Short report of Australia’s Medical Data

NEW PERFORMANCE MEASURES OF HOSPITAL-ACQUIRED COMPLICATIONS (HACs)

This report requires a reflecion on both the technical features of hospital data, as well as the way we might use it to better understand the Australian health care system.

We need good quality performance measures to help drive improvements in delivery of care in Australia’s health care system. To help drive this change, the Australian Commission on Safety and Quality in Health Care (ACSQHC) have developed new indicator sets, one of which is hospital-acquired complications (HACs). The ACSQHC have a suite of publicly available information on HACs, including fact sheets on the clinical significance of the measures, the history of indicator development, specifications and metadata for calculating each of the measures, as well as tools for implementing the measures on existing datasets (link to ACSQHC’s page on HACs).

Data on and interpretation of rates of HACs in Australian hospitals have been published by the ACSQHC in the report ‘The state of patient safety and quality in Australian hospital 2019’ (see pages 27-41).

Written activity

You work in a hypothetical health care organisation, let’s call it The Knightly Foundation (TKF). The work of TKF was inspired by the many trials and tribulations of the Knightly family within this course – and seeks to improve the delivery of health care in Australia accordingly.

TKF wishes to calculate and publish detailed rates of HACs for every Australian hospital using hospital administrative data. Of particular interest are two types of HACS – ‘Healthcare associated infections‘ and ‘Unplanned intensive care admissions’. The director of TKF hopes to eliminate the presence of these HACs in the Australian hospital system through a major media campaign – publicly ‘naming and shaming’ hospitals, and the treating clinicians, where any HACs have occurred. These hospitals and clinicians would be ranked on a scale from ‘extremely dangerous’ to ‘somewhat dangerous’, while those with no HACs would be declared ‘safe’.

Review the following resources about two HACs above:

A NSW admitted patient data collection (APDC) data dictionary
A dataset specification document of the national Admitted Patient Care National Minimum Data Set.
Current Specification – Hospital-Acquired Complications (HACs) List – Version 3.1 (12th edition) (Excel file with information about numerator and denominator information required to compute each HAC) and
background information on the HAC measures from the ACSQHC (please note that this is a long document and you are NOT required to read its entirety!)

Questions to answer

Briefly outline what data elements you would need to report on the two HAC measures (Complication 3. Healthcare associated infection and Complication 5. Unplanned intensive care admissions). Are all these available in the data provided? (Note: you do not need to produce a list of exact variable names or specific ICD codes, rather the types of variables and information required).
Concentrating on Complication 3. Healthcare associated infections only – you are being asked to examine the trend of the indicator over time, in NSW as a whole, and within Taree region over the past 5 years, in adults (patients aged 18 and over). You also need to determine if there is a variation/difference between planned and emergency admission patients. Briefly outline the data elements you would require (aside from the ones you mentioned in Question 1 above) to carry out this task. How would you present your findings?
While the director of TKF is excited about the proposed report, some of your colleagues are concerned about the approach being taken. Identify one or two potential issues which may need to be considered when reporting on this data and explain why they are potential issues.
What recommendation/s would you make to your director in response to the issue(s) identified?