A.8 Strategic indicators

Health Directorate strategic indicators

Strategic objectives and indicators

The government’s overarching health policy, Your health—our priority, identifies the following priorities:

  • timely access to better care
  • management of chronic disease
  • improved care for the elderly
  • comprehensive services for mental health
  • supporting children and vulnerable families, and
  • addressing the gap in Aboriginal and Torres Strait Islander health status.

Some strategic indicators which were reported in 2011‑12 have been deleted from the 2012‑13 set of strategic indicators. The strategic indicators relating to emergency department access block were deleted, as they are no longer consistent with national reporting or reporting under the national health reforms. The strategic indicators relating to discharge planning have also been deleted, as they are not reflective of wider discharge planning services.

Strategic objective 1: Removals from waiting list for elective surgery

This refers to the number of people removed from the ACT elective surgery waiting lists managed by ACT public hospitals. This may include public patients treated in private hospitals.

Strategic indicator 1: Number of people removed from waiting list

 

  2012‑13 target 2012‑13 result
People removed from the ACT elective surgery waiting list 11,000 11,579

 

In order to improve access to elective surgery, the Commonwealth and state and territory governments have entered into a partnership to significantly increase the number of elective surgery operations provided in our public hospitals each year and reduce the number of people waiting more than clinically recommended times for that surgery. As part of this program, the Commonwealth and the ACT governments have committed funds to specifically increase access to surgery from 2009–10 to 2012‑13.

Strategic objective 2: No waiting for access to emergency dental health services

Strategic indicator 2: Percentage of assessed emergency clients seen within 24 hours

This provides an indication of the responsiveness of the dental service to emergency clients.

 

  2012‑13 target 2012‑13 result
Percentage of emergency clients seen within 24 hours 100% 100%

 

Strategic objective 3: Reaching the optimum occupancy rate for acute adult overnight hospital beds

Strategic indicator 3: The mean percentage of adult overnight acute medical and surgical beds in use

This provides an indication of the efficient use of resources available for hospital services.

 

  2012‑13 target 2012‑13 result
Percentage of adult overnight acute medical and surgical beds in use 85% 93%1*

*Correction of typography error

 

1. There has been an increase in the number of non-same day bed days, which has impacted on the bed occupancy rate.

Strategic objective 4: Access to radiotherapy services

Strategic indicator 4: Percentage of radiotherapy patients who commence treatment within standard time frames

This provides an indication of the effectiveness of public hospitals in meeting the need for cancer treatment services.

 

Category 2012‑13 target 2012‑13 result
Urgent—treatment starts within 48 hours 100% 100%
Semi-urgent—treatment starts within 4 weeks 95% 100%
Non-urgent—treatment starts within 6 weeks 95% 98%

 

Strategic objective 5: Government capital expenditure on healthcare infrastructure

Strategic indicator 5: Capital consumption

This indicator provides information on government investment to improve healthcare infrastructure. Information on the level of funding allocated for health infrastructure as a proportion of overall expenditure provides an indication of investment towards developing sustainable and improved models of care. The aim for the ACT is to better the national rate.

 

Government1 capital expenditure as a proportion of government2 capital consumption expenditure by
healthcare facilities, 2007–08 to 2009–10
ACT rate National rate
2007–08 1.89 1.51
2008–09 2.76 1.90
2009–10 2.67 1.57

 

Source: Health Expenditure Australia 2009–10 (Australian Institute of Health and Welfare).

Excludes local government.

Expenditure on publicly owned healthcare facilities.

Strategic objective 6: Management of chronic disease

Strategic indicator 6: Maintenance of the highest life expectancy at birth in Australia

 

Maintenance of the highest life expectancy at birth in Australia ACT rate National rate
Females 84.8 84.2
Males 81.0 79.7

 

Source: ABS 2012, Deaths, Australia, 2011, cat. no. 3302.0, ABS, Canberra.

Life expectancy at birth provides an indication of the general health of the population and reflects a range of issues other than the provision of health services, such as economic and environmental factors. The ACT has the highest life expectancy of any jurisdiction in Australia, and the government aims to maintain this result.

Strategic objective 7: Lower than national average prevalence of circulatory disease

Strategic indicator 7: The proportion of the ACT population with some form of circulatory disease

 

Cardiovascular disease ACT rate National rate
Proportion of the ACT population diagnosed with some form
of cardiovascular disease
18.4% 16.9%

 

Source: Australian Health Survey: First Results, 2011‑12, cat. no: 4364.0.55.001, ABS, Canberra.

Population projections suggest that the ACT population is ageing faster than that of other jurisdictions. The median age of the ACT population (34.5 years in 2011) has increased 6.4 years since 1985. While people of all ages can present with chronic disease, the ageing of the population and its longer lifespan mean that chronic diseases will place major demands on the health system for workforce and financial resources.

Strategic objective 8: Lower than national average prevalence of diabetes

Strategic indicator 8: The proportion of the ACT population diagnosed with some form of diabetes

 

Diabetes ACT rate National rate
Prevalence of diabetes in the ACT 3.8% 3.7%

 

Source: Australian Health Survey: First Results, 2011‑12, cat. no: 4364.0.55.001, ABS, Canberra.

This provides an indication of the success of prevention and early intervention initiatives. The self-reported prevalence of diabetes in Australia has more than doubled over the past 25 years. Prevalence rates may increase in the short term as a result of early intervention and detection campaigns. This would be a positive result, as experts predict that only half of those with diabetes are aware of their condition. This can have significant impacts on their long-term health.

Strategic objective 9: Higher than national average proportion of government recurrent health funding expenditure on public health activities

Strategic indicator 9: Proportion of government recurrent health funding expenditure on public health activities

Improvements in the prevention of diseases can reduce longer-term impacts on the health system, particularly for people with chronic diseases. The aim for the ACT is to better the Australian average.

 

Estimated total government expenditure on public health activities as a proportion of total current health expenditure ACT rate National rate
2008–09 3.1% 2.7%
2009–10 2.7% 2.2%
2010–11 2.6% 2.1%

 

Source: Health Expenditure Australia 2010–11 (Australian Institute of Health and Welfare).

Strategic objective 10: Maintaining the waiting times for in-hospital assessments by the Aged Care Assessment Team

Strategic indicator 10: The mean waiting time in working days between the request for, and provision of, assessment by the Aged Care Assessment Team (ACAT) for patients in public hospitals

This provides an indication of the responsiveness of ACAT in assessing the needs of clients.

 

  2012‑13 target 2012‑13 result
Mean waiting time in working days 2 days 2.5 days1

 

1. The ACT Aged Care Assessment Team (ACAT) was unable to meet the indicator target due to increased public and private hospital referrals and ongoing issues with unexpected staff unavailability. To improve performance on this indicator, ACAT is attempting to recruit additional casual backfill assessors to deal with the increased levels of referrals. The result is still within the national response timeframe.

Strategic objective 11: Providing comprehensive services for mental health and reducing the usage of seclusion

Strategic indicator 11: The proportion of clients with episodes of seclusion of public mental health in the ACT who are subject to seclusion during an inpatient episode

This measures the effectiveness of public mental health services in the ACT over time in providing services that minimise the need for seclusion.

 

  2012‑13 target 2012‑13 result
Proportion of clients of public mental health services in the ACT subject to seclusion during an inpatient episode <3% 1.5%

 

ACT Health is leading an innovative piece of research into seclusion reduction practices in the mental health inpatient unit at the Canberra Hospital. The findings of the research, which concluded in April 2012, show the importance of consumer involvement in the grass roots of decision making, the importance of the consumer experience when implementing change and how understanding consumers’ past traumatic experiences provides for informed care and can improve outcomes for mental health consumers, leading to a more compassionate and therapeutic relationship between consumers and staff. The research was done in collaboration with consumer representatives and clinical staff through weekly Seclusion and Restraint Review Meetings (SRRM) and has led to a huge reduction in the use of seclusion at that unit.

Strategic objective 12: Maintaining consumer and carer participation on relevant mental health committees

Strategic indicator 12: The proportion of mental health ACT committees in which consumers and carers are represented

This measure ensures that the committees which monitor the delivery and planning of our mental health services have effective input from mental health consumers.

 

  2012‑13 target 2012‑13 result
Proportion of mental health services committees with consumer and carer representation 100% 100%

 

Strategic objective 13: Patients return rate to an ACT public mental health inpatient unit lower than national average

Strategic indicator 13: The proportion of clients who return to hospital within 28 days of discharge from an ACT public mental health inpatient unit

 

  2012‑13 target 2012‑13 result
Proportion of clients who return to hospital within 28 days of discharge from an ACT public mental health inpatient unit <10% 9.8%

 

Source: Report on Government Services, 2013.

Strategic objective 14: Addressing gaps in Aboriginal and Torres Strait Islander health status

Strategic indicator 14: Immunisation rates—ACT Indigenous population

This provides an indication of the public health services to minimise the incidence of vaccine preventable diseases, as recorded by the Australian Childhood Immunisation Register, in the ACT’s indigenous population. The ACT aims to maintain the immunisation coverage rates for vulnerable groups and, in particular, minimise disparities between Indigenous and non-Indigenous Australians.

 

Immunisation rates for vaccines in the national schedule for the ACT Indigenous population: 2012‑13 target 2012‑131 result
12 to 15 months ≥90% 81.5
24 to 27 months ≥90% 91.6
60 to 63 months ≥90% 91.0
All ≥90% 88.0

 

Source: Productivity Commission’s Review of Government Service (ROGS).

1. The very low numbers of Aboriginal and Torres Strait Islander children in the Territory means that the ACT Aboriginal and Torres Strait Islander coverage data should be read with caution. Given the small population, small changes can result in significant rate fluctuations.

Strategic objective 15: Maximising the quality of hospital services

The following three indicators are a selection of the patient safety and service quality indicators that are used to monitor ACT public hospital services. The targets provide an indication of the desired outcomes over time. Given the nature of the indicators, small fluctuations during a particular period can skew results. Determining the success of the Health Directorate in meeting these indicators requires a consideration of performance over time rather than for any given period.

Strategic indicator 15.1: The proportion of people who undergo a surgical operation requiring an unplanned return to the operating theatre within a single episode of care due to complications of their primary condition

This provides an indication of the quality of theatre and post-operative care.

 

  2012‑13 target 2012‑13 result
Canberra Hospital <1.0% 0.75%1
Calvary Public Hospital 0.5% 0.05%

 

1. The Canberra Hospital target is based on similar rates for peer hospitals—based on Australian Council on Healthcare Standards (ACHS).

Strategic indicator 15.2: The proportion of people separated from ACT public hospitals who are readmitted to hospital within 28 days of their separation due to complications of their condition (where the readmission was unforeseen at the time of separation)

This provides an indication of the effectiveness of hospital-based and community services in the ACT in the treatment of people who receive hospital-based care.

 

  2012‑13 target 2012‑13 result
Canberra Hospital <2.0% 1.30%
Calvary Public Hospital 1.0% 0.6%

 

Strategic indicator 15.3: The number of people admitted to hospitals per 10,000 occupied bed days who acquire a bacteraemial infection during their stay

This provides an indication of the safety of hospital-based services.

 

  2012‑13 target 2012‑13 result
Canberra Hospital < 7 per 10,000 6.7 per 10,000
Calvary Public Hospital < 3 per 10,000 1.3 per 10,000

 

Strategic objective 16: High participation rate in the Cervical Screening Program

Strategic indicator 16: Two-year participation rate in the Cervical Screening Program.

The two-year participation rate provides an indication of the effectiveness of early intervention health messages. The ACT aims to exceed the national average for this indicator.

 

  ACT rate National rate
Two-year participation rate 58.8% 57.4%

 

Strategic objective 17: Improved Emergency Department timeliness

Strategic indicator 17: The proportion of Emergency Department presentations that are treated within clinically appropriate timeframes

 

  2012‑13 target 2012‑13 result
One (resuscitation, seen immediately) 100% 100%
Two (emergency, seen within 10 mins) 80% 74%
Three (urgent, seen within 30 mins) 75% 43%
Four (semi-urgent, seen within 60 mins) 70% 46%
Five (non-urgent, seen within 120 mins) 70% 79%
All presentations 70% 51%

 

Strategic objective 18: Improved breast screen participation rate for women aged 50 to 69 years

Strategic indicator 18: The proportion of women in the target age group (50 to 69 years) who have a breast screen in the 24 months prior to each counting period

 

  2012‑13 target 2012‑13 result
Proportion of women aged 50 to 69 60% 56%1

 

1. Breast Screen ACT has readily available appointments but is experiencing difficulty filling them. A number of initiatives are underway to raise the awareness and profile of the service, particularly within the target group of women aged 50 to 69.

Strategic objective 19: Achieve lower than the Australian average in the Decayed, Missing, or Filled Teeth (DMFT) Index

Strategic indicator 19: The mean number of teeth with dental decay, missing or filled teeth at ages 6 and 12

This gives an indication of the effectiveness of prevention, early intervention and treatment services in the ACT. The aim for the ACT is to better the Australian average.

 

  Dental health—Decay, missing or filled teeth (DMFT) ACT rate1 National rate
a DMFT Index at 6 years 1.16 2.31
b DMFT Index at 12 years 0.71 1.11

 

Source: Child Dental Health Survey, 2008 (published: Australian Institute of Health and Welfare, 2012).

1. Lowest of all jurisdictions.

Strategic objective 20: Reducing the risk of fractured femurs in ACT residents aged over 75 years

Strategic indicator 20: Reduction in the rate of broken hips (fractured neck of femur)

This provides an indication of the success of public and community health initiatives to prevent hip fractures.

In 2011‑12, the ACT rate of admissions in persons aged 75 years and over with a fractured neck of femur was 6.6 per 1,000 ACT population. This is slightly higher than the previous rate of 5.3 in 2010–11; however, the difference is not statistically significant. This is within the long-term target and follows the generally decreasing trend since 2001–02.

 

  2011‑12 outcome Long-term target
Rate per 1,000 people 6.6 5.3

 

The low numbers of patients included in this calculation means that the rate of broken hips in older persons should be read with caution. Given the small numbers, small changes can result in significant rate fluctuations.

Strategic objective 21: Reduction in the youth smoking rate

Strategic indicator 21: Percentage of persons aged 12 to 17 years who smoke regularly

The results from the 2008 Secondary School Alcohol and Drug Survey (ASSAD) show that 6.7 per cent of students were smokers in that year. This demonstrates a continued decline in smoking from 15.3 per cent in 2001 to 6.7 per cent in 2008. The national rate for smoking in 2008 was 7.3 per cent.

 

  2011 outcome National rate Long-term target
Percentage of persons aged 12–17 who are
current smokers
5.8% 6.7% 5%

 

Source: ASSAD confidentialised unit record files 2011, ACT Health. Australian secondary students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2011 report, The Cancer Council Victoria, December 2012.