The safety and quality of the care provided in Australia’s health system is important to all heart, stroke and vascular disease patients, their families and carers. A safe and high-quality health system provides the most appropriate and best-value care, while keeping patients from preventable harm (AIHW 2020).
At a national level, the Australian Commission on Safety and Quality in Health Care (ACSQHC) provides leadership to improve the safety and quality of health care in Australia.
Performance and safety reporting
A selection of indicators of safety and quality in the Australian health care system are reported through the Australian Health Performance Framework (AHPF) (NHIPPC 2017), MyHospitals (AIHW 2019) and at a variety of other national, state and territory and local levels, including within individual services and clinical teams.
Two measures of safety in the AHPF that are relevant to patients with heart, stroke or vascular disease are:
- in-hospital mortality rate for acute myocardial infarction (AMI), heart failure and stroke
- unplanned hospital readmission for AMI and heart failure.
Variations in practice
The Australian Atlas of Health Care Variation maps differences in health care use according to where people live. Health care variation is appropriate where it reflects difference in patients’ needs or preferences. When variation does not reflect these differences, it is considered unwarranted and represents an opportunity for the health system to improve.
Since 2015, 4 Atlases have been published. They have identified variations in hospital admissions for AMI, heart failure and AF, and in lengths of hospital stay for stroke, as well as variations in diagnostic procedures such as echocardiography and myocardial perfusion scans.
The most recent Atlas found that in 2017–18 hospitalisation rates of heart failure varied significantly by remoteness and socioeconomic position, and were higher for Aboriginal and Torres Strait Islander people.
Reducing variation will involve a combination of approaches, including primary prevention, better care in the community including improved integration with hospital care, consumer enablement, more effective use of medicines, and greater use of exercise and cardiac rehabilitation programs (ACSQHC & AIHW 2021).
Better Cardiac Care measures for Aboriginal and Torres Strait Islander people
The Better Cardiac Care for Aboriginal and Torres Strait Islander People project is an initiative of the Australian Health Ministers’ Advisory Council. It aims to reduce deaths and ill health from cardiac conditions among Indigenous Australians.
Five priority areas consisting of 21 measures were developed to monitor the progress of the project. The sixth national report 2021 notes that the level of access for cardiac-related health services has improved, and that the mortality rate from cardiac conditions is falling among the Indigenous population. Challenges remain, including high rates of disease incidence, and the need to increase the uptake recommended interventions (AIHW 2022).
Clinical quality registries
Clinical quality registries collect and analyse clinical and other data to identify benchmarks for clinical performance and related variation in clinical outcomes. Registries report this information to clinicians to improve clinical practice, patient outcomes and the quality and value of health care.
Some examples of clinical quality registries in the cardiovascular field include (ACSQHC 2021):
- National Cardiac Registry (NCR)
- Australian Stroke Clinical Registry (AuSCR)
- Victorian Cardiac Outcomes Registry (VCOR)
- Queensland Cardiac Outcomes Registry (QCOR)
- Coronary Angiogram Database of South Australia (CADOSA)
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database Program (ANZSCTS Database)
- Australian Genetic Heart Disease Registry (AGHDR)
The National Clinical Quality Registry and Virtual Registry Strategy 2020–2030 coordinates efforts to maximise the potential of registries to deliver improved cardiovascular care (Department of Health 2020).