The Health Roundtable

CareTrack Australia

Presenter: Natalie Hannaford

Hospital Code Name:

Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012

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The Health Roundtable

KEY PROBLEM

Evidence of poor compliance with clinical guidelines – this is limited to studies of single conditions

Community acquired pneumonia – use of PSI 5%; appropriate antibiotics – 18%

Low Back Pain – of almost 4000 presentations, more than a quarter were sent for imaging

Reflects care that is inappropriate, not cost effective and not in line with evidence or consensus based guidelines

Healthcare in Australia consumes nearly 10% of GDP, over $100 billion AUD per year.

No coordinated system available in Australia to measure, monitor and act on health care performance data

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The Health Roundtable

THE CARETRACK STUDY

AIM - Determine the percentage of healthcare encounters at which a sample of adult Australians received appropriate care in 2009 and 2010 in two Australian states

22 conditions – most common according to burden of disease, national health priority areas and studies of general practice activity and “Preventive Care”

522 clinical indicators developed from National and International guidelines and ratified by 45 experts

On site medical record review by trained surveyors Developed a web based tool for onsite encrypted

data collection 3

The Health Roundtable

WHAT, WHO and WHERE Surveyors assessed a total of 270, 052

healthcare encounters 35573 of these were deemed eligible by the surveyors 84937 deemed ineligible by software filtering 149542 deemed ineligible by surveyors

1154 participants in the final sample.

225 healthcare providers - GP’s, hospitals and allied health professionals in regions across NSW and SA.

Metro, rural and remote4

The Health Roundtable

CARETRACK RESULTS

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The Health Roundtable

RESULTS

Australians received appropriate care at 57% of eligible healthcare encounters

For 39 practices or facilities with more than 300 encounters compliance ranged from 32% to 86%

The use of risk assessment tools is poor – overall compliance for four tools was 1% (AUSDRISK, ABCD2, PSI or CURB 65)

Condition compliance ranged from 90% for CAD to 13% for alcohol dependence

Inadequate documentation of information in medical records limits the results of this study

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The Health Roundtable

LESSONS LEARNT

Measuring care processes is a useful way of monitoring compliance or otherwise for common conditions and/or certain aspects of care

Standard documentation in medical records is lacking – vast amounts of data are missing – what was really done?

Highlights gaps in “translating the evidence” into everyday practice (i.e. not embedded). Provides an opportunity for more work in this area

More effective use of electronic information systems provides a major opportunity for improving care.

Gaining access to medical records in this country involves a lot of work……. 7