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This page refers to the Performance and Accountability Framework, an intergovernmental document that assigned various reporting responsibilities to the former National Health Performance Authority. From 1 July 2016, activities related to reporting against the indicators contained in the Framework are the responsibility of the Australian Institute of Health and Welfare.
Figure one represents the coverage of the Framework amongst three agencies: COAG Reform Council (CRC), Australian Commission on Safety and Quality in Health Care (ACSQHC) and the National Health Performance Authority (the Authority).
CRC and ACSQHC have pre-existing reporting tools that have been incorporated into the Framework. CRC is required to report against indicators under the National Healthcare Agreement and National Partnership. CRC will undertake ‘comparisons of national, state and territory performance’ which lead to ‘reports on jurisdictional performance’ and ‘recommendations of whether to pay reward funding’.
ACSQHC’s pre-existing indicators are the ‘ACSQHC indicators’ . The Framework established ACSQHC standards and guidelines on the basis of these indicators.
A number of reporting products have been created by the Framework for the Authority. These draw on an agreed set of ‘National Health Performance Authority indicators’. The Authority will report on ‘Comparisons of LHN, hospital (public and private) and Medicare Local performance’, which form the basis of Hospital Performance Reports and Healthy Communities Reports.
The reporting products are also interlinked within the Framework: ‘comparison of national, state and territory performance’, ‘ACSQHC standards and guidelines’, and ‘Comparisons of LHN, hospital (public and private) and Medicare Local Performance’.
The flowchart also illustrates the elements of health system reporting that fall outside of the National Health Performance Authority Framework: AIHW flagship reports, RoGs annual comparisons, Aboriginal and Torres Strait Islander Health Performance Framework, public reporting by state and territory governments, and the National Mental Health Report.
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Figure two demonstrates the interaction between components of the health system which contribute to Health Systems outcomes. Service delivery outcomes are linked to and impact on individual health outcomes and population health outcomes. Individual health outcomes also link to and impact on population health outcomes.
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Figure three encapsulates the RoGS General Performance Framework objectives which are related to performance. There are three key domains of performance: equity, effectiveness and efficiency.
The equity domain outputs are: ‘access’ and ‘equity of access indicators’.
The effectiveness domain outputs fall under three interconnected areas: ‘access’, ‘appropriateness’ and ‘quality’. ‘Access indicators’ form a subset of the output ‘access’; ‘Appropriateness indicators’ form a subset of ‘appropriateness’; and ‘Quality indicators’ is a subset of ‘quality’.
The efficiency domain outputs are: ‘inputs per output unit’ and ‘technical efficiency indicators’.
The RoGS performance framework outputs aim to produce three outcomes: ‘Equity of outcome indicators’, ‘Program effectiveness indicators’, and ‘Cost effectiveness indicators’.
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Figure four illustrates the service process that underpins the RoGS General Performance Framework. The diagram presents a continuous sequence from program or service objectives to the achievement of outcomes through a three step process: input, process and output.
The three service processes (input, process and output) require technical efficiency to achieve their desired outcomes. Cost-effectiveness is a required service input to achieve program or service outcomes. The diagram also illustrates that the desired outcome of overall program effectiveness requires both technical efficiency and cost-effectiveness in the three service processes.
The diagram also shows that all outcomes may be affected by external influences.
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Figure five is a diagram illustrating the application of the RoGS process to Hospital/Local Hospital Network indicators. The performance objective domains are: equity, effectiveness and efficiency. Seventeen output indicators have been or are being developed against which performance is to be reported.
The output for the equity domain is access. Access is to be reported against two indicators: ‘access to services by type of service compared to need’, and ‘special needs groups’ (for which a specific indicator is to be developed).
The outputs for the effectiveness domain comprise ‘access’, appropriateness’, ‘quality’ and ‘sustainability’.
The indicators to be reported for access and appropriateness are: ‘ED waiting times by triage category’, ‘percentage of ED patients transferred to a ward/discharged within four hours by triage category’, ‘elective surgery patient waiting times by triage category’, ‘cancer care pathway – waiting times’, and another output indicator to be developed.
Quality will be measured against four outputs: ‘safety’, ‘responsiveness’, ‘capability’ and ‘continuity’. The indicators to be reported for safety are: ‘healthcare associated Staphlococcus Aureus infections’, and ‘healthcare associated Clostridium Difficile infections’. The indicator for responsiveness is ‘measures of patient experience with hospital services’. The indicator for capability is to be developed and the indicator for ‘continuity’ is the ‘rate of community follow up within the first seven days of discharge from psychiatric admission’.
The indicator to be reported as a measure of sustainability is to be developed.
The output indicators to be reported for the efficiency domain are: ‘relative stay index for multi-day stay patients’, ‘day of surgery admission rates for non-emergency multi-day stay patients’, ‘cost per weighted separation’ and ‘financial performance against budget’.
Four outcome indicators have been developed: ‘Hospital Standardised Mortality Ratio’, ‘death in low mortality Diagnostic Related Groups’, ‘in hospital mortality rates for various conditions’, and ‘unplanned hospital readmission rates for various conditions’. These outcome indicators report performance across the seventeen output indicators.
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Figure six is a diagram illustrating the application of the RoGS process to Medicare Local indicators. The performance objective domains are: equity, effectiveness and efficiency. Twenty-four output indicators have been or are being developed against which performance is to be reported.
The output for the equity domain is access. Four indicators are to be reported: ‘access to services by type of service compared to need’, ‘to be developed – special needs groups’, ‘after hours GP service utilisation’, and ‘primary care-type ED attendances’.
The output for the effectiveness domain comprises ‘access’, appropriateness’, ‘quality’ and ‘sustainability’.
The indicators for access (under effectiveness) are: ‘GP type service use’, ‘allied health type service use’, ‘specialised service utilisation’, ‘waiting time for GP services’, ‘waiting times for community health services’, ‘screening rates for breast, cervical and bowel cancer’, ’GP service utilisation by residents of Residential Aged Care Facilities’, ‘proportion of children with four-year developmental health check’, ‘number of women with at least one antenatal visit in the first trimester’, ‘percentage of population receiving primary mental health care’, ‘rates of contact with primary mental health care by children and young people’, and ‘vaccination rates for children’.
There are two indicators for appropriateness: ‘percentage of asthma patients with a written asthma plan’, and ‘percentage of diabetic patients who have a GP annual cycle of care.’
Quality will be measured against four indicators: ‘safety’, ‘responsiveness’, ‘capability’ and ‘continuity.’ The indicator to be reported for ‘safety’ is ‘aged standardised mortality of potentially avoidable deaths’; for ‘responsiveness’ the indicator to be reported is ‘measures of patient experience’; while for capability and continuity indicators are to be developed.
The indicator for sustainability is to be developed.
For the efficiency domain, one indicator will be reported: ‘financial performance against budget’.
Two outcome indicators have been developed which reflect performance across the twenty-four output indicators: ‘selected potentially avoidable hospitalisations’, and ‘five-year survival proportions of selected cancers’. Further outcome indicators have been developed for contextual and planning purposes. These are: ‘incidence of ischaemic heart disease’, ‘incidence of end-stage kidney disease’, ‘prevalence of overweight and obese status’, ‘prevalence of diabetes’, ‘estimated life expectancies at birth’, incidence of selected cancers’, ‘prevalence of smoking’, ‘infant/young child mortality rate’, and ‘proportion of babies born with low birth weight’.
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