Archived March 2004

In November 1996, the Department of Human Services, Acute Health, Quality Committee endorsed the implementation of a set of key performance indicators relevant to the acute health sector in Victoria.

Acute Health Performance Indicators: Strategy for Victoria Discussion Paper was the first step in progressing this body of work. In October 1998 and in line with the directions proposed in the Discussion Paper a tender for the Acute Health Clinical Indicator Project was awarded to a consortium comprising the Australian Council on Healthcare Standards (ACHS) Care Evaluation Program and Monash University Department of Epidemiology and Preventive Medicine. The principal aim of the consultancy was to identify a concise set of clinical indicators capable of measuring and assessing the quality of clinical care within Victorian public hospitals that would be suitable for implementation and monitoring at the state level.

The final project Report, consisting of two separate volumes was submitted to the Department in July 1999. The first volume of the Report, undertaken by the Australian Council on Healthcare Standards, details:

• clinical indicators suitable for statewide monitoring (which includes 4 clinical indicators of medical care, 8 clinical indicators of surgical care, 2 clinical indicators of gynaecological care and 1 clinical indicator for day procedures);
• data definitions for reporting against the recommended indicators;
• methods for calculating performance against the recommended indicators;
• suggested timelines for statewide implementation of the indicators;
• recommended reporting frequencies against the identified indicators;
• the results of a survey on the ability of public hospitals to collect the data required for reporting against the recommended indicators; and
• policy recommendations designed to facilitate the success of the acute health clinical indicator program.

The first volume of the report is available as three Word files, front cover and index - 16KB, the body of the report - 260KB and the appendices - 224KB.

The second volume of the Report describes the findings of a comprehensive literature review undertaken by Monash University's Department of Epidemiology and Preventive Medicine, which reviewed, amongst other things:

• the latest national and international trends in the development, implementation and reporting of clinical indicators and their use in health care quality improvement;
• selection criteria currently used for the identification of appropriate clinical indicators, with special emphasis on the applicability of such criteria in relation to the Victorian public hospital system;
• the use and usefulness of administrative databases and other data sources (such as medical records and specialty specific clinical databases) for collecting information against clinical indicators with examples from other state based programs;
• statistical techniques for the stratification and risk adjustment of data to ensure that performance comparisons are based on health care providers with similar underlying characteristics (ie. so that 'apples are compared with apples'); and
• clinical indicators suitable for use in a clinical indicator program, based on an assessment of their suitability against defined criteria of what constitutes an 'ideal' indicator

The second volume of the report is available as Word files (Index and Part A of the Report - 192KB), (Appendix 1 - 231KB), (Appendix 2 - 140KB), (Appendix 3 - 39KB) and (Appendix 4 - 12KB)

Trial of Clinical Indicators 2001/2002

In 2001/2002, the Department successfully trialled four of the indicators recommended by the ACHS / Monash Consortium. They were chosen because of the relative frequency with which the relevant clinical procedures are performed and their clinical significance to the community.

The indicators trialled were:

1. The number of patients having a colonoscopy which results in perforation of the colon as a proportion of the total number of patients having a colonoscopy, during the time period under study.
   
2. The number of patients having a large bowel resection and anastomosis for cancer of the colon, with anastomotic breakdown as a proportion of the total number of patients having a large bowel resection and anastomosis for cancer of the colon, during the time period under study.
   
3. The number of patients having a laparoscopic cholecystectomy with a bile duct injury requiring operative intervention as a proportion of the total number of patients having a laparoscopic cholecystectomy, during the time period under study.
   
4. The number of patients with acute myocardial infarction who receive thrombolytic therapy within one hour of presentation to the hospital, as a proportion of the total number of patients with acute myocardial infarction requiring thrombolysis who receive thrombolytic therapy during the time period under study.

Clinical Indicators 2002/2003

An expanded set of Clinical Indicators will be collected, developed and trialed over 2002/03 to provide a more comprehensive picture of high cost/high volume outcome in public hospitals. From 1 July 2002, health service quality committees will be required to review, and if necessary, act on information obtained from clinical indicator data. Health service data will be compiled by the Department with benchmark and comparative information fed back to hospitals. Aggregated data will be reported to the Victorian Quality Council (VQC) on a six monthly basis.

The 2002/03 clinical indicator reporting will build on the lessons learned from the four clinical indicators trialed in the previous 12 months. As a result of feedback from hospitals and a review of sentinel events and adverse events reported to the Department, the clinical indicator program will expand the current panel of clinical indicators to include:

• All perforations sustained during endoscopic procedures (expanded from 2001/02).
• All perforations sustained during laparoscopic procedures (previously sentinel event).
• Post-partum haemorrhage resulting in hysterectomy (previously sentinel event).
• Fractured neck of femur injuries sustained by patients whilst an inpatient (as a measure of falls within organisations).
• Anastomotic breakdown following large bowl resection and anastomosis for cancer of the colon and of the rectum will continue to be collected and will be expanded to include all anastomotic breakdown following large bowel resection.
• Bile duct injury following laparoscopy will be expanded to include all episodes of bile leakage following laparoscopic cholecystectomy, not just those requiring operative intervention.

Clinical indicator data for 2002/2003 data will be entered through the AIMS website. The guidelines for collecting and reporting indicators will be included in the Quality Fund Business Rules that will be posted during August.

Future Directions for 2002/03

The clinical Indicator Program will continue to expand throughout 2002/2003. Work is underway to establish the feasibility of collecting data about the incidence of pressure ulcers developed by patients in hospitals and the rate of injury due to medication errors.

Work is ongoing with databases for:

• Intensive care;
• Vascular surgery; and
• Cardiothoracic Surgery.

This will result in indicators in these areas.