Indicators of effectiveness

Identifying and definitional attributes

• Health, Standard 12/09/2016

Indicators of effectiveness, also known as outcome indicators, provide markers of how close care is to recommended care, monitor outcomes and provide signals to patients and clinicians on quality of care.
In 2009, Australian Health Ministers endorsed the recommendation by the Australian Commission on Safety and Quality in Health Care (the Commission) that hospitals routinely review a set of core hospital level outcome indicators.

The indicator set includes:

• in hospital mortality for fractured neck of femur
• unplanned/unexpected same hospital readmissions of patients discharged following management of hip replacement.

These indicators were subsequently included in the Australian national health Performance and Accountability Framework (PAF).^a The PAF specifies indicators that are intended to be publicly reported at hospital and Local Hospital Network level. The specification for these indicators is published on the Commission’s website,^b and the public and private hospital sector have been provided with a Toolkit, which enables local generation of these indicators.

Ongoing monitoring and review of a set of outcome-based indicators can detect significant variance and highlight issues of data quality and consistency, resources, or of quality of care. High outlier rates should be seen as a prompt to further detailed investigation. Several jurisdictions and private hospital ownership groups generate these indicators, and provide them to hospitals for routine review and investigation of high outlier rates.

Where routine access to linked hospitalisation and mortality datasets is available, or where individual patient follow-up is authorised for studies and registries, the following endpoints are sometimes used in monitoring patient outcomes:

• 30 day mortality following hip fracture^c
• discharge to usual place of residence
• 3 month outcome indicators based on survival status, place of residence, living alone status, and quality of life. Three month outcome indicators are best collected via manual case follow-up or, for death and readmission, state wide or nationally linked datasets.

^a Available at www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/PAF.
^b See www.safetyandquality.gov.au/our-work/information-strategy/
indicators/core-hospital-based-outcome-indicators/.
^c See bhi.nsw.gov.au/__data/assets/pdf_file/0004/177205/
APR_HealthcareInFocus2012_effectiveness-appropriateness.pdf.