and non-acute inpatient costs.

• HCC Adjusted Cost per AN-DRG Weighted Inpatient: This measure adjusts the reported unit costs of Principal Referral, Paediatric Specialist, Ungrouped Acute Hospitals and Bankstown/Lidcombe hospital, to remove the additional costs of indirect teaching and research and the impact of patient severity not picked up in casemix adjustments. These costs are estimated by utilising a proxy measure based on the level of High Cost Complex (HCC) casemix weighted separations within each of these hospitals. The proxy measure is utilised to distribute a pool of $130m in costs. The pool has been adjusted to reflect changes in the estimation of direct Teaching and Research costs that were introduced in 1997-98 Unaudited Annual Return. Overall the HCC adjustment reduces the estimated inpatient costs of these hospitals by around 7%. The adjustment is important to take account of differences between hospitals within the Principal Referral peer group, related to indirect teaching and research and severity. Table X details the methodology for deriving HCC Adjusted Cost per AN-DRG Weighted Inpatient.

• Cost per Emergency OOS: In previous editions, diagnostic as well as emergency care OOS have been included in this measure. However, in this version only emergency care OOS are included.

• Outlier Bed Days % Total Acute Days: In previous editions, this measure incorrectly included all bed days in the numerator, rather than only bed days above the trim points, thus overstating the measure. This has been corrected in the 1997/98 Edition.

• Same Day: The definition of same day used in this edition remains the same as for previous years and is in accordance with the National Health Data Dictionary (NHDD), which is “date of admission = date of separation”. However it is recognised that for many purposes this definition is not satisfactory, and consequently another measure Same Day (Disch by Hosp) % Total Seps is published for the first time, which only includes episodes where the patient was discharged, transfers and deaths are excluded.

• Surgical: Where measures are described as ‘surgical’, surgical is defined as being separations classified to a surgical DRG. Surgical DRGs are identified with a "#" symbol in Appendix 1. There is one exception to this. The measure Same Day Surgery Separations % Total Surgical Seps has been removed, as the measure was supposed to quantify efficiency, for which DRGs are not particularly useful. A much more meaningful measure in terms of efficiency is Same Day Elective Surgery Separations % Total Elective Surgical Seps, where surgery is defined in terms of indicator procedures as reported to the Commonwealth in the Waiting Times data collections. This measure is the first listed under the ‘Efficiency’ subheading.

• Community Residential Care (CRC) Centres and Cost per OOS measures: In previous versions of the NSW Hospitals Comparison Data Book beds for CRCs have been included but only part of their activity, occasions of service, has been included. Other activity measured by occupied bed days has been excluded. Costs for the CRCs are included in the financial data and hence some of the cost measures in previous editions have been overstated, particularly where there is significant CRC activity. The derivation of the Cost per OOS measures has been adjusted to incorporate CRC activity. In addition CRC beds are now reported separately and excluded from Average Available Beds, Annual Throughput per Bed, Bed Occupancy Rate and Inpatient Clinical EFT Staff per Available Bed.

• Salary Measures: The three measures of salary per EFT staff are no longer published due to the varying interpretations of average EFT staff affecting the meaningfulness of the measures. The Medical Salary and VMO Payment measures have been grouped to allow a more meaningful analysis of payments for medical services.

• Transfers In and Transfers Out are no longer published as their definition is too broad to allow meaningful interpretation.

• Liveborn Babies Gestational Age<34 weeks and Liveborn Babies Transferred to Hosp with NIC are discussed under "Framework for Managing the Quality of Health Services in NSW" and Same Day Elective Surg Seps % Total Elective Surg Seps is discussed under "Changes to Measures".

• Cost per Rehab and Extended Care OOS (Program 5.1) augments the Cost per OOS measures for the Emergency, Primary and Community Based Services and the Outpatient Services programs.

• separations and bed days by service type (i.e. acute, rehabilitation, palliative, maintenance care, other, with acute further broken down by whether bed days accrued in acute, psychiatric or acute and psychiatric wards)

• separations and bed days by payment status (i.e. public, chargeable - further broken down into private, compensable, DVA, nursing home type and ineligible)

• average available beds by institution type

• presentations and weighted presentations to Emergency Departments by admission status

• expenses by programs further broken down by admitted and non-admitted components

• expenses as program fractions, i.e. proportion of expenses in each program.

Page Owner: IMCS         Last Updated : Tuesday, 20-Jul-99 09:53:20
URL: internal.health.nsw.gov.au/iasd/imcs/