Presented by Catherine Gerard Senior Analyst, Health Quality and Evaluation

1. Kupu Taurangi Hauora o Aotearoa
Catherine Gerard - Senior Analyst

2. Theme
Engaged Patients
Rebalancing the clinical relationship
Exploring the opportunities for information and
technology to do the right thing and do it right!
HINZ Conference
27-29 November 2013

3. Overview
• The Commission
• Unwarranted variation in healthcare and why
it matters
• The New Zealand Atlas of Healthcare Variation
• Addressing variation

4. The Commission
Supporting the health and disability sector to deliver safe and
quality health care to all New Zealanders

5. The Commission
Works with clinicians, health providers and consumers to:
• improve the quality and safety of services
• increase consumer engagement and participation

6. It’s about…
• ‘Shining a light’ on important quality and safety issues
through public reporting
• ‘Lending a hand’ through making expert advice, guidance and
tools available
• ‘Intelligent commentator’
“Doing the right thing, and doing it right, first time”

7. Doing the right thing and doing it right
• Doing it right is relatively straightforward
– Measurement of specific harms
– Monitoring of specific processes
• Doing the right thing – much more complicated
– What is the right thing?
– What is the best thing?

9. Atlases

10. Global development

11. Taxonomy of variation1
• Effective care
• Preference-sensitive care
• Supply-sensitive care
Appleby, Raleigh, Frosini et al. Variations in health care: the good, the bad
and the inexplicable. Kings Fund (2011).

12. Variation
Jack Wennberg: ‘unwarranted variation’
‘Variation in the utilization of health care
services that cannot be explained by variation in
patient illness or patient preferences.’

13. Understanding variation
Mulley (2010)
‘reducing variation can be the key to doing
things consistently right’
BUT
‘if all variation were bad, solutions would be
easy. The difficulty is in reducing bad variation…
…while preserving the good variation that
makes care patient centred.’
Mulley AJ (2010). Improving productivity in the NHS. BMJ 341(7766): 3965.

14. New Zealand Atlas of Healthcare Variation
•
•
•
•
Part of this international trend
Domain concept – multiple related indicators
Web only release – drill down and mash-up
Commentary and conversation

17. Measuring variation
Tin openers and dials
• Concept from Carter and Klein
• Tin openers open up cans of worms
• Dials measure things

18. This is not a league table
• High is not necessarily better
• Low may not be worse
• The middle might not be right

19. Linking data to demonstrate variation
• NZ national collections powerful – nearly all
Atlases bring together different data sets
• Increasingly able to do this at an individual
level
– CVD (PHO enrolments, NMDS, Mortality, Pharms,
Labs, NNPAC)
– Gout (labs, pharms, mortality and NMDS)
• eNHI protects privacy

20. Gout: allopurinol use & admissions

21. Interpreting variation
Promote local variation
analysis through resources
to:
• support local data
analysis/audit
• interpret variation

22. National Atlases
• Benchmarking: national, regional,
international (?)
• Develop and test common measures
• Co-ordinate a debate

23. Local data analysis
Primary care PMS data
- Richer data than national data collections
- Data at individual patient and practitioner level
- Can account for patient preferences, condition and
circumstances

24. King’s Fund report recommends1
• Routine systematic collection of data, both
locally and nationally
• Local analysis of the causes of variation and
prioritise those that impact most on equity,
effectiveness, efficiency and health outcomes
• Promote shared decision-making
Appleby, Raleigh, Frosini et al. Variations in health care: the good, the bad
and the inexplicable. Kings Fund (2011).

26. Our website: www.hqsc.govt.nz/atlas
Catherine Gerard
catherine.gerard@hqsc.govt.nz