Improving Health Systems Performance: Enhancing Hospital Outcomes

This is a 3-year project funded by the Health Research Council of New Zealand which is being conducted by researchers from the University of Auckland, the University of Otago and Victoria University. The principal aim is the assessment of the performance of the hospital sector through progressive waves of structural, professional and managerial change.

Investment in health has doubled over the last decade and much of that has been absorbed in the hospital sector. Have we got value for that increase in investment, as judged by throughput, output and quality of care? This is what the current project is designed to assess. It will do so by using existing information sources from the New Zealand Health Information Service. It will increase the utility of this information by electronically and confidentially linking the core hospital file to other data sources. In this way, the research will maximise the gain that can be derived from otherwise disconnected repositories of information. The study will influence health outcomes both directly - through the potential for the improvement of the quality of care - and indirectly - through contributing hard evidence on the productivity and effectiveness of investment in hospital and related services.
 

Objectives


  • Quantifying, in readily interpretable terms, the extent of between-hospital variation in the access to inpatient and outpatient services (time to service and variation in relation to geographical location and socioeconomic status).
  • Assessing the quality and safety of hospital services using a range of mortality and clinical indicators and follow up attendances. This will include both cross-sectional analyses and longitudinal analyses looking at variability in trends.
  • Assessing the productivity and efficiency of hospital-related services.
  • Analysing the effectiveness of primary health care services using preventive health (ambulatory sensitive) indicators.
  • Studying the effectiveness and appropriateness of health service delivery.
  • Assessing the quality of new outpatient datasets by means of comparisons with established primary health care data.
     

Research team


Professor Peter Davis, Director, COMPASS
Mr Roy Lay-Yee, Research Fellow, COMPASS
Dr Barry Milne, Research Fellow, COMPASS
Mr Martin von Randow, Data Manager, COMPASS
Dr Gerry Cotterell, Research Manager, COMPASS
Dr Katharina Bauer, Administrator, COMPASS
Mr Peter Beaver, PhD Student, COMPASS
Dr Jacqueline Cumming, Associate Professor, Health Services Research Centre, Victoria University
Dr Jaikishan Desai, Deputy Director, Health Services Research Centre, Victoria University
Ms Corinne Ross, PhD Student, Health Services Research Centre, Victoria University
Dr Phil Hider, Senior Lecturer, Christchurch School of Medicine, University of Otago, Christchurch.
Dr Patrick Graham, Senior Research Fellow, Christchurch School of Medicine, University of Otago, Christchurch.
Professor Nicholas Mays, Head of Department, Health Services Research and Policy, London School of Hygiene and Tropical Medicine
Associate Professor Jonathan Koea, General Surgeon, Auckland Hospital
Dr Steven Stillman, Senior Fellow, Motu Economic and Public Policy Research Institute.
 

Progress to date


We are developing performance indicators from Ministry of Health administrative data (the National Minimum Data Set) based on internationally accepted definitions and using those indicators to describe the quality of care across New Zealand public hospitals over time. For each indicator, we are examining patterns by patient socio-demographic characteristics and illness conditions, hospital, region and year. Ultimately we will construct statistical models aimed at explaining indicator variation and identifying the sources of that variation adjusting for case mix with particular interest at the hospital level.
 

Presentations


Evaluating performance in the New Zealand public hospital sector

Professor Peter Davis, Phil Hider, Dr Jaikishan Desai
COMPASS annual research colloquium
Statistics New Zealand House, Wellington
30 July 2010

Interest in measuring hospital performance in relation to quality and productivity has rapidly grown worldwide. This project is a collaborative project that aims to apply new developments in the use of performance indicators and statistical modelling to explore the potential for administrative data to help inform hospital policy and practice in New Zealand.

This presentation provides background information about the project, outline the methods that are being employed and highlight the key outputs that will be generated from the work. We will also present:

  • our econometric strategy for examining variation in output indicators of hospital productivity in New Zealand
  • descriptive statistics and selected results of graphical analyses of temporal and spatial variation in a basic set of output indicators (length of stay, day case surgeries, outpatient services, emergency department services, and unplanned readmissions).

Publications


  • Primary health care access and ambulatory sensitive hospitalizations in New Zealand. Milne B, Parker K, McLay J, von Randow M, Lay-Yee R, Hider P, Cumming J, Davis P. Journal of Ambulatory Care Management, 2015, 38(2), 176-185.
  • Efficiency, effectiveness, equity (E(3)). Evaluating hospital performance in three dimensions. Davis P, Milne B, Parker K, Hider P, Lay-Yee R, Cumming J, Graham P. Health Policy. (2013) 112(1-2):19-27. doi: 10.1016/j.healthpol.2013.02.008.
  • Can patient safety indicators monitor medical and surgical care at New Zealand public hospitals? Hider P, Parker K, von Randow M, Milne B, Lay-Yee R, Davis P. NZ Medical Journal, 127 (1405), 32-44.