Dr. Pay Tuohy: Enhancing the Health & Wellbeing of Children & Young People in New Zealand
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A presentation given at the CHA conference The Journey, in October 2012.
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Dr. Pay Tuohy: Enhancing the Health & Wellbeing of Children & Young People in New Zealand
- 1. Enhancing health and wellbeing in New Zealand children and young people
- 2. Quality Improvement cycles Act Plan Quality improvement actions Check Do Small Maintaining the gains with steps of Standards and Quality Assurance continuous improvement
- 3. Well-child/Tamariki Ora Draft Quality framework Health Quality and Safety Commission adapted the IHI Triple Aim for NZ. The three dimensions in the New Zealand adapted model are: • improved quality, safety and experience of care • improved health and equity for all populations • best value for public health system resources. The three sides of the WCTO triangle are: • improved safety and quality experience of child, family/and community • improved health and equity across populations • best value for health system resource
- 4. Quality initiatives in Child health in New Zealand Well-child/Tamariki Ora quality framework • Immunisation coverage target • B4School check quality initiative • Reducing rheumatic fever • Children’s Commissioners Compass • Development of clinical networks • QI for maternal and newborn screening • Maternity quality initiative
- 5. Improved health and equity across populations
- 6. Improved health and equity across populations • To improve immunisation coverage at 2 years to 95% by July 2012 • To reduce ethnic and socio-demographic disparities in coverage
- 7. The 2 year immunisation target 100% Coverage at 2 by Socioeconomic quintile 95% 90% 85% 3% difference Total % Coverage (%) 80% Dep 1-2 % 75% Dep 3-4 % Dep 5-6 % 70% Dep 7-8 % 65% 10% difference Dep 9-10 % Dep Unavailable % 60% 55% 50% Sep-2011 Jun-2007 Jun-2008 Jun-2009 Jun-2010 Jun-2012 Dec-2010 Sep-2007 Dec-2007 Sep-2008 Dec-2008 Sep-2009 Dec-2009 Sep-2010 Mar-2008 Mar-2009 Mar-2010 Jun-2011 Mar-2012 Dec-2011 Mar-2011
- 10. Best value for health system resource
- 11. The B4 School Check is a universal-offer Well-Child check It aims to identify and address any health, behavioural, social, or developmental concerns which could affect a child’s ability to get the most benefit from school.
- 12. 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 0.0% 10.0% 30.0% 50.0% 70.0% 90.0% 20.0% 40.0% 60.0% 80.0% 0.0% Auckland Auckland Bay of Plenty Bay of Plenty Canterbury Canterbury Capital and… Capital and Coast Counties … Counties Manukau Hawkes Bay Hawkes Bay Hutt Hutt Lakes Lakes Midcentral Midcentral Nelson… Nelson… Northland Northland Otago Otago South… South Canterbury Southland Southland Tairawhiti Tairawhiti % of PEDS Pathway A referred Taranaki Taranaki Waikato Waikato % of Decay Level 2 - 6 referred Wairarapa Wairarapa Waitemata Waitemata West Coast West Coast Whanganui Whanganui % of Extreme Obese Referred 100.0% 120.0% 20.0% 40.0% 60.0% 0.0% 80.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 0.0% Auckland Bay of Plenty Auckland Canterbury Bay of Plenty Capital and… Canterbury Counties… Capital and… Hawkes Bay Counties… Hutt Hawkes Bay Lakes Hutt Lakes Midcentral When we started Midcentral Nelson… Nelson… Northland Northland Otago Otago South… South… Southland Southland Extreme Obese that are referred Tairawhiti Tairawhiti Taranaki Taranaki Waikato % of Abnormal SDQ scores referred Waikato Wairarapa Wairarapa Waitemata Waitemata West Coast West Coast Whanganui Whanganui
- 13. The quality letter. • A Quality Improvement process for the 4 year old check. • Shared with providers and DHB management • An opportunity to provide up to date information and share good practice • Provision of benchmarking information
- 14. Quality improvement in action 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% 01-July-2011 01-January-2012 01-April-2012 01-July-2012 Lift the Lip % of 2-6 referred % of BMI>=21 referred PEDS % of pathway A referred SDQ-P abnormal that were referred
- 15. Improved safety and quality experience for child, family and community Improving community involvement and parent satisfaction with the B4School check
- 16. Improved safety and quality experience for child, family and community We developed a relationship with Richard Taylor of Weta workshop to promote the B4School checks using the Wot- Wots.
- 17. Improved safety and quality experience for child, family and community Validation of the Strengths and Difficulties Questionnaire
- 18. SDQ validation • The SDQ is a behavioural and emotional screen used in many countries and translated into over 30 languages • Parents and early childhood teachers have told us that they were uncertain about he screen because it had not been tested on New Zealand children • Ministry of Health has contracted Auckland University of Technology to validate the SDQ on New Zealand children
- 19. Conclusion • Reframing difficult problems within a QI perspective can lead to rapid gains • A Quality Framework will ensure that all aspects of quality are considered and addressed • Once you have had success, your learning is generalisable to other areas • Improving quality doesn’t always save money, but it can increase efficiency
Hinweis der Redaktion
- Quality improvement is a cyclical or iterative process. The Archetypal CQI cycle was described by Deming – Plan Do Check ActIt requires a series of conscious actions which improve quality by first setting standards which act as an agreed baseline or a “chock” for the quality cycle. This is complemented by continuous activity which identifies opportunities for improvement, and puts in place agreed actions, monitors results and restarts the cycle.However there are three fundamentals1 – Know where you are heading2 - Know how you are going to get here3 - Know when to stop
- However one of the essentials is knowhing what you want your quality improvement activity to cover. It’s essential to have a clear concept of the outcomes you want, and ensure that all aspects of quality are addressed. The Triple Aim model addresses the range of quality domains curently consisered important in the provision of healthcare. In the context of child health these are Improved safety and quality experience of child, family/and community, Improved health and equity across populations and Best value for health system resource
- The WCTO qi
- As you can see we have increased coverage and reduced inequalities since the target initiative commended in 2007. We have had a threefold reduction in inequalities and an almost 20% increase in coverage. Children from both the lowest and highest quintile now have identical coverage of 94%.We did this through a systematic approach which involved being clear about the evidence, agreeing a national plan of action, monitoring results using our NIR, and revising the plan if results were not as we expected.
- The basis of this is getting best efficiency. For immunisation this is maximising coverage within existing funding. No new money went into the increasing immunisation programme, apart from some infrastructure enhancements – NIR and training for staff, and the payments ($21 per vaccination given) for the additional coverage which is undertaken on a fee for service basis.
- The B4 School Check is a Universal offer Well child check which aims to identify and address any health, behavioural, social, or developmental concerns which could affect a child’s ability to get the most benefit from school, such as a hearing problem or communication difficulty.The Check is highly manualised, has it’s own dedicated information system, and is delivered in a range of settings by trained nurses, mainly practice nurses, public health and well child nurses.It is the eighth core contact of the Well Child Tamariki Ora Schedule of services.The value for money for this check is maximised by ensuring optimal referral rates for any issues found.
- The B4school check efficiency gains revolved aroungmaximising referrals for children with significant issues identified at the check. We also need to measure and analyse outcomes as referrals are only a proxy for outcomes.