Development of Babies Living in Smokefree Homes. System Level Measure (SLM)

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Imogen Burke
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1 Development of Babies Living in Smokefree Homes System Level Measure (SLM) Dr Peter Jones Chief Advisor Clinical Lead, SLM Programme WCTO Symposium November 2017

Genesis of System Level Measures (SLMs) From Primary Care Leaders Forum Aligned with NZ Triple Aim Move away from pay-for-performance Shift health sector performance from outputs to outcomes Measure

2 Genesis of System Level Measures (SLMs) From Primary Care Leaders Forum Aligned with NZ Triple Aim Move away from pay-for-performance Shift health sector performance from outputs to outcomes Measure performance of the whole health system that is achieved through integration of services and systems Reduce demand on hospital resources through strengthening of primary health care Eliminate health inequities for Māori and other groups that experience disparity in access to health care and outcomes Enhance people s experience of integrated health care Build capacity and capability for quality improvement 2

Journey of SLMs Mandate from sector leaders and the Minister

balance between aspiration and reality Iterative process

Implementation (sector-centred) Development and agreement of

3 Journey of SLMs Mandate from sector leaders and the Minister Co-design with sector on selection of measures About 6 months balance between aspiration and reality Iterative process between Measure Reference Group and the Minister Implementation (sector-centred) Development and agreement of implementation framework Agreement on set of SLMs Tight Loose Tight Agile CQI focus 3

4 What is SLM framework? An organising framework for continuous quality improvement and system integration System Level Measures (SLMs) are: Outcomes focussed set nationally require all parts of the health system to work together focus on children, youth and vulnerable populations connected to local clinically led quality improvement activities and contributory measures. Contributory measures: chosen locally based on local needs, demographics and service configurations used to measure local progress against quality improvement activities. All measures held in an online Measures Library ( 4

5 Current System Level Measures 1. Ambulatory sensitive hospitalisations (ASH) rates for zero-to-four year olds ie, Keeping children out of hospital 2. Acute hospital bed days per capita ie, Using health services effectively and managing acute demand 3. Patient experience of care ie, Person-centred care 4. Amenable mortality rates ie, Early detection and prevention 5. Youth access to and utilisation of youth appropriate health services ie, Youth are healthy, safe and supported 6. Babies living in smoke-free homes ie, A healthy start 5

6 New Zealand Health System Central Government Minister of Health Ministry of Health Health Quality & Safety Commission NZ 20 District Health Boards (DHB) DHB Provider Arms District Alliance (current) Private Providers Other Private and NGO Providers - Predominantly hospital services - Public Health Services - Some Community Services - Assessment, Treatment and Rehabilitation 30 Primary Health Organisations (PHO) - General Practice Teams District Alliance (future) - Pharmacists, Ambulance, Laboratories, Radiology clinics - Midwives - Private hospitals - Māori and Pacific providers - Disability support services - Community trusts - Voluntary providers New Zealand health and disability support service users 6

7 Developmental measure Babies living in smoke-free homes Proportion of babies who live in a smoke-free household at six weeks post natal Introduced in SLM framework July 2017; is part of Maori health plans; is a supporting measure for Better Public Services target Healthy Mums and Babies Aims to reduce the rate of infant exposure to cigarette smoke to reduce a range of poor neonatal and child health outcomes Will encourage an integrated approach between maternity, community and primary care and facilitate access to other community services and supports Measure will draw on the data collected for the Households are smoke-free at six weeks postnatal indicator by WCTO providers Ministry will also provide data following indicators: Percentage of women identified as smokers during postnatal period (2 weeks after birth) and Percentage or number of pregnant women who identify as smokers upon registration with a DHB employed midwife or Lead Maternity Carer who are offered brief advice and support to stop smoking 7

8 Activities Focus on data integrity and coverage Agreeing on measure definition (numerator, denominator) Consistent data collection A finalised Babies Living in Smoke Free Homes measure used across all Ministry frameworks and system reporting Mechanism for data stewardship in Ministry established Routinely providing unencrypted NHI level data to DHBs, PHOs and WCTO providers to enable CQI to improve rates of babies living in smoke-free homes 8

9 QUESTIONS? Key Contacts: Dr Peter Jones Kanchan Sharma

Appendix B System Level Measures Improvement Plans

Appendix B System Level Measures Improvement Plans Appendix B System Level Improvement Plans This plan has been endorsed by: Donovan Clarke Chief Executive Manaia Health PHO Jensen Webber Chief Executive Te Tai Tokerau PHO Dr Nick Chamberlain Chief Executive