Ministry releases reports on intervention rates for select group of elective procedures
Tuesday 8 May 2007, 1:20PM
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Intervention rates Credit:
Ministry of Health
Work towards ensuring all New Zealanders get similar access to elective services has moved a step closer with information going to district health boards detailing their intervention rates for a group of defined procedures.
The reports set out intervention rates for a selected group of procedures including general surgery, orthopaedics, ophthalmology, paediatric surgery, gynaecology, cardiology, plastics, and ear, nose and throat procedures, compared with the national average.
The figures relate to a subset of elective procedures and don't include surgery for things considered urgent such as acute appendicitis or surgery for cancer.
"In a publicly funded health system there is an expectation that each board will deliver similar levels of elective services to their population. But access to elective services around the country has not been consistent. This work is a major step towards trying to address that imbalance,'' says Dr Ray Naden, clinical advisor to the elective services programme.
"To address the differences we first need to understand the reasons for them. These reports will help district health boards do that,’’ he says.
“Boards will be able to use the information to help identify priority areas of unmet need and to guide how they allocate the $200 million in new funding to improve access to elective services.’’
The reports started with 13 working parties, involving 54 clinicians and others. Participants in each group agreed on the list of procedures - mainly surgical - which they thought patients with the same level of need should have access to, irrespective of where they lived.
The reports do not include patients who pay for their own treatment within the private sector.
Using data supplied by boards the working parties calculated standardised discharge ratios (SDR) for each specialty area.
If all DHBs were providing services at the same level, they would all be at 1. A rate higher than 1 indicates that the board is providing more than the average rate in New Zealand, and a rate lower than 1 indicates that the board is providing less than the average rate in New Zealand. Intervention rate analysis does not necessarily indicate what the right rate might be, but compares individual boards with the national mean, taking board population demographics into account. (Note: there are currently standardised discharge ratios for 14 procedures that are published on the NZHIS website.)
For example, a standardised discharge ratio of 0.9 for orthopaedics means that people who live in that district receive 90 per cent of the national average for the subset of specified orthopaedic procedures.
"Although this data is an improvement on what we have had previously it does not give definitive answers about differences in services between DHBs, '' Dr Naden says.
"For example, a board which has an SDR of 0.8 for dental may be providing very good preventive and primary oral health services, therefore people in that district need less secondary elective dental surgery than people in other parts of the country. In this instance an SDR below 1.0 is an indication of a better than average service.''
"If a board has a low SDR in a particular area, which does indicate an intervention rate below the average, the Ministry will want to know the reasons for this and, if necessary, what the board is doing to address this.''
Dr Naden says boards have welcomed the improved comparative data.
“Boards have a good understanding of the local factors that are likely to affect the range and level of services required for the people in their district. They will use this work to further assess the needs in their population.’’
A link to the reports: www.moh.govt.nz/electiveservices
The reports set out intervention rates for a selected group of procedures including general surgery, orthopaedics, ophthalmology, paediatric surgery, gynaecology, cardiology, plastics, and ear, nose and throat procedures, compared with the national average.
The figures relate to a subset of elective procedures and don't include surgery for things considered urgent such as acute appendicitis or surgery for cancer.
"In a publicly funded health system there is an expectation that each board will deliver similar levels of elective services to their population. But access to elective services around the country has not been consistent. This work is a major step towards trying to address that imbalance,'' says Dr Ray Naden, clinical advisor to the elective services programme.
"To address the differences we first need to understand the reasons for them. These reports will help district health boards do that,’’ he says.
“Boards will be able to use the information to help identify priority areas of unmet need and to guide how they allocate the $200 million in new funding to improve access to elective services.’’
The reports started with 13 working parties, involving 54 clinicians and others. Participants in each group agreed on the list of procedures - mainly surgical - which they thought patients with the same level of need should have access to, irrespective of where they lived.
The reports do not include patients who pay for their own treatment within the private sector.
Using data supplied by boards the working parties calculated standardised discharge ratios (SDR) for each specialty area.
If all DHBs were providing services at the same level, they would all be at 1. A rate higher than 1 indicates that the board is providing more than the average rate in New Zealand, and a rate lower than 1 indicates that the board is providing less than the average rate in New Zealand. Intervention rate analysis does not necessarily indicate what the right rate might be, but compares individual boards with the national mean, taking board population demographics into account. (Note: there are currently standardised discharge ratios for 14 procedures that are published on the NZHIS website.)
For example, a standardised discharge ratio of 0.9 for orthopaedics means that people who live in that district receive 90 per cent of the national average for the subset of specified orthopaedic procedures.
"Although this data is an improvement on what we have had previously it does not give definitive answers about differences in services between DHBs, '' Dr Naden says.
"For example, a board which has an SDR of 0.8 for dental may be providing very good preventive and primary oral health services, therefore people in that district need less secondary elective dental surgery than people in other parts of the country. In this instance an SDR below 1.0 is an indication of a better than average service.''
"If a board has a low SDR in a particular area, which does indicate an intervention rate below the average, the Ministry will want to know the reasons for this and, if necessary, what the board is doing to address this.''
Dr Naden says boards have welcomed the improved comparative data.
“Boards have a good understanding of the local factors that are likely to affect the range and level of services required for the people in their district. They will use this work to further assess the needs in their population.’’
A link to the reports: www.moh.govt.nz/electiveservices